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For: Green B, Wong E, Andrews S, Hampshire-Jones K, McKinnon S, Brooks C, McAdam R, Gray S, Vickers C, Blake Y, Sekhon G, Merrick S, Faerber J, Mather P, Gilbert E, McBride R, Coombes A, Walker M, Owen A, Davies J, Richardson S, Carr S, Mapson R, Spivey J, Draper S, Kendall F, Hubbard G, Stratton R. Increased protein intake is associated with improved hand grip strength and quality of life in home enterally tube fed adults using a high-energy, high-protein feed. Clin Nutr ESPEN 2020. [DOI: 10.1016/j.clnesp.2019.12.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]

For:	Green B, Wong E, Andrews S, Hampshire-Jones K, McKinnon S, Brooks C, McAdam R, Gray S, Vickers C, Blake Y, Sekhon G, Merrick S, Faerber J, Mather P, Gilbert E, McBride R, Coombes A, Walker M, Owen A, Davies J, Richardson S, Carr S, Mapson R, Spivey J, Draper S, Kendall F, Hubbard G, Stratton R. Increased protein intake is associated with improved hand grip strength and quality of life in home enterally tube fed adults using a high-energy, high-protein feed. Clin Nutr ESPEN 2020. [DOI: 10.1016/j.clnesp.2019.12.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]

Number

Cited by Other Article(s)

Griffen C, Schoeler NE, Browne R, Cameron T, Kirkpatrick M, Thowfeek S, Munn J, Champion H, Mills N, Phillips S, Air L, Devlin A, Nicol C, Macfarlane S, Bittle V, Thomas P, Cooke L, Ackril J, Allford A, Appleyard V, Szwec C, Atwal K, Hubbard GP, Stratton RJ. Tolerance, adherence, and acceptability of a ketogenic 2.5:1 ratio, nutritionally complete, medium chain triglyceride-containing liquid feed in children and adults with drug-resistant epilepsy following a ketogenic diet. Epilepsia Open 2024;9:727-738. [PMID: 38411329 PMCID: PMC10984290 DOI: 10.1002/epi4.12910] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2023] [Revised: 01/22/2024] [Accepted: 01/23/2024] [Indexed: 02/28/2024] Open

Abstract

OBJECTIVE

To investigate incorporating a ready-to-use 2.5:1 ratio liquid feed into a ketogenic diet (KD) in children and adults with drug-resistant epilepsy.

METHODS

Following a three-day baseline, patients (n = 19; age: 19 years [SD 13], range: 8-46 years) followed a KD for 28 days (control period), then incorporated ≥200 mL/day of a ready-to-use liquid feed, made with a ratio of 2.5 g of fat to 1 g of protein plus carbohydrate and including medium chain triglycerides ([MCTs]; 25.6% of total fat/100 mL) for 28 days as part of their KD (intervention period). Outcome measures (control vs intervention period) included gastrointestinal (GI) tolerance, adherence to KD and intervention feed, dietary intake, blood ß-hydroxybutyrate (BHB) concentration, seizure outcomes, health-related quality of life (HRQoL), acceptability and safety.

RESULTS

Compared to the control period, during the intervention period, the percentage of patients reporting no GI symptoms increased (+5% [SD 5], p = 0.02); adherence to the KD prescription was similar (p = 0.92) but higher in patients (n = 5) with poor adherence (<50%) to KD during the control period (+33% [SD 26], p = 0.049); total MCT intake increased (+12.1 g/day [SD 14.0], p = 0.002), driven by increases in octanoic (C8; +8.3 g/day [SD 6.4], p < 0.001) and decanoic acid (C10; +5.4 g/day [SD 5.4], p < 0.001); KD ratio decreased (p = 0.047), driven by a nonsignificant increase in protein intake (+11 g/day [SD 44], p = 0.29); seizure outcomes were similar (p ≥ 0.63) but improved in patients (n = 6) with the worst seizure outcomes during the control period (p = 0.04); and HRQoL outcomes were similar. The intervention feed was well adhered to (96% [SD 8]) and accepted (≥88% of patients confirmed).

SIGNIFICANCE

These findings provide an evidence-base to support the effective management of children and adults with drug-resistant epilepsy following a KD with the use of a ready-to-use, nutritionally complete, 2.5:1 ratio feed including MCTs.

PLAIN LANGUAGE SUMMARY

This study examined the use of a ready-to-use, nutritionally complete, 2.5:1 ratio (2.5 g of fat to 1 g of protein plus carbohydrate) liquid feed, including medium chain triglycerides (MCTs), into a ketogenic diet (KD) in children and adults with drug-resistant epilepsy. The results show that the 2.5:1 ratio feed was well tolerated, adhered to, and accepted in these patients. Increases in MCT intake (particularly C8 and C10) and improvements in seizure outcomes (reduced seizure burden and intensity) and KD adherence also occurred with the 2.5:1 ratio feed in patients with the worst seizures and adherence, respectively.

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Green B, Sorensen K, Phillips M, Green L, Watson R, McCallum A, Brook S, Oldham S, Barry M, Tomlinson L, Williams A, Crease S, Wills C, Talbot R, Thomas R, Barker J, Owen A, Davies J, Robinson C, Lumsdon A, Morris S, McMurray C, Cunningham N, Miller L, Day C, Stanley K, Price S, Duff S, Julian A, Thomas J, Fleming CA, Hubbard G, Stratton R. Complex Enterally Tube-Fed Community Patients Display Stable Tolerance, Improved Compliance and Better Achieve Energy and Protein Targets with a High-Energy, High-Protein Peptide-Based Enteral Tube Feed: Results from a Multi-Centre Pilot Study. Nutrients 2020;12:nu12113538. [PMID: 33217943 PMCID: PMC7698793 DOI: 10.3390/nu12113538] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2020] [Revised: 11/09/2020] [Accepted: 11/12/2020] [Indexed: 12/18/2022] Open

Affiliation(s)

Benjamin Green Medical Affairs, Nutricia, Trowbridge BA14 0XQ, UK; (K.S.); (G.H.); (R.S.) Correspondence: ; Tel.: +44-0-7920-587679
Katy Sorensen Medical Affairs, Nutricia, Trowbridge BA14 0XQ, UK; (K.S.); (G.H.); (R.S.)
Mary Phillips Royal Surrey County Hospital NHS Foundation Trust, Guildford GU2 7XX, UK;
Lisa Green Calderdale and Huddersfield NHS Foundation Trust, Huddersfield HD3 3EA, UK; (L.G.); (R.W.); (A.M.); (S.B.)
Rachel Watson Calderdale and Huddersfield NHS Foundation Trust, Huddersfield HD3 3EA, UK; (L.G.); (R.W.); (A.M.); (S.B.)
Adrienne McCallum Calderdale and Huddersfield NHS Foundation Trust, Huddersfield HD3 3EA, UK; (L.G.); (R.W.); (A.M.); (S.B.)
Sarah Brook Calderdale and Huddersfield NHS Foundation Trust, Huddersfield HD3 3EA, UK; (L.G.); (R.W.); (A.M.); (S.B.)
Siobhan Oldham Gloucestershire Hospitals NHS Foundation Trust, Gloucestershire GL53 7AN, UK; (S.O.); (M.B.); (L.T.); (A.W.)
Michelle Barry Gloucestershire Hospitals NHS Foundation Trust, Gloucestershire GL53 7AN, UK; (S.O.); (M.B.); (L.T.); (A.W.)
Lyndsey Tomlinson Gloucestershire Hospitals NHS Foundation Trust, Gloucestershire GL53 7AN, UK; (S.O.); (M.B.); (L.T.); (A.W.)
Alice Williams Gloucestershire Hospitals NHS Foundation Trust, Gloucestershire GL53 7AN, UK; (S.O.); (M.B.); (L.T.); (A.W.)
Sam Crease Somerset NHS Foundation Trust, Somerset TA6 4RN, UK; (S.C.); (C.W.); (R.T.)
Carrie Wills Somerset NHS Foundation Trust, Somerset TA6 4RN, UK; (S.C.); (C.W.); (R.T.)
Rose Talbot Somerset NHS Foundation Trust, Somerset TA6 4RN, UK; (S.C.); (C.W.); (R.T.)
Rourke Thomas University Hospitals Bristol and Weston NHS Foundation Trust, Bristol BS1 3NU, UK; (R.T.); (J.B.)
Julie Barker University Hospitals Bristol and Weston NHS Foundation Trust, Bristol BS1 3NU, UK; (R.T.); (J.B.)
Annalisa Owen Aneurin Bevan University Health Board, Newport NP18 3XQ, UK; (A.O.); (J.D.)
Judith Davies Aneurin Bevan University Health Board, Newport NP18 3XQ, UK; (A.O.); (J.D.)
Carys Robinson North Tees and Hartlepool NHS Foundation Trust, Stockton on Tees TS19 8PE, UK; (C.R.); (A.L.); (S.M.); (C.M.)
Anna Lumsdon North Tees and Hartlepool NHS Foundation Trust, Stockton on Tees TS19 8PE, UK; (C.R.); (A.L.); (S.M.); (C.M.)
Samm Morris North Tees and Hartlepool NHS Foundation Trust, Stockton on Tees TS19 8PE, UK; (C.R.); (A.L.); (S.M.); (C.M.)
Chloé McMurray North Tees and Hartlepool NHS Foundation Trust, Stockton on Tees TS19 8PE, UK; (C.R.); (A.L.); (S.M.); (C.M.)
Nicola Cunningham Northumbria Healthcare NHS Foundation Trust, North Shields NE29 8NH, UK; (N.C.); (L.M.)
Lily Miller Northumbria Healthcare NHS Foundation Trust, North Shields NE29 8NH, UK; (N.C.); (L.M.)
Carolyn Day University Hospitals of Derby and Burton NHS Foundation Trust, Derby DE22 3NE, UK; (C.D.); (K.S.)
Kristina Stanley University Hospitals of Derby and Burton NHS Foundation Trust, Derby DE22 3NE, UK; (C.D.); (K.S.)
Susan Price University Hospitals Birmingham NHS Foundation Trust, Birmingham B15 2GW, UK; (S.P.); (S.D.)
Susan Duff University Hospitals Birmingham NHS Foundation Trust, Birmingham B15 2GW, UK; (S.P.); (S.D.)
Anna Julian NHS Greater Glasgow and Clyde, Glasgow G12 0XH, UK; (A.J.); (J.T.); (C.-A.F.)
Jennifer Thomas NHS Greater Glasgow and Clyde, Glasgow G12 0XH, UK; (A.J.); (J.T.); (C.-A.F.)
Carole-Anne Fleming NHS Greater Glasgow and Clyde, Glasgow G12 0XH, UK; (A.J.); (J.T.); (C.-A.F.)
Gary Hubbard Medical Affairs, Nutricia, Trowbridge BA14 0XQ, UK; (K.S.); (G.H.); (R.S.)
Rebecca Stratton Medical Affairs, Nutricia, Trowbridge BA14 0XQ, UK; (K.S.); (G.H.); (R.S.) Faculty of Medicine, University of Southampton, Southampton SO17 1BJ, UK

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