- Meet Consumers/Patients
|Nutrition and You: Pass the Carbs, Please!|
Pass the Carbs, Please!
Modular products can be used to supplement "complete nutrition.” They can be an appropriate option for those looking to add extra carbohydrates to boost calories or perhaps to make special solutions such as oral rehydration solutions. They are not designed to fully support consumers’ nutritional needs because they do not provide a complete source of vitamins and minerals. Instead, most modular products consist of one or two of the major nutrients (protein, carbohydrate, or fat).
Carbohydrate modular products are used in a variety of circumstances. They can be used to supply additional calories from carbohydrate, especially when it is important to limit fat or protein intake, as in kidney or heart disease. They can be used in the care of patients with inborn errors of metabolism. Carbohydrate modulars are also used when a home parenteral and/or enteral (HPEN) consumer’s medical status prevents adequate intake of calories, for example when gastrointestinal volume is restricted. They can be used when the renal solute load (the amount of nitrogenous waste and minerals that must be excreted by the kidney) is limited, and to increase the energy density of foods. They come in powder and liquid forms, and can be sprinkled onto or mixed into food, mixed into beverages, or diluted into enteral formula or water and flushed through feeding tubes.
Modular Carbohydrate Products
Since Abbott Nutrition discontinued Polycose in late 2013, consumers looking for commercial carbohydrate modulars have had limited choices. There are now, however, several products available. Specialty high-carbohydrate products designed for inborn errors of metabolism are sometimes used, but their costs can be prohibitive.
Nutricia recently re-released Polycal, a pure carbohydrate modular made from maltodextrin. Maltodextrin, also referred to as a glucose polymer, is derived from corn and is absorbed more slowly than glucose but more quickly than starch. SolCarb by Solace Nutrition is a similar carbohydrate modular made from maltodextrin. These may be used when a rapid source of glucose is required, such as in situations with inborn errors of metabolism, as well as a source of calories. Duocal by Nutricia is a high-calorie modular composed of two energy nutrients (59% carbohydrate and 41% fat). Duocal’s blend of nutrients is designed to add calories without milk protein to lessen the risk of GI distress.
Not for Everyone
There are a few cautions about carbohydrate modular additives. First, carbohydrate quantity and type significantly affect enteral formula osmolality (the number of particles in solution), and high osmolality may lead to gastrointestinal distress. Consumers with fragile digestive tracts should seek medical guidance before adding any product to their feeding program (oral or enteral).
Enteral formula viscosity should be considered, and powder should be well dissolved to avoid tube or pump occlusions. When modulars are providing significant calories, vitamin and mineral intake from other sources should be evaluated to ensure nutritional adequacy. The American Society for Parenteral and Enteral Nutrition (A.S.P.E.N.) recommends that formulas with additives should hang for no longer than four hours. Finally, modular enteral formulas usually have the billing code B4155, and some insurance companies require clinical justification before they will cover them.
As always, check with your physician and dietitian before making any changes to your current regimen to be sure it is appropriate for your condition.
Carbohydrate modularsManufacturerFood sourceCalories per tbsp.Other nutrientsCalories per packageSolCarbSolaceMaltodextrin23-851/227g (8oz) canDuocal (41% fat)NutriciaCornstarch, vegetable oils421.87g fat/tbsp.1968/400g canPolycalNutriciaMaltodextrin 29 1536/400g canSOSVitafloGlucose syrup 120, 160, or 190 calories per pkt.
Carbohydrate modulars can be used to supply additional calories; in the care of patients with inborn errors of metabolism; when a HPEN consumer’s medical status prevents adequate intake of calories; when a patient’s renal solute load is limited; or to increase the energy density of foods.
Written by Sarah Carter, RD, LDN, CDE, CNSC. Reviewed by Carol Ireton-Jones, PhD, RD, LD, CNSC, and Laura Matarese, PhD, RD, CNSC, FASPEN.
LifelineLetter, January/February 2015