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Appendix A10 Nutritional supplements and enteral feeds

Appendix A10 Nutritional supplements and enteral feeds Patients at risk of malnutrition may be prescribed oral product development by the manufacturers inevitably Nutritional supplements (ONS) or enteral feeds as long means that over time the availability and composition of as they have a functional gastrointestinal tract. Many of some products may change and new products will appear. these products are prescribed only in specified clinical The information given here is for guidance only and circumstances defined by the Advisory Committee on product details should be checked before clinical usage. Borderline Substances (ACBS); they are termed ACBS pre- For current product availability, composition and pre- scribable. Standard ACBS indications are disease related scribing indications, consult the British National Formu- malnutrition, intractable malabsorption, preoperative lary (BNF), the Monthly Index of Medical Specialities preparation of malnourished patients, dysphagia, proven (MIMS) or the manufacturers (for web addresses, see inflammatory bowel disease, following total gastrectomy, Table and Table ).

APPENDIX Appendix A10 Nutritional supplements and enteral feeds Patients at risk of malnutrition may be prescribed oral nutritional supplements (ONS) or enteral feeds as long

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Transcription of Appendix A10 Nutritional supplements and enteral feeds

1 Appendix A10 Nutritional supplements and enteral feeds Patients at risk of malnutrition may be prescribed oral product development by the manufacturers inevitably Nutritional supplements (ONS) or enteral feeds as long means that over time the availability and composition of as they have a functional gastrointestinal tract. Many of some products may change and new products will appear. these products are prescribed only in specified clinical The information given here is for guidance only and circumstances defined by the Advisory Committee on product details should be checked before clinical usage. Borderline Substances (ACBS); they are termed ACBS pre- For current product availability, composition and pre- scribable. Standard ACBS indications are disease related scribing indications, consult the British National Formu- malnutrition, intractable malabsorption, preoperative lary (BNF), the Monthly Index of Medical Specialities preparation of malnourished patients, dysphagia, proven (MIMS) or the manufacturers (for web addresses, see inflammatory bowel disease, following total gastrectomy, Table and Table ).

2 Information on which short bowel syndrome and bowel fistula. The following products are suitable for special diets, kosher, halal, tables provide a guide to the range of proprietary supple- gluten free, lactose free, vegetarian or vegan, can also be ments, feeds and other Nutritional support products cur- obtained directly from the manufacturers. rently available in the UK. Product composition within a particular category will differ; some products may be more appropriate than Appendix Adult Nutritional supplements others in particular clinical circumstances. Ongoing and enteral feeds Table Prescribable liquid (sip feed ) supplements Note: Many sip feed supplements are available in a variety of flavours to offset taste fatigue. Some, but not all, are nutritionally complete; check compositional details before use.

3 Some products can also be used for tube feeding. Product type Product name (manufacturer) Quantity Per bottle/can kJ kcal Protein (g) Fibre (g). Standard energy Ensure (Abbott) 1058 251 (1 kcal/mL) 250 mL. Fresubin Original (Fresenius Kabi) 840 200 200 mL. Juice type Ensure Plus Juce (Abbott) 1404 330 (low fat) 220 mL. ( kcal/mL) Fortijuce (Nutricia Clinical) 1280 300 200 mL. Provide Xtra Juice Drink (Fresenius Kabi) 1260 250 200 mL. Resource Fruit (Nestl ) 1040 250 200 mL. High energy Ensure Plus Milkshake style (Abbott) 1390 330 ( kcal/mL) 220 mL. Ensure Plus Savoury (Abbott) 1390 330 220 mL. Ensure Plus Yoghurt style (Abbott) 1390 330 220 mL. Ensure Twocal (Abbott) 1675 400 200 mL. Fortisip Bottle (Nutricia Clinical) 1260 300 200 mL. Appendix .

4 Manual of Dietetic Practice, Fifth Edition. Edited by Joan Gandy. 2014 The British Dietetic Association. Published 2014 by John Wiley & Sons, Ltd. Companion Website: Appendices 955. Table (Continued). Product type Product name (manufacturer) Quantity Per bottle/can kJ kcal Protein (g) Fibre (g). Fortisip Compact (Nutricia Clinical) 1250 300 125 mL. Fortisip Extra (Nutricia Clinical) 1350 320 200 mL. Fortisip Yogurt Style (Nutricia Clinical) 1260 300 200 mL. Fresubin 2 kcal Drink (Fresenius Kabi) 1680 400 200 mL. Fresubin Energy (Fresenius Kabi) 1260 300 200 mL. Renilon (Nutricia Clinical) 1050 250 125 mL. High energy + fibre Ensure Plus Fibre (Abbott) 1284 300 ( kcal/mL) 200 mL. Fresubin 2 kcal Fibre Drink (Fresenius Kabi) 1680 400 20 200 mL. Fresubin Energy Fibre (Fresenius Kabi) 1260 300 200 mL.

5 Fortisip Compact Fibre (Nutricia Clinical) 1250 300 125 mL. Fortisip Multi Fibre (Nutricia Clinical) 1260 300 200 mL. Resource Fibre (Nestl ) 1672 400 200 mL. High protein Fortimel Regular (Nutricia Clinical) 840 200 ( kcal/mL) 200 mL. Fresubin Protein Energy Drink (Fresenius Kabi) 1260 300 200 mL. Resource Protein (Nestl ) 1060 250 200 mL. Thickened Fresubin Thickened (Fresenius Kabi) 1260 300 *. ( kcal/mL) 200 mL. Syrup (stage 1) and custard (stage 2). Nutilis Complete Stage 1 (Nutricia) 1263 300 125 mL. Resource Thickened Drink (Nestl ) 435 103 114 mL. Syrup and custard consistencies SLO Drinks (SLO Drinks) * * *. Syrup, custard and pudding consistencies Thick & Easy Thickened Juices (Fresubin Kabi) * * *. 118-mL pot or bottle Custard consistency Powdered Complan Shake In 250 mL of water 1057 251 (Complan Foods) In 200 mL of whole milk 1621 387 57-g sachet Foodlink Complete (Foodlink) 1048 249* * 3 heaped tablespoonfuls in 250 mL of water Foodlink Complete with Fibre (Foodlink) 1137 270 4 heaped tablespoonfuls in 250 mL of water Oral Impact (Nestl ) * * *.

6 74 g in 250 mL of water Vegenat-med Balanced Protein (Vegenat) 1924 458 110-g sachet Vegenat-med High Protein (Vegenat) 1940 463 110-g sachet *Exact composition varies see manufacturer's data. Appendix . 956 Appendices Table Non-prescribable liquid supplements These products can be purchased by patients from supermarkets and chemists, and are useful at times when dietary intake is poor. None is nutritionally complete. Product name (manufacturer) Per sachet + 200 mL of whole milk Quantity kJ kcal Protein (g) Fibre (g). Build-Up Nutrition Shake (Nestl ) 1105 263 38-g sachet in 200 mL of whole milk Complan (Complan Foods) 1596 380 57-g sachet in 200 mL of whole milk Table Prescribable solid/semi solid supplements Dessert style also useful for dysphagic patients.

7 Product type Product name (manufacturer) Per bottle/can Quantity kJ kcal Protein (g) Fibre (g). Solid/semi solid desserts Clinutren Dessert (Nestl ) 650 156 125 g Ensure Plus Cr me (Abbott) 718 171 125 g Forticreme Complete (Nutricia Clinical) 844 200 125 g Fortisip Fruit Dessert (Nutricia Clinical) 840 200 150 g Fresubin Cr me (Fresenius Kabi) 945 225 125 g Resource Dessert Energy (Nestl ) 839 200 125 g Resource Dessert Fruit (Nestl ) 848 200 125 g Appendix . Appendices 957. Table Single nutrient component supplements Component Product name (manufacturer) Notes, ACBS indications and Nutritional values Carbohydrate Caloreen (Nestl ) 1640 kJ (390 kcal)/100 g Disease related malnutrition or Powder malabsorption states or other conditions Maxijul Liquid (SHS) 850 kJ (200 kcal)/100 mL requiring fortification with a high or Liquid readily available carbohydrate supplement Maxijul Super Soluble (SHS) 1615 kJ (380 kcal)/100 g Powder Polycal (Nutricia Clinical) 1630 kJ (384 kcal)/100 g Powder Polycal Liquid (Nutricia Clinical) 1050 kJ (247 kcal)/100 mL.

8 Liquid Resource Optifibre (Nestl ) 323 kJ (76 kcal) and 78 g Powder of fibre/100 g 10, 15, 20, 25 (Vitaflo) 1590 kJ (380 kcal)/100 g Powder Vitajoule (Vitaflo) 1610 kJ (380 kcal)/100 g Powder Fat Calogen (Nutricia Clinical) Liquid (100% 1850 kJ (450 kcal)/100 mL Disease related malnutrition or LCTs fat emulsion) malabsorption states or other conditions Fresubin 5kcal Shot (Fresenius Kabi) 2100 kJ (500 kcal)100 mL requiring fortification with a high fat Liquid supplement Liquigen (SHS) 1850 kJ (450 kcal)/100 mL Steatorrhoea associated with cystic fibrosis Liquid (97% MCTs) (pancreas), intestinal lymphangiectasia, Medium-Chain Triglyceride (MCT) Oil (SHS) 3515 kJ (855 kcal)/100 mL intestinal surgery, chronic liver disease/. Liquid (100% MCTs) cirrhosis and other proven malabsorption syndromes Protein Casilan 90 (Heinz) 1572 kJ (370 kcal)/100 g Disease related malnutrition or Powder (90% protein) malabsorption states or other conditions Protifar (Nutricia Clinical) Powder (89% 1580 kJ (373 kcal)/100 g requiring fortification with a high protein protein) supplement Vitapro (Vitaflo) 1506 kJ (360 kcal)/100 g Protein energy malnutrition or Powder (75% protein) malabsorption states, hypoproteinaemia and as a protein source in modular feed LCTs, long chain triglycerides; MCTs, medium chain triglycerides.

9 Appendix . 958 Appendices Table Multiple nutrient component supplements Components Product name Notes, ACBS indications and Nutritional values (manufacturer). Fat/ MCT Duocal (SHS) Conditions requiring extra 50 g in 150 mL of water provides 1041 kJ. carbohydrate Powder calories, fat malabsorption (249 kcal), 36 g of CHO and g of fat or where assimilation of LCTs is impaired Duocal (SHS) Conditions requiring extra Per 100 mL: 695 kJ (166 kcal), g of CHO and Liquid calories g of fat (30% MCTs). Protein/ ProSource (Nutrinovo) Protein energy malnutrition Per 30 mL: 420 kJ (100 kcal), 10 g of protein and carbohydrate Liquid and patients on a fluid 15 g of CHO. restricted diet Calogen Extra (Nutricia High energy fat emulsion with Per 100 mL: 1650 kJ (400 kcal), g of protein, Clinical) protein, carbohydrate, vitamins g of CHO and g of fat Liquid and minerals Protein/fat/ Calshake (Fresenius Kabi) For increased energy 87-g sachet + 240 mL of whole milk provides carbohydrate Powder requirements, patients approx.

10 2495 kJ (596 kcal), g of protein, with cystic fibrosis, cancer or g of CHO and g of fat HIV/AIDS. Enshake (Abbott) High energy, high protein sachet + 240 mL of whole milk provides Powder drink for patients with approx. 2519 kJ (600 kcal), 16 g of protein, involuntary weight loss g of CHO and g of fat Pro-Cal (Vitaflo) Disease related malnutrition or 15-g sachet provides 418 kJ (/100 kcal), 2 g of Powder malabsorption states and protein, 4 g of CHO and g of fat Pro-Cal Shot (Vitaflo) other conditions requiring Per 30 mL: 418 kJ (/100 kcal), 2 g of protein, 4 g Liquid fortification with energy and of CHO and g of fat QuickCal (Vitaflo) Powder protein, burns 13-g sachet provides 418 kJ (100 kcal), g of protein, g of CHO and 10 g of fat Scandishake Mix (Nutricia High energy supplement for 85-g sachet + 240 mL of whole milk provides Clinical) Powder disease related malnutrition 2457 kJ (588 kcal), g of protein, g of based on skimmed milk CHO and g of fat powder, carbohydrate and fat Vitasavoury 200 (Vitaflo) Low volume, high energy 33-g sachet provides 855 kJ (200 kcal), 4 g of Powder supplements for disease protein, g of CHO and g of fat Vitasavoury 300 (Vitaflo) related malnutrition or 50-g sachet provides 1295 kJ (300 kcal)


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