AI Article Synopsis
- Patients with cystic fibrosis (CF) often require Pancreatic Enzyme Replacement Therapy (PERT) to digest dietary fats, but determining the right dose for each meal can be difficult.
- This study tested a mobile app that supports PERT dosing based on individual food types and in vitro digestion research, with patients tracking their diet and enzyme use over a month.
- Results showed that while overall fat absorption remained stable, the app helped narrow the range of PERT doses needed, and children with initially low fat absorption saw significant improvements after following the app's dosing recommendations.
Article 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.
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| http://dx.doi.org/10.1016/j.jcf.2020.11.016 | DOI Listing |
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