High Energy High Protein Tube Feed Study

September 27, 2019 updated by: Nutricia UK Ltd

Evaluating the Tolerance, Compliance and Acceptability of a Nutritionally Complete, High Energy, High Protein, Enteral Feed in Adults - a Pilot Study

Enteral tube feeds are commonly used to meet the entire or partial nutritional requirements of patients with disease-related malnutrition and other conditions who need nutrition support. A large proportion of tube fed patients have increased protein and/or energy requirements due to a higher body mass or increased metabolic stress as a result of disease, surgery or trauma. A high energy, high protein feed has been developed to help meet the needs of such patients. The aim of this study is to investigate the tolerance, compliance and acceptability of this high energy high protein tube feed in adult patients who require nutritional support via tube feeding. 50 eligible patients requiring tube feeding will receive the high energy, high protein feed, according to nutritional requirements for 4 weeks. The primary outcome is nutritional intake, and secondary outcomes include gastrointestinal (GI) tolerance, compliance, acceptability and functional measures. Additional exploratory outcomes of quality of life and micronutrient levels will also be investigated.

Study Overview

Status

Status

Indicates the current recruitment status or the expanded access status.
Completed

Conditions

Conditions

The disease, disorder, syndrome, illness, or injury that is being studied. On ClinicalTrials.gov, conditions may also include other health-related issues, such as lifespan, quality of life, and health risks.

Intervention / Treatment

Intervention / Treatment

A process or action that is the focus of a clinical study. Interventions include drugs, medical devices, procedures, vaccines, and other products that are either investigational or already available. Interventions can also include noninvasive approaches, such as education or modifying diet and exercise.

Detailed Description

Introduction

The present study will investigate the effect of a high energy, high protein tube feed in patients requiring enteral feeding in the community. The primary objective is to evaluate the effect of daily intake of the high energy, high protein tube feed, in addition to appropriate nutritional management, on total nutrient intakes for 4 weeks. The secondary objectives are to evaluate the effect of daily intake of the feed on gastrointestinal tolerance, compliance, acceptability and functional measures. Additional exploratory measures will be quality of life and micronutrient levels. Enteral tube feeding patients will be recruited by the dietitians responsible for their care, from a variety of dietetic services across the United Kingdom. Potential participants that require a high energy, high protein tube feed will already be known to the Investigating Dietitian or dietetic team at the investigating sites or will be referred to the dietetic service during the duration of the study.

Intervention

Following a 3 day baseline period, each patient will receive the high energy, high protein tube feed for a period of 4 weeks (28 days). The appropriate feed and prescription will be determined on an individual basis by the Dietitian responsible for the patient's nutritional management, based on the patient's clinical requirement and preference and the Dietitian's clinical judgement.

The study feed is classed as a 'Dietary Food for Special Medical Purposes' (EC Directive 1999/21/EC, 1999).

Outcome measures

  1. Nutrient intake (energy, protein, fluid and micronutrients)
  2. Gastro-intestinal tolerance Gastro-intestinal tolerance will be measured using a standardised gastro-intestinal tolerance questionnaire.
  3. Compliance with feed prescription Compliance with feed prescription will be assessed daily throughout the study
  4. Acceptability Feed acceptability, such as preference and ease of use will be assessed at the end of study.
  5. Anthropometry Weight and height will be measured where possible using standard measures.
  6. Patient history Previous nutritional support provided to the patient, previous enteral feeding products prescribed, history of intolerance, the need for a high energy, high protein feed, weight history and other relevant dietetic history.
  7. Muscle Function (Hand Grip Strength)
  8. Quality of life
  9. Micronutrients levels

Statistical aspects

As this is a pilot study no power calculation was undertaken. The sample size of this trial is similar to other published trials of tube feeds in patient populations. In addition to helping to inform clinical practice, the data collected will also be used to support an application to the Advisory Committee of Borderline Substances (ACBS). Recruiting a sample of 50 patients should enable sufficient data to be collected to meet ACBS requirements for the study, while allowing for drop outs during the study period.

Data will be analysed using repeated measures analysis of variance (ANOVA) or t-test where appropriate. Categorical data will be analysed using appropriate methods (e.g. chi-squared). Interim analysis may be undertaken after 30 patients have been recruited. Statistical analysis will be undertaken using IBM SPSS version 23.0 Armonk, New York, USA.

Ethical Considerations

This study will be undertaken in adults with capacity to consent only. In line with the guidance of the Medical Research Council, written informed consent will be obtained for each participant taking part in the study. The investigator will ensure that the study will be conducted in full conformance with the principles of the 'Declaration of Helsinki' (64th WMA General Assembly, Fortaleza, Brazil, October 2013) and with the laws and regulations of the country in which the research is conducted, whichever affords the greater protection to the individual.

Study Monitoring

Monitoring will be organised by the sponsor to evaluate the progress of the study, verify the accuracy and completeness of the Case Report Forms (CRFs) and to ensure adherence to the protocol. Monitoring visits will be scheduled periodically in consultation with the investigator. During monitoring, the study monitor will need access to all patient's study records and raw data used for and generated during the study needed to verify the data in the CRF. If necessary, the investigator must provide the monitor any required background data.

Confidentiality

On recruitment to the study, all participants will be allocated a unique study number, which will be the only identifier on all participant data that will leave the institution involved. For patients consenting to provide blood samples, names will be required to be stored with blood sample results. These results will be accessible by the Investigating Dietitian responsible for the patient's care. For the purposes of data analysis and any publication and dissemination of the data, all results will be analysed and identified using the patient's unique study number only. No identifiable personal data will be published.

Study Type

Study Type

Describes the nature of a clinical study. Study types include interventional studies (also called clinical trials), observational studies (including patient registries), and expanded access.
Interventional

Enrollment (Actual)

Enrollment

The number of participants in a clinical study. The "anticipated" enrollment is the target number of participants that the researchers need for the study.
22

Phase

Phase

The stage of a clinical trial studying a drug or biological product, based on definitions developed by the U.S. Food and Drug Administration (FDA). The phase is based on the study's objective, the number of participants, and other characteristics. There are five phases: Early Phase 1 (formerly listed as Phase 0), Phase 1, Phase 2, Phase 3, and Phase 4. Not Applicable is used to describe trials without FDA-defined phases, including trials of devices or behavioral interventions.
  • Not Applicable

Contacts and Locations

This section provides the contact details for those conducting the study, and information on where this study is being conducted.

Study Locations

  • United Kingdom
      • Bristol, United Kingdom, BS2 8HW
        • University Hospitals Bristol
      • Caerleon, United Kingdom, NP16 3XQ
        • Aneurin Bevan University Health Board
      • London, United Kingdom, SE1 9RT
        • Guy's and St Thomas' NHS Foundation Trust
      • Wolverhampton, United Kingdom, WV10 0QP
        • Royal Wolverhampton Nhs Trust
    • London
      • Lewisham, London, United Kingdom, SE13 6LH
        • Lewisham Health Care NHS Trust
    • Somerset
      • Bridgwater, Somerset, United Kingdom, TA6 4RN
        • Somerset Partnership NHS Foundation Trust
    • West Sussex
      • Worthing, West Sussex, United Kingdom, BN11 2DH
        • Western Sussex Hospitals NHS Trust

Participation Criteria

Researchers look for people who fit a certain description, called eligibility criteria. Some examples of these criteria are a person's general health condition or prior treatments.

Eligibility Criteria

Eligibility Criteria

The key requirements that people who want to participate in a clinical study must meet or the characteristics they must have. Eligibility criteria consist of both inclusion criteria (which are required for a person to participate in the study) and exclusion criteria (which prevent a person from participating). Types of eligibility criteria include whether a study accepts healthy volunteers, has age or age group requirements, or is limited by sex.

Ages Eligible for Study

18 years and older (ADULT, OLDER_ADULT)

Accepts Healthy Volunteers

No

Genders Eligible for Study

All

Description

Inclusion Criteria

  • Male or female
  • Age 18 years and over
  • Requiring tube feeding in the community to meet nutritional requirements
  • Expected to receive at least 500kcal from tube feeding
  • Capacity to consent

Exclusion Criteria

  • Patients receiving parenteral nutrition
  • Patients with major hepatic dysfunction (i.e. decompensated liver disease)
  • Patients with major renal dysfunction (i.e. requiring filtration or Stage 4/5 chronic kidney disease (CKD))
  • Patients in intensive care
  • Patients with galactosaemia or severe lactose intolerance
  • Participation in other clinical studies within 2 weeks prior to entry of this study
  • Inability to provide informed consent
  • Investigator concern around willingness/ability of patient to comply with protocol requirements

Study Plan

This section provides details of the study plan, including how the study is designed and what the study is measuring.

How is the study designed?

Design Details

  • Primary Purpose: SUPPORTIVE_CARE
  • Allocation: NA
  • Interventional Model: SINGLE_GROUP
  • Masking: NONE

Arms and Interventions

Participant Group / Arm

Participant Group / Arm

A group or subgroup of participants in a clinical trial that receives a specific intervention/treatment, or no intervention, according to the trial's protocol.
Intervention / Treatment

Intervention / Treatment

A process or action that is the focus of a clinical study. Interventions include drugs, medical devices, procedures, vaccines, and other products that are either investigational or already available. Interventions can also include noninvasive approaches, such as education or modifying diet and exercise.
EXPERIMENTAL: High Energy High Protein Tube Feed
As study is a single arm design, all patients will be in the intervention group. The will act as their own control by means of a 3 day baseline period. All patients in the study will receive the same intervention, the high energy high protein tube feed, in quantities specified by their dietitian based on their nutritional requirements.
Dietary supplement: High Energy High Protein Tube Feed
Following a 3 day baseline period all patients will receive the high energy, high protein tube feed for a period of 4 weeks (28 days).

What is the study measuring?

Primary Outcome Measures

Primary Outcome Measures

In a clinical study's protocol, the planned outcome measure that is the most important for evaluating the effect of an intervention/treatment. Most clinical studies have one primary outcome measure, but some have more than one.
Outcome Measure
Measure Description
Time Frame
Change in nutrient intakes (energy, protein, fluid and micronutrients)
Time Frame: Measurements will be taken at Baseline (DAY 1) and End of Study (DAY 31).
Nutrient intakes, including the intake of all nutrition provided (including the study feed, other enteral tube feeding, foods, drinks and oral nutritional supplements) will be recorded using 24hr diet recalls. Nutritics® (https://www.nutritics.com/p/references), a dietary analysis program, will be used to calculate energy, protein, micronutrient and fluid intakes.
Measurements will be taken at Baseline (DAY 1) and End of Study (DAY 31).

Secondary Outcome Measures

Secondary Outcome Measures

In a clinical study's protocol, a planned outcome measure that is not as important as the primary outcome measure for evaluating the effect of an intervention but is still of interest. Most clinical studies have more than one secondary outcome measure.
Outcome Measure
Measure Description
Time Frame
Gastro-intestinal tolerance
Time Frame: Gastro-intestinal tolerance will be recorded at baseline (DAY 1, 2 and 3) and on days 4, 5, and 6 of the study (the first 3 days the patient is taking the study feed) and once at the end of each week the patient is taking the feed.
Tolerance will be recorded using a standardised gastro-intestinal tolerance questionnaire, measuring incidence and severity of gastro-intestinal symptoms and Bristol Stool Chart© type and frequency of bowel movements, to be completed by the patient.
Gastro-intestinal tolerance will be recorded at baseline (DAY 1, 2 and 3) and on days 4, 5, and 6 of the study (the first 3 days the patient is taking the study feed) and once at the end of each week the patient is taking the feed.
Compliance with feed prescription measured via daily feed intake recoding
Time Frame: Every day throughout study completion, 31 days in total.
Compliance will be assessed daily throughout the Baseline period and Intervention period by recording how much study feed was received, to be recorded by the patient or carer. The amount prescribed by the Dietitian will be recorded at the start of the study, and any changes to this prescription also noted. Compliance will be calculated as feed taken as a percentage of feed prescribed.
Every day throughout study completion, 31 days in total.
Acceptability
Time Frame: End of study (DAY 31)
Feed acceptability (preference, ease of use) will be assessed at the end of study by a questionnaire completed by the patient or carer.
End of study (DAY 31)
Muscle Function (hand grip strength)
Time Frame: Measurements will be taken at Baseline (DAY 1) and End of Study (DAY 31).
Hand grip strength will be measured, where possible, in all patients in the dominant arm using a handgrip dynamometer. Three measurements will be taken and the mean used for analysis.
Measurements will be taken at Baseline (DAY 1) and End of Study (DAY 31).
EQ-5D Quality of life
Time Frame: Measurements will be taken at Baseline (DAY 1) and End of Study (DAY 31).
Quality of life will be measured using the EQ-5D questionnaire.
Measurements will be taken at Baseline (DAY 1) and End of Study (DAY 31).
Micronutrient status
Time Frame: Measurements will be taken at Baseline (DAY 1) and End of Study (DAY 31).
In a subset of patients blood samples will be taken and analysed to assess micronutrient status.
Measurements will be taken at Baseline (DAY 1) and End of Study (DAY 31).

Collaborators and Investigators

This is where you will find people and organizations involved with this study.

Sponsor

Sponsor

The organization or person who initiates the study and who has authority and control over the study.
Nutricia UK Ltd

Investigators

Investigators

A researcher involved in a clinical study. Related terms include site principal investigator, site sub-investigator, study chair, study director, and study principal investigator.
  • Principal Investigator: Rebecca Stratton, PhD, Nutricia Ltd

Study record dates

These dates track the progress of study record and summary results submissions to ClinicalTrials.gov. Study records and reported results are reviewed by the National Library of Medicine (NLM) to make sure they meet specific quality control standards before being posted on the public website.

Study Major Dates

Study Start (ACTUAL)

Study Start

The actual date on which the first participant was enrolled in a clinical study. The "anticipated" study start date is the date that the researchers think will be the study start date.
June 1, 2017

Primary Completion (ACTUAL)

Primary Completion

The date on which the last participant in a clinical study was examined or received an intervention to collect final data for the primary outcome measure. Whether the clinical study ended according to the protocol or was terminated does not affect this date. For clinical studies with more than one primary outcome measure with different completion dates, this term refers to the date on which data collection is completed for all the primary outcome measures. The "anticipated" primary completion date is the date that the researchers think will be the primary completion date for the study.
May 31, 2018

Study Completion (ACTUAL)

Study Completion

The date on which the last participant in a clinical study was examined or received an intervention/treatment to collect final data for the primary outcome measures, secondary outcome measures, and adverse events (that is, the last participant's last visit). The "anticipated" study completion date is the date that the researchers think will be the study completion date.
May 31, 2018

Study Registration Dates

First Submitted

First Submitted

The date on which the study sponsor or investigator first submitted a study record to ClinicalTrials.gov. There is typically a delay of a few days between the first submitted date and the record's availability on ClinicalTrials.gov (the first posted date).
May 22, 2017

First Submitted That Met QC Criteria

First Submitted That Met QC Criteria

The date on which the study sponsor or investigator first submits a study record that is consistent with National Library of Medicine (NLM) quality control (QC) review criteria. The sponsor or investigator may need to revise and submit a study record one or more times before NLM's QC review criteria are met. It is the responsibility of the sponsor or investigator to ensure that the study record is consistent with the NLM QC review criteria.
May 24, 2017

First Posted (ACTUAL)

First Posted

The date on which the study record was first available on ClinicalTrials.gov after National Library of Medicine (NLM) quality control (QC) review has concluded. There is typically a delay of a few days between the date the study sponsor or investigator submitted the study record and the first posted date.
May 30, 2017

Study Record Updates

Last Update Posted (ACTUAL)

Last Update Posted

The most recent date on which changes to a study record were made available on ClinicalTrials.gov. There may be a delay between when the changes were submitted to ClinicalTrials.gov by the study's sponsor or investigator (the last update submitted date) and the last update posted date.
October 1, 2019

Last Update Submitted That Met QC Criteria

Last Update Submitted That Met QC Criteria

The most recent date on which the study sponsor or investigator submitted changes to a study record that are consistent with National Library of Medicine (NLM) quality control (QC) review criteria. It is the responsibility of the sponsor or investigator to ensure that the study record is consistent with the NLM QC review criteria.
September 27, 2019

Last Verified

Last Verified

The most recent date on which the study sponsor or investigator confirmed the information about a clinical study on ClinicalTrials.gov as accurate and current. If a study with a recruitment status of recruiting; not yet recruiting; or active, not recruiting has not been confirmed within the past 2 years, the study's recruitment status is shown as unknown.
September 1, 2019

More Information

Terms related to this study

Keywords

Other Study ID Numbers

Other Study ID Numbers

Identifiers or ID numbers other than the NCT number that are assigned to a clinical study by the study's sponsor, funders, or others. These numbers may include unique identifiers from other trial registries and National Institutes of Health grant numbers.
  • NPPE001

Plan for Individual participant data (IPD)

Plan to Share Individual Participant Data (IPD)?

NO

Drug and device information, study documents

Studies a U.S. FDA-regulated drug product

No

Studies a U.S. FDA-regulated device product

No

This information was retrieved directly from the website clinicaltrials.gov without any changes. If you have any requests to change, remove or update your study details, please contact register@clinicaltrials.gov. As soon as a change is implemented on clinicaltrials.gov, this will be updated automatically on our website as well.

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