Energy diet - cystic fibrosis
This document is part of the ACI Diet Specifications for Adult Inpatients. It is not to be used for patient education.
Aim
To provide a high protein, high energy diet with added salt for people with cystic fibrosis (CF). This diet provides approximately 120% protein (average extra 15g per day) and approximately 130% energy of the full diet.
Characteristics
A diet high in protein, high in energy, with added salt and fortification of foods with added fats. Salt is supplemented with high salt foods, as well as serving extra salt sachets with meals.
Extra high-energy snacks are required. Large serves need to be available. Menu items to be fortified with fat (preferably mono and polyunsaturated) and protein wherever possible.
High energy nutrient supplements are often used.
Indications
To be used for patients with cystic fibrosis and cystic fibrosis related diabetes.
Nutritional adequacy
Nutritionally adequate.
Precautions
Patients with CF have increased energy expenditure up to twice the basal metabolic rate due to increased work of breathing and impaired absorption and utilisation of nutrients. Appetite may be poor and may not reflect needs for metabolism. Frequent snacks and availability of choice and extra servings is essential to help meet needs. Frequent dietitian review and provision of high-energy supplements are recommended. The full diet will not provide adequate nutrition for people with cystic fibrosis.
Salt supplementation is important to maintain normal hydration.
Not to be combined with diets that restrict fat or sugar.
Paediatrics
Suitable for use in paediatrics when combined with an age-appropriate diet.
Apple gel or fruit purees are to be provided for infants and toddlers requiring pancreatic enzyme replacement therapy administration
Specific menu planning guidelines
| Allowed | Not allowed | |
|---|---|---|
| Hot main dishes | All, preferably fried, roasted and served with creamy sauces Extra serves to be available Serve with extra oil/PC margarine or butter/high fat dressing | - |
| Sauces, gravies | All Include gravies, white sauces, cheese sauces | - |
| Starchy vegetables / pasta / rice | All High energy mashed potato, made on milk and added margarine | - |
| Vegetables | All, with added margarine/oil/high fat dressing | - |
| Soups | All – serve with thin/sour cream Offer one Band 1 choice twice per day | - |
| Sandwiches | All Band 1 providing at least 800kJ per serve and at least 10g protein per serve OR spread with high fat spread (margarine/cream cheese/ mayonnaise) | - |
| Salads, dressings | Salads – one Band 1 choice per day containing at least 20g protein, all others to be Band 2 providing at least 10g protein per serve and all served with high fat dressing/mayonnaise | - |
| Breads, cereals | All bread Serve with extra PC margarine/butter Cereals served with cream and milk | - |
| Spreads | All Send extra PC spread with each meal | - |
| Hot breakfast choices | All | - |
| Fruit | With fruits – serve with cream/ice cream/custard Offer glucose supplement syrup or powder as prescribed by dietitian Offer whipped/thin cream | - |
| Yoghurt | All yoghurts, full fat preferred | - |
| Desserts | Serve milk-dessert or high energy dessert at both lunch and dinner Offer one Band 1 dessert containing at least 500kJ and at least 4g protein at 2 meals per day Serve all with cream (thin, thick, whipped or double) or ice cream High-protein custards made on milk and skim milk powder/egg Low joule jelly allowed on dietitian prescription | - |
| Milk and cheese | All full cream dairy products and dairy alternatives High energy/high protein milk, fortified with skim milk powder Offer milk drink at every meal and midmeal Add cheese to main meals | - |
| Beverages | Full fat milks including flavoured milks (preferred beverage) All others, including soft drink Juice at all meals when available Diet cordial and soft drink allowed as per dietitian prescription | - |
| Biscuits | All, serve crackers with high fat spread | - |
| Miscellaneous | Extra snacks and larger serves to be available Extra midmeals to be available – offer one choice per midmeal of Band 1 sandwich or Band 1 dessert among other choices High fat spread PC (margarine/butter) served with every meal Oil/high fat dressings available Cream (thin/whipped/sour) to be offered with meals 2 salt sachets with every meal Nutritional supplements as prescribed by dietitian Fat/glucose supplements and milk powder may be added to foods and beverages and available at all meals Apple gel and fruit purees available at every meal for infants and toddlers requiring pancreatic enzyme therapy Artificial sweeteners are allowed, but sugar is preferred Pepper, herbs and spices | - |
References
- Agency for Clinical Innovation. Nutrition standards for paediatric inpatients in NSW hospitals. Sydney 2011.
- Agency for Clinical Innovation. 2011. Nutrition standards for adult inpatients in NSW hospitals. Sydney 2011.
- Dietitians Association of Australia. 2014. Nutrition Manual 9th ed. Canberra: DAA.
- Turck D, Braegger CP, Colombo C, Declerq D, Morton A, Pancheva R, Robberecht E, Stern, M, Strandvik B, Wolfe S, Schneider SM and Wilschanski M. 2016 ESPEN-ESPGHAN-ECFS guidelines on nutrition care for infants, children, and adults with cystic fibrosis. Clinical Nutrition. Jun;35(3):557-77
- Middleton PG, Wagenaar, M, Matson AG, Craig ME, Holmes-Walker DJ, Katz T and Hameed S. 2014. Australian standards of care for cystic fibrosis-related diabetes. Respirology: 19, 185–192.
- Dietitians Association of Australia. 2006. Australasian Clinical Practice Guidelines for Nutrition in Cystic Fibrosis. Canberra.
- Shaw V and Lawson M. 2007 Clinical Paediatric Dietetics Blackwell Publishing 3rd Edition.