Fact sheetDiet specifications

Published on 16 Oct 2016


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

  1. Agency for Clinical Innovation. Nutrition standards for paediatric inpatients in NSW hospitals. Sydney 2011.
  2. Agency for Clinical Innovation. 2011. Nutrition standards for adult inpatients in NSW hospitals. Sydney 2011.
  3. Dietitians Association of Australia. 2014. Nutrition Manual 9th ed. Canberra: DAA.
  4. 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
  5. 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.
  6. Dietitians Association of Australia. 2006. Australasian Clinical Practice Guidelines for Nutrition in Cystic Fibrosis. Canberra.
  7. Shaw V and Lawson M. 2007 Clinical Paediatric Dietetics Blackwell Publishing 3rd Edition.
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