Protein Top-up Acceptability Study for Patients With Increased Protein Needs

Acceptability of the patients existing feeding regimen (including any protein module use) will be assessed on day 1, baseline period. Acceptability with the study product will be assessed at the end of the intervention period using a standardised questionnaire completed by the patient.

Compliance with the recommended intake of patients' currently prescribed high protein modular feed (if an existing user) and feeding regimen overall will be assessed separately at baseline. Similarly, compliance with the study product will be assessed daily throughout the intervention period and weekly when considering the patients feeding regimen overall. Compliance data will not be used in calculations for nutrient intake. For daily compliance questions, patients will be asked to record how many servings are taken compared to that recommended by their Health Care Professional (HCP). The daily amount prescribed by the HCP managing the patients care will be recorded at the start of the study and any changes to this prescription during the study will be noted. To strengthen compliance measures for the HPLM only, a count of the HPLM will be conducted on day 29 and compared to amount prescribed at baseline.

Gastrointestinal tolerance (including symptoms of diarrhoea, constipation, nausea, vomiting, abdominal pain, bloating, flatulence and burping) and information about bowel movements will be assessed during baseline (day 1), and on days 8, 15 and 29 of the intervention period using a standardised gastrointestinal tolerance questionnaire. This will be completed by the patient or their carer (using the scale: none, mild, moderate, severe symptoms)

During recruitment, on a per patient and condition specific basis, the patients managing Dietitians will calculate estimated energy and protein requirements as per standard dietetic practice. Intake of all nutrition provided (including the HPLM, other enteral tube feeds, foods, drinks and oral nutritional supplements) will be recorded at baseline and at the end of the intervention period via 24 hour dietary recall. Actual intakes will subsequently be compared against Dietitians calculated estimated energy and protein requirements and percentage achievements of these requirements will also be calculated. This will include details of feeding regimens as required. Trained research staff will subsequently analyse all records utilising a nutritional software package (Nutritics Professional v3.09, Nutritics, Ireland) for macro- and micro-nutrient intakes.

To assess physical function, the 30-s Chair Stand Test will be completed during baseline (day 1) and at the end of the intervention period (day 29). Patients will be requested to stand up and sitting down from a chair as many times as possible within 30 seconds. This will be performed 3 times (with a 1 min rest in between sets) and an average score taken. A standard chair (with a seat height of approximately 40 cm) without armrests will be used. Initially, patients will be seated with their back in an upright position and arms folded across the chest. They will need to look straight forward and begin once ready and maintain their own preferred speed.

The risk of malnutrition will be assessed during baseline (day 1) and at the end of the intervention period (day 29) using the Malnutrition Universal Screening Tool (MUST). MUST is a five-step screening tool to identify adults, who are malnourished, at risk of malnutrition (undernutrition), or obese. Trials sites will receive a guide and flowchart to help quantify MUST score.

Height will be captured, wherever possible, using standard measures to the nearest 0.1cm.

Weight will be determined to the nearest 0.1kg, using portable scales, shoeless and wearing light weight clothing.

The dietetic goal of each patient will be recorded at baseline by the Dietitian and achievement of this goal (via yes/no responses) in the view of the Dietitian will be assessed at the end of the intervention (day 29).

All adverse events will be recorded, throughout the study.

A detailed patient history will be recorded at baseline to assess previous compliance, relevant clinical issues, diagnosis, medication prescribed, details of current and previous feeding regimens, feeding history, need for protein supplementation and any other relevant clinical information related to the patient's condition or diet.