Fibre

Watch: Using dietary fibre to care for patients with acute illnesses with specialist dietitian, Nirouz Zarroug

This webinar had the focus on the use of fibre supplements' in the nutritional management of patients with acute illness. The speaker, Nirouz Zarroug, discussed the impact of clinical decisions related to patient care.Note that : At the time of recording the webinar, Nirouz was working as a Clinical Specialist Dietitian at the Royal Liverpool University Hospital. She is currently employed as a Medical & Scientific Affairs Dietitian at Nestlé Nutrition and Health.

Acceptability and tolerance study of a high‑protein semi‑elemental feed containing PHGG fibre

METHOD A prospective, singlearm multicentre study was carried out to assess GI tolerance and compliance to a new formula, Peptamen HN PHGG®. Participants were under the care of a Dietitian and recruited from two NHS settings. Participants were adults who were tube fed, receiving >60% of their estimated requirements enterally, experiencing GI discomfort (diarrhoea, constipation, excessive wind or nausea) and able to consent. RESULTS 21 participants (30–88 years), identified by Dietitians as meeting inclusion criteria, were consented and enrolled; 13 participants had completed the trial at the time of writing. Primary diagnoses included oesophageal cancer, GI tract surgery, pancreatitis, aspergilloma, EhlersDanlos, and myasthenia gravis. Four participants were fed into the stomach and nine into the jejunum. All patients began the trial due to diarrhoea. At baseline, 92% (n=12) had a type 6 or 7 stool; one patient had an ileostomy reporting diarrhoea. At the end of the study, 77% (n=10) reported a type 4 or 5 stool, with only 23% (n=3) still reporting type 6 or 7. Average stool frequency decreased from 2.9 to 2.3 per day. 77% (n=10) reported improved tolerance after starting the formula. 92% (n=12) tolerated the prescribed volume; 54% (n=7) tolerated a higher volume compared to their previous feed. CONCLUSIONS Tubefeed tolerance remains a challenge. Historically, Dietitians have needed to choose between a semielemental peptidebased feed or a fibre feed. This study shows Peptamen HN PHGG® was well tolerated by most participants, with reductions in undesirable GI symptoms, improvements in stool frequency and type, increased compliance, and high satisfaction levels.

Fibres in paediatric functional gastrointestinal disorders. Practical considerations from clinical cases

The use of a PHGG supplement or a nutritionally complete formula containing PHGG as a source of soluble dietary fibre can be helpful to manage paediatric conditions associated with chronic or recurrent gastrointestinal symptoms. Claudio Romano, Socrate Pallio , Ugo Cucinotta , Paola Accorsi & Valeria Dipasquale (2021): Fibers in pediatric functional gastrointestinal disorders. Practical considerations from clinical cases, Expert Review of Gastroenterology & Hepatology. DOI: 10.1080/17474124.2021.1884543

Listen: Fibre Inclusion in Paediatric Enteral Feeding with Mikayla Profe-Fuchsloch

Information for Healthcare Professional Use Only In this episode of the Inside Medical Nutrition podcast, Dr. Linia Patel speaks with Mikayla Profe-Fuchsloch, a dietitian and assistant professor at the University of Coventry, about the impact of fibre inclusion in enteral nutrition for paediatric patients. Fibre, which is classified by solubility, viscosity, and fermentability, increases stool weight, improves bowel regularity, and can balance stool frequency in both diarrhoea and constipation cases. All these features make it a useful addition to enteral nutrition. It is not uncommon when managing paediatric patients with complex medical needs to have issues related with the gastrointestinal system. There can be issues with gut dysmotility and symptoms such as gastroesophageal reflux, delayed gastric emptying, diarrhoea and constipation. In clinical practice, adding in a fibre supplement or choosing a fibre containing enteral feed can help to manage these issues. Current guidance from the European Society of Paediatric Gastroenterology, Hepatology and Nutrition on how much fibre per day paediatric patients require recommends an increased fibre intake in children with neurodisabilities of 17-21g of fibre per day.1 This may be provided by the fibre from an enteral feed as well as the addition of a fibre supplement. Fibre supplements that are partially hydrolysed, such as Partially Hydrolysed Guar Gum (PHGG), which can help to improve bowel motions1. PHGG has been shown to work as a prebiotic, supporting the growth of beneficial gut bacteria2,3,4. In addition, the combination of peptide-based feeds and fibre can help to improve tolerance and gastrointestinal symptoms. Mikayla shares a case study where PHGG fibre supplementation significantly improved bowel motions and reduced medication reliance in a child with complex clinical conditions. She stresses the importance of a gradual introduction of fibre, monitoring tolerance through detailed symptom diaries, and involving parents in the decision-making process. She also points out the lack of standardised tools for fibre introduction, emphasising individualised approaches. Listen to the full podcast episode to learn more about fibre inclusion in enteral nutrition and the role it plays. 1. Romano C, van Wynckel M, Hulst J, et al. J Pediatr Gastroenterol Nutr. 2017;65:242–264 2. Ohashi Y, et al. Benef Microbes 2015;6(4):451-455. 3. Yasukawa Z, et al. Nutrients 2019;11(9):2170. 4. Reider SJ, et al. Nutrients 2020;12(5):1257.

Q&A ESN | How we can use fibre or fibre containing feeds in jejunal feeding

Question is part of “Fibre Maze; Influence on Gut Health and GI disorders” webinar. The answer is delivered with Dr Graeme O’Connor RD PhD , Clinical Academic Lead , Great Ormond Street Hospital, UK. To watch the full length of the sessions Fibre Maze: Influence on Gut Health and GI disorders Session 1 click here. & Session 2 click here. & for Q&A session click here. & for PHGG fibre Expert Experience click here. To read and download more on PHGG fibre “Fibres in paediatric functional gastrointestinal disorders. Practical considerations from clinical cases” click here.

Q&A ESN | What to recommend for a fibre sensitive patient

Question is part of “Fibre Maze; Influence on Gut Health and GI disorders” webinar. The answer is delivered with Dr Graeme O’Connor RD PhD , Clinical Academic Lead , Great Ormond Street Hospital, UK. To watch the full length of the sessions Fibre Maze: Influence on Gut Health and GI disorders Session 1 click here. & Session 2 click here. & for Q&A session click here. & for PHGG fibre Expert Experience click here. To read and download more on PHGG fibre “Fibres in paediatric functional gastrointestinal disorders. Practical considerations from clinical cases” click here.

Fibre Maze: Influence on Gut Health and GI disorders - Q&A session

This session is part of the webinar 'Fibre Maze – Influence on Gut Health and GI disorders'. In this session Dr. Anna Rybak & Dr Graeme O’Connor answered questions and discussed topics raised by dietitians during the event.

Watch: Fibre for Paediatric Nutrition in Acute Care with Dr Graeme O’Connor

This session is part of the webinar 'Fibre Maze – Influence on Gut Health and GI disorders'. In this session Dr. Graeme discusses the barriers to meet nutrition requirements in an acute clinical setting plus a case study presentation.

Fibre Maze: Influence on Gut Health and GI disorders - Dr. Anna Rybak MD, PhD

This session is part of the webinar 'Fibre Maze – Influence on Gut Health and GI disorders'. In this session Dr. Anna discusses how fibre plays an essential role in maintaining the structure and function of the gut microbiome. Dr Anna Rybak is paediatric gastroenterologist, and she is a co-author of 50 publications, first author of 13 original publications, and a co-author of several book chapters on motility disorders and feeding disorders in children.

Highlight of the month

Webinar - Fibre and Peptide Feeds: From historical avoidance to evidence-based inclusion