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RESEARCH: Vanessa J Poustie, Jayne E Russell, Ruth M Watling, Deborah Ashby, Rosalind L Smyth CALICO Trial Collaborative Group Oral protein energy supplements for children with cystic fibrosis: CALICO multicentre randomised controlled trial BMJ 2006; 332: 632-636 [Abstract] [Full text]

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Oral protein energy supplements for children with cystic fibrosis: no improvement of nutritional status?

Hubertus GM Arets, Janna W Woestenenk   (25 May 2006)

Oral protein energy supplements for children with cystic fibrosis: no improvement of nutritional status? 25 May 2006
Hubertus GM Arets, Paediatric Pulmonologist Cystic Fibrosis Centre Utrecht, P.O. BOX 85090, 3508AB Utrecht, The Netherlands, Janna W Woestenenk Send response to journal: Re: Oral protein energy supplements for children with cystic fibrosis: no improvement of nutritional status?	With great interest we read the manuscript of Dr Poussie et al. concerning the (lack of) effect of protein energy supplements in children with cystic fibrosis. Although we appreciate the huge effort, that has been made conducting this study, there are some specific points that make us question if the conclusions made by the authors are correct. The intervention made by prescribing supplemental products was evaluated by a 4 day dietary diary completed by the patient or parents at the beginning and at the end of the 12 months intervention period. However, only 60% of diaries were returned and from these diaries the increased energy intake in the intervention group was confirmed. The reliability of diaries has been questioned before and no information about the other 357 days is available. This is combined with the finding that no weight gain was seen, although a 10kg increase could have been expected, as was also stated by the authors. Therefore the question remains how energy intake really was during the intervention period. But does this justify the finding that energy supplements are not useful? To our opinion the answer to this question is “no”. In daily practice observed and objectified supplemental energy intake, e.g. by tube feeding does result in increased weight gain and body mass index. It seems therefore logical to conclude that only prescribing and advising increased supplement intake is not enough. This is only useful if this advice is incorporated in an individual advice including assistance, reassurance and compliance. Especially it should be made in concern of the use of other food products and other meals, use of pancreatic enzymes, the patient’s daily activities and the social context of eating within the patient’s family. In general the effect of whatever treatment or intervention can only be judged properly if not only an “intention to treat” but a real and reliable intervention is achieved. Competing interests: None declared