Search

A variety of enteral formulas for various diseases have become available in India in the last few years. Awareness among pediatricians about the availability and indications for these therapeutic formulas is low. A literature search was conducted in PUBMED and relevant data collected from all English language publications available. Data on the commercial preparations was sourced from the individual companies, the Diet 4 life initiative as well as FSSAI (Food safety and standards authority of India). Therapeutic enteral formulas, which are indicated in various disease states belong to four categories - lactose modified, hydrolyzed, MCT based and metabolic disease specific formulas. Lactose modified formulas which are used in temporary or permanent lactose intolerance and Galactosemia are either casein or soy protein based. Hydrolyzed formulas could be partially hydrolyzed, extensively hydrolyzed or amino acid based. Only extensively hydrolyzed formula should be recommended in milk protein allergy. Amino acid (elemental) formulas are mainly indicated in patients with diffuse intestinal mucosal disease. MCT formulas are used in chronic liver disease with cholestasis, and have 30 to 80% MCT. Formulas for inborn errors of metabolism are free of specific carbohydrate, amino acid or fatty acid. Proprietary formulas presently available in India with their specifications have been listed.

The problem of poor nutrition with impaired growth persists in young children worldwide, including in India, where wasting occurs in 20% of urban children (&lt, 5 years). Exacerbating this problem, some children are described by their parent as a picky eater with behaviors such as eating limited food and unwillingness to try new foods. Timely intervention can help prevent nutritional decline and promote growth recovery, oral nutritional supplements (ONS) and dietary counseling (DC) are commonly used. The present study aimed to determine the effects of ONS along with DC on growth in comparison with the effects of DC only. Enrolled children (N = 321) were &gt, 24 to ≤48 months old, at malnutrition risk (weight-for-height percentile 3rd to 15th), and described as a picky eater by their parent. Enrollees were randomized to one of the three groups (N = 107 per group): ONS1 + DC, ONS2 + DC, and DC only. From day 1 to day 90, study findings showed significant increases in weight-for-height percentile for ONS1 + DC and for ONS2 + DC interventions, as compared to DC only (p = 0.0086 for both). There was no significant difference between the two ONS groups. Anthropometric measurements (weight and body mass index) also increased significantly over time for the two ONS groups (versus DC only, p &lt, 0.05), while ONS1 + DC significantly improved mid-upper-arm circumference (p &lt, 0.05 versus DC only), as well. ONS groups showed a trend toward greater height gain when compared to DC only group, but the differences were not significant within the study interval. For young Indian children with nutritional risk and picky eating behaviors, our findings showed that a 90-day nutritional intervention with either ONS1 or ONS2, along with DC, promoted catch-up growth more effectively than did DC alone.

OBJECTIVES: This was a multicenter prospective randomized double-blind study with two parallel experimental groups (EXP GRPS) & an open-labeled control grp (CON). Objective was to investigate the effect of two oral nutritional supplements (ONS) along with dietary counseling (DC) vs DC alone on growth among picky eating children from India, aged > 24 m to ≤ 48 m over 90 days. METHODS: Study recruited 321 children [n = 107/grp] in ages mentioned above from urban/semi-urban India with a weight-for-height between 3(rd)–15(th) centile (WHO 2006) and picky eating behaviors. Subjects in the 2 EXP GRPS received a daily supplement of one of the two similar ONS [Pediasure (PDS) & Pediasure Advance (PDS Adv)} along with DC for 90 days, whereas subjects in CON received only DC. Children in both EXP GRPS consumed min of 1 & max to 2 servings of ONS/day & there were 5 study visits (Day 1, 7, 30, 60, 90). Primary variable was the change in WHO weight-for-height centile from Day 1 to 90. Secondary variables included change in weight-for-age, height-for-age, BMI-for-age, MUAC-for-age, average intake of energy, macros & micronutrients (using 24 hr. dietary recall) and change in appetite & palatability score. RESULTS: Post 90 days, both EXP GRPS had significantly higher change in growth parameters like weight-for-height centile (P = 0.0086), BMI-for-age centile (P = 0.0214 & P = 0.0203 for PDS & PDS Adv respectively) & weight-for-age centile (P = 0.0054) as compared to CON. PDS group reported a significant improvement in MUAC-for-age centile (P = 0.0241) vs CON post 90-days. Significant improvement in appetite score was reported by EXP GRPS (P = 0.0067 & P = 0.0245 for PDS & PDS Adv) vs CON. Significant improvement in avg. intake of energy, protein, fat, calcium, iron, vit C & thiamine was observed for EXP GRPS vs CON for all visit days except day1. Nutrient & energy intakes at baseline were lower than RDA's but ONS helped to fill the nutritional gaps at end of 90 days. There were no significant differences observed in the height-for-age and palatability score. CONCLUSIONS: ONS's formulated with macro & micronutrients along with DC are more efficacious in catch up growth vs DC alone post 90 days supplementation. FUNDING SOURCES: Abbott Nutrition has funded this study.

FIGURE 1. A, Chest x-ray showing the picture mimicking tension hydropneum abdomen showing the herniation of the stomach and left lobe of the liver. D, Ch left lung. From the Department of Gastroenterology, Minimal Access Surgery, Cardiothoracic Surgery, and Radiology, Sahara Hospital, Lucknow, India. Disclosures: Authors have nothing to disclose with regard to commercial support. Received for publication Nov 19, 2009; accepted for publication Nov 26, 2009; available ahead of print Feb 22, 2010. Address for reprints: Sanjay K. Somani, MD, DM, Department of Gastroenterology, Sahara Hospital, Viraj Khand, Lucknow-226010, UP, India (E-mail: sanjayksomani@rediffmail.com). J Thorac Cardiovasc Surg 2011;141:300-1 0022-5223/$36.00 Copyright 2011 by The American Association for Thoracic Surgery doi:10.1016/j.jtcvs.2009.11.062