title: The challenge of nutritional profiling of a protein-free feed module for children on low protein tube feeds with organic acidaemias.
abstract: Enteral tube feeding for children with organic acidaemias (OA) is recommended. Protein restriction, providing minimum safe levels of protein intake, is advocated. Standard paediatric tube feeding formulae provide more than the minimum safe protein requirements and are unsuitable in OA without modification. Modified paediatric enteral feeds consist of several modular ingredients. The aim of this prospective longitudinal interventional study was to assess the efficacy of a premeasured novel protein-free module developed for children aged over 12 months compared to conventional practice.
  
  
  
  In total, 15 children with OA (11.6-31 kg) needing enteral feeding were recruited. The protein-free module, from either a protein-free infant feed or modular ingredients, was replaced by the study feed. To ensure metabolic stability, energy and protein intake were unchanged. Dietary intake, anthropometry and nutritional biochemistry were recorded at baseline and week 26.
  
  
  
  Dietary intakes of magnesium (P = 0.02), sodium (P = 0.005), vitamin D (P = 0.04), docosahexaenoic acid (P = 0.01) and arachidonic acid (P = 0.001) significantly improved; plasma selenium (P = 0.002) and whole blood glutathione peroxidase (P = 0.02) significantly increased. Feed preparation accuracy as measured by composition analysis showed consistent errors both in pre- and study feeds.
  
  
  
  A protein-free module improved nutritional intake and biochemistry, although feed preparation errors remained a common finding.
authors.affiliation: Birmingham Children's Hospital, Birmingham, UK.
authors.forename: A
authors.initials: A
authors.lastname: Daly
authors.affiliation: Birmingham Children's Hospital, Birmingham, UK.
authors.forename: S
authors.initials: S
authors.lastname: Evans
authors.affiliation: Birmingham Children's Hospital, Birmingham, UK.
authors.forename: C
authors.initials: C
authors.lastname: Ashmore
authors.affiliation: Birmingham Children's Hospital, Birmingham, UK.
authors.forename: S
authors.initials: S
authors.lastname: Chahal
authors.affiliation: Birmingham Children's Hospital, Birmingham, UK.
authors.forename: S
authors.initials: S
authors.lastname: Santra
authors.affiliation: Birmingham Children's Hospital, Birmingham, UK.
authors.forename: A
authors.initials: A
authors.lastname: MacDonald
mesh_terms: D000138:Acidosis / Q000628:therapy*; D000886:Anthropometry; D002648:Child; D002675:Child, Preschool; D004040:Dietary Carbohydrates / Q000008:administration & dosage; D004041:Dietary Fats / Q000008:administration & dosage; D004044:Dietary Proteins / Q000008:administration & dosage*; D004750:Enteral Nutrition; D005006:Ethnicity; D005260:Female; D006801:Humans; D007223:Infant; D008137:Longitudinal Studies; D008297:Male; D018977:Micronutrients / Q000008:administration & dosage; D015596:Nutrition Assessment; D009751:Nutritional Requirements; D011446:Prospective Studies
chemical_list: D004040:Dietary Carbohydrates; D004041:Dietary Fats; D004044:Dietary Proteins; D018977:Micronutrients
keywords: enteral feeding; feed module; low protein; organic acidaemias