How should Fresubin LP (nutritional supplement) be used in patients requiring nutritional support?

Fresubin LP: Clinical Use in Nutritional Support

Fresubin LP is a polymeric oral nutritional supplement (ONS) that should be prescribed at 2 servings daily (providing approximately 600 kcal and 22.4 g protein when using the powder formulation) for patients with malnutrition or at risk of malnutrition who cannot meet their nutritional requirements through regular diet alone. 1

Primary Indications for Use

Fresubin LP is indicated when:

• Patients cannot achieve adequate oral intake despite nutritional counseling 2
• Body Mass Index (BMI) < 20 kg/m² 2
• Unintentional weight loss > 10% over 6 months 2
• Serum albumin < 35 g/L 2
• Mini Nutritional Assessment-Short Form (MNA-SF) score ≤ 11 1

Dosing and Administration

Standard dosing protocol:

• 2 servings per day providing 600 kcal and 22.4 g protein (when using Fresubin powder formulation) 1
• Alternative formulations may provide 500-600 kcal/day as supplementation 2
• Should supplement regular meals, not replace them 2
• Timing should be between main meals to avoid reducing appetite for regular food 2

Expected Clinical Outcomes

A 12-week randomized controlled trial demonstrated:

• Mean body weight increase of 1.381 kg compared to control (p < 0.001) 1
• Significant improvements in BMI, mid-arm circumference, and calf circumference 1
• Enhanced intake of energy, protein, vitamin D, and calcium 1
• These outcomes were achieved in Chinese free-living adults at risk of malnutrition 1

Disease-Specific Applications

Inflammatory Bowel Disease (IBD)

• Fresubin and similar polymeric supplements (Ensure Plus, Jevity) can be used as part of exclusive enteral nutrition (EEN) or partial enteral nutrition (PEN) strategies 2
• For preoperative optimization in malnourished Crohn's disease patients: EEN may reduce postoperative complications when used before elective surgery 2
• Does not require elemental formulation; intact protein formulas are acceptable 2

Critical Illness and Hospitalized Patients

• Energy targets: 25-30 kcal/kg/day, with protein 1.2-2 g/kg/day 2
• In polymorbid medical inpatients, reaching 75% of estimated nutrition goals significantly reduces adverse events and mortality 2
• Should be initiated early (within 24-48 hours) when oral intake is inadequate 2

Chronic Kidney Disease

• Energy requirement: 35 kcal/kg body weight/day for stable patients within ideal body weight ±10% 2
• Standard ONS formulations are appropriate for short-term use 2
• For enteral nutrition > 5 days, consider disease-specific formulas with reduced electrolyte content 2

Geriatric Malnutrition

• Energy target: 30 kcal/kg body weight/day 3
• Protein target: 1.2-1.5 g/kg body weight/day 3
• ONS should provide at least 400 kcal/day including ≥30g protein/day 3
• Combine with small, frequent meals and physical activity 3

Monitoring and Reassessment

Regular evaluation should include:

• Body weight and BMI tracking 1
• Anthropometric measurements (mid-arm circumference, calf circumference) 1
• Serum albumin and prealbumin levels 2
• Assessment of continued need for supplementation 2
• Review every 6-8 weeks initially, then periodically once stable 2

Critical Pitfalls to Avoid

Common errors in ONS use:

• Replacing meals instead of supplementing: Fresubin must be given between meals to avoid reducing appetite for regular food 2
• Inadequate dosing: Providing < 400 kcal/day or < 30g protein/day is unlikely to achieve meaningful clinical benefit 3
• Ignoring drug interactions: In patients taking multiple medications (especially elderly), review all concurrent drugs for potential interactions 4, 5
• Premature discontinuation: Continue supplementation until nutritional parameters normalize and adequate oral intake is consistently achieved 2
• Using ONS when tube feeding is indicated: If oral intake plus ONS cannot meet 60% of requirements after 7-10 days, consider enteral tube feeding 2

When to Escalate to Tube Feeding

Transition to enteral tube feeding when:

• Oral diet plus ONS fails to achieve adequate nutritional status after appropriate trial 2
• Patient cannot consume sufficient volume orally 2
• Anticipated duration of inadequate oral intake is 5-7 days or longer 6
• In critically ill patients, if < 60% of caloric requirements met via oral route after 7-10 days 2

Special Considerations

Electrolyte monitoring is essential:

• Historical data shows Fresubin's sodium and potassium content may be insufficient for some patients 7
• In 8 of 21 postoperative patients, parenteral potassium supplementation was required 7
• Monitor serum electrolytes regularly, especially in patients with renal disease or those on diuretics 2, 7

Product selection:

• Standard polymeric formulas like Fresubin are appropriate for most patients 2
• Disease-specific formulations are not generally superior to standard formulas in most conditions 2
• Fiber-enriched formulas (30g fiber with 33% insoluble, 67% soluble) may benefit patients with bowel dysfunction 2