Clinical evaluation of an evidence-based method based on food characteristics to adjust pancreatic enzyme supplements dose in cystic fibrosis

Joaquim Calvo-Lerma; Mieke Boon; Carla Colombo; Barbara de Koning; Inês Asseiceira; Maria Garriga; Maria Roca; Ine Claes; Anna Bulfamante; Sylvia Walet; Luisa Pereira; Mar Ruperto; Etna Masip; Andrea Asensio-Grau; Arianna Giana; Philine Affourtit; Ana Heredia; Saioa Vicente; Ana Andrés; Kris de Boeck; Jessie Hulst; Carmen Ribes-Koninckx

doi:10.1016/j.jcf.2020.11.016

Clinical evaluation of an evidence-based method based on food characteristics to adjust pancreatic enzyme supplements dose in cystic fibrosis

Joaquim Calvo-Lerma^*, Mieke Boon, Carla Colombo, Barbara de Koning, Inês Asseiceira, Maria Garriga, Maria Roca, Ine Claes, Anna Bulfamante, Sylvia Walet, Luisa Pereira, Mar Ruperto, Etna Masip, Andrea Asensio-Grau, Arianna Giana, Philine Affourtit, Ana Heredia, Saioa Vicente, Ana Andrés, Kris de BoeckJessie Hulst, Carmen Ribes-Koninckx

^*Corresponding author for this work

Pediatrics

Research output: Contribution to journal › Article › Academic › peer-review

11 Citations (Scopus)

Abstract

Background: Patients with cystic fibrosis (CF) and pancreatic insufficiency need pancreatic enzyme replacement therapy (PERT) for dietary lipids digestion. There is limited evidence for recommending the adequate PERT dose for every meal, and controlling steatorrhea remains a challenge. This study aimed to evaluate a new PERT dosing method supported by a self-management mobile-app. Methods: Children with CF recruited from 6 European centres were instructed to use the app, including an algorithm for optimal PERT dosing based on in vitro digestion studies for every type of food. At baseline, a 24h self-selected diet was registered in the app, and usual PERT doses were taken by the patient. After 1 month, the same diet was followed, but PERT doses were indicated by the app. Change in faecal fat and coefficient of fat absorption (CFA) were determined. Results: 58 patients (median age 8.1 years) participated. Baseline fat absorption was high: median CFA 96.9%, median 2.4g faecal fat). After intervention CFA did not significantly change, but range of PERT doses was reduced: interquartile ranges narrowing from 1447-3070 at baseline to 1783-2495 LU/g fat when using the app. Patients with a low baseline fat absorption (CFA<90%, n=12) experienced significant improvement in CFA after adhering to the recommended PERT dose (from 86.3 to 94.0%, p=0.031). Conclusion: the use of a novel evidence-based PERT dosing method, based on in vitro fat digestion studies incorporating food characteristics, was effective in increasing CFA in patients with poor baseline fat absorption and could safely be implemented in clinical practice.

Original language	English
Pages (from-to)	e33-e39
Journal	Journal of Cystic Fibrosis
Volume	20
Issue number	5
DOIs	https://doi.org/10.1016/j.jcf.2020.11.016
Publication status	Published - Sept 2021

Bibliographical note

Funding Information:
We acknowledge the support of the MyCyFAPP Project consortium. We especially thank the participation and the effort of the patients involved in the study and their families. This work was fully funded by the European Union and the Horizon 2020 Research and Innovation Framework Programme (PHC-26-2014 call Self management of health and disease: citizen engagement and mHealth) under grant number 643806. Authors have nothing to disclose.

Funding Information:
We acknowledge the support of the MyCyFAPP Project consortium. We especially thank the participation and the effort of the patients involved in the study and their families. This work was fully funded by the European Union and the Horizon 2020 Research and Innovation Framework Programme (PHC-26-2014 call Self management of health and disease: citizen engagement and mHealth) under grant number 643806 .

Publisher Copyright:
© 2020

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EMC MM-04-54-07

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Calvo-Lerma, J., Boon, M., Colombo, C., de Koning, B., Asseiceira, I., Garriga, M., Roca, M., Claes, I., Bulfamante, A., Walet, S., Pereira, L., Ruperto, M., Masip, E., Asensio-Grau, A., Giana, A., Affourtit, P., Heredia, A., Vicente, S., Andrés, A., ... Ribes-Koninckx, C. (2021). Clinical evaluation of an evidence-based method based on food characteristics to adjust pancreatic enzyme supplements dose in cystic fibrosis. Journal of Cystic Fibrosis, 20(5), e33-e39. https://doi.org/10.1016/j.jcf.2020.11.016

@article{f25ae6a395fa4b2aa1a9dd4e35858d4e,

title = "Clinical evaluation of an evidence-based method based on food characteristics to adjust pancreatic enzyme supplements dose in cystic fibrosis",

abstract = "Background: Patients with cystic fibrosis (CF) and pancreatic insufficiency need pancreatic enzyme replacement therapy (PERT) for dietary lipids digestion. There is limited evidence for recommending the adequate PERT dose for every meal, and controlling steatorrhea remains a challenge. This study aimed to evaluate a new PERT dosing method supported by a self-management mobile-app. Methods: Children with CF recruited from 6 European centres were instructed to use the app, including an algorithm for optimal PERT dosing based on in vitro digestion studies for every type of food. At baseline, a 24h self-selected diet was registered in the app, and usual PERT doses were taken by the patient. After 1 month, the same diet was followed, but PERT doses were indicated by the app. Change in faecal fat and coefficient of fat absorption (CFA) were determined. Results: 58 patients (median age 8.1 years) participated. Baseline fat absorption was high: median CFA 96.9%, median 2.4g faecal fat). After intervention CFA did not significantly change, but range of PERT doses was reduced: interquartile ranges narrowing from 1447-3070 at baseline to 1783-2495 LU/g fat when using the app. Patients with a low baseline fat absorption (CFA<90%, n=12) experienced significant improvement in CFA after adhering to the recommended PERT dose (from 86.3 to 94.0%, p=0.031). Conclusion: the use of a novel evidence-based PERT dosing method, based on in vitro fat digestion studies incorporating food characteristics, was effective in increasing CFA in patients with poor baseline fat absorption and could safely be implemented in clinical practice.",

author = "Joaquim Calvo-Lerma and Mieke Boon and Carla Colombo and {de Koning}, Barbara and In{\^e}s Asseiceira and Maria Garriga and Maria Roca and Ine Claes and Anna Bulfamante and Sylvia Walet and Luisa Pereira and Mar Ruperto and Etna Masip and Andrea Asensio-Grau and Arianna Giana and Philine Affourtit and Ana Heredia and Saioa Vicente and Ana Andr{\'e}s and {de Boeck}, Kris and Jessie Hulst and Carmen Ribes-Koninckx",

note = "Funding Information: We acknowledge the support of the MyCyFAPP Project consortium. We especially thank the participation and the effort of the patients involved in the study and their families. This work was fully funded by the European Union and the Horizon 2020 Research and Innovation Framework Programme (PHC-26-2014 call Self management of health and disease: citizen engagement and mHealth) under grant number 643806. Authors have nothing to disclose. Funding Information: We acknowledge the support of the MyCyFAPP Project consortium. We especially thank the participation and the effort of the patients involved in the study and their families. This work was fully funded by the European Union and the Horizon 2020 Research and Innovation Framework Programme (PHC-26-2014 call Self management of health and disease: citizen engagement and mHealth) under grant number 643806 . Publisher Copyright: {\textcopyright} 2020",

year = "2021",

month = sep,

doi = "10.1016/j.jcf.2020.11.016",

language = "English",

volume = "20",

pages = "e33--e39",

journal = "Journal of Cystic Fibrosis",

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Calvo-Lerma, J, Boon, M, Colombo, C, de Koning, B, Asseiceira, I, Garriga, M, Roca, M, Claes, I, Bulfamante, A, Walet, S, Pereira, L, Ruperto, M, Masip, E, Asensio-Grau, A, Giana, A, Affourtit, P, Heredia, A, Vicente, S, Andrés, A, de Boeck, K, Hulst, J & Ribes-Koninckx, C 2021, 'Clinical evaluation of an evidence-based method based on food characteristics to adjust pancreatic enzyme supplements dose in cystic fibrosis', Journal of Cystic Fibrosis, vol. 20, no. 5, pp. e33-e39. https://doi.org/10.1016/j.jcf.2020.11.016

TY - JOUR

T1 - Clinical evaluation of an evidence-based method based on food characteristics to adjust pancreatic enzyme supplements dose in cystic fibrosis

AU - Calvo-Lerma, Joaquim

AU - Boon, Mieke

AU - Colombo, Carla

AU - de Koning, Barbara

AU - Asseiceira, Inês

AU - Garriga, Maria

AU - Roca, Maria

AU - Claes, Ine

AU - Bulfamante, Anna

AU - Walet, Sylvia

AU - Pereira, Luisa

AU - Ruperto, Mar

AU - Masip, Etna

AU - Asensio-Grau, Andrea

AU - Giana, Arianna

AU - Affourtit, Philine

AU - Heredia, Ana

AU - Vicente, Saioa

AU - Andrés, Ana

AU - de Boeck, Kris

AU - Hulst, Jessie

AU - Ribes-Koninckx, Carmen

N1 - Funding Information: We acknowledge the support of the MyCyFAPP Project consortium. We especially thank the participation and the effort of the patients involved in the study and their families. This work was fully funded by the European Union and the Horizon 2020 Research and Innovation Framework Programme (PHC-26-2014 call Self management of health and disease: citizen engagement and mHealth) under grant number 643806. Authors have nothing to disclose. Funding Information: We acknowledge the support of the MyCyFAPP Project consortium. We especially thank the participation and the effort of the patients involved in the study and their families. This work was fully funded by the European Union and the Horizon 2020 Research and Innovation Framework Programme (PHC-26-2014 call Self management of health and disease: citizen engagement and mHealth) under grant number 643806 . Publisher Copyright: © 2020

PY - 2021/9

Y1 - 2021/9

N2 - Background: Patients with cystic fibrosis (CF) and pancreatic insufficiency need pancreatic enzyme replacement therapy (PERT) for dietary lipids digestion. There is limited evidence for recommending the adequate PERT dose for every meal, and controlling steatorrhea remains a challenge. This study aimed to evaluate a new PERT dosing method supported by a self-management mobile-app. Methods: Children with CF recruited from 6 European centres were instructed to use the app, including an algorithm for optimal PERT dosing based on in vitro digestion studies for every type of food. At baseline, a 24h self-selected diet was registered in the app, and usual PERT doses were taken by the patient. After 1 month, the same diet was followed, but PERT doses were indicated by the app. Change in faecal fat and coefficient of fat absorption (CFA) were determined. Results: 58 patients (median age 8.1 years) participated. Baseline fat absorption was high: median CFA 96.9%, median 2.4g faecal fat). After intervention CFA did not significantly change, but range of PERT doses was reduced: interquartile ranges narrowing from 1447-3070 at baseline to 1783-2495 LU/g fat when using the app. Patients with a low baseline fat absorption (CFA<90%, n=12) experienced significant improvement in CFA after adhering to the recommended PERT dose (from 86.3 to 94.0%, p=0.031). Conclusion: the use of a novel evidence-based PERT dosing method, based on in vitro fat digestion studies incorporating food characteristics, was effective in increasing CFA in patients with poor baseline fat absorption and could safely be implemented in clinical practice.

AB - Background: Patients with cystic fibrosis (CF) and pancreatic insufficiency need pancreatic enzyme replacement therapy (PERT) for dietary lipids digestion. There is limited evidence for recommending the adequate PERT dose for every meal, and controlling steatorrhea remains a challenge. This study aimed to evaluate a new PERT dosing method supported by a self-management mobile-app. Methods: Children with CF recruited from 6 European centres were instructed to use the app, including an algorithm for optimal PERT dosing based on in vitro digestion studies for every type of food. At baseline, a 24h self-selected diet was registered in the app, and usual PERT doses were taken by the patient. After 1 month, the same diet was followed, but PERT doses were indicated by the app. Change in faecal fat and coefficient of fat absorption (CFA) were determined. Results: 58 patients (median age 8.1 years) participated. Baseline fat absorption was high: median CFA 96.9%, median 2.4g faecal fat). After intervention CFA did not significantly change, but range of PERT doses was reduced: interquartile ranges narrowing from 1447-3070 at baseline to 1783-2495 LU/g fat when using the app. Patients with a low baseline fat absorption (CFA<90%, n=12) experienced significant improvement in CFA after adhering to the recommended PERT dose (from 86.3 to 94.0%, p=0.031). Conclusion: the use of a novel evidence-based PERT dosing method, based on in vitro fat digestion studies incorporating food characteristics, was effective in increasing CFA in patients with poor baseline fat absorption and could safely be implemented in clinical practice.

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U2 - 10.1016/j.jcf.2020.11.016

DO - 10.1016/j.jcf.2020.11.016

M3 - Article

C2 - 33279468

AN - SCOPUS:85097149532

SN - 1569-1993

VL - 20

SP - e33-e39

JO - Journal of Cystic Fibrosis

JF - Journal of Cystic Fibrosis

IS - 5

ER -

Clinical evaluation of an evidence-based method based on food characteristics to adjust pancreatic enzyme supplements dose in cystic fibrosis

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