The Prospective Assessment of Nutrition in Children with Cystic Fibrosis

Authors

  • Vesal Moeeni Department of Paediatrics, University of Otago (Christchurch), Christchurch, New Zealand
  • Pardis Shojaee Paediatric Department, Mashhad University of medical sciences, Ghaem Hospital, Mashhad, Iran
  • Hamidreza Kianifar Paediatric Department, Mashhad University of medical sciences, Ghaem Hospital, Mashhad, Iran
  • Tony Walls Department of Paediatrics, University of Otago (Christchurch), Christchurch, New Zealand
  • Philip Pattemore Department of Paediatrics, University of Otago (Christchurch), Christchurch, New Zealand
  • Andrew S. Day Department of Paediatrics, University of Otago (Christchurch), Christchurch, New Zealand

DOI:

https://doi.org/10.6000/1929-4247.2015.04.03.1

Keywords:

Cystic Fibrosis, Malnutrition, Nutritional Risk Screening (NRS), NRS tools, over-nutrition

Abstract

Aims: Patients with Cystic Fibrosis (CF) have increased risk of malnutrition. Early detection of nutritional deterioration enables prompt intervention and correction. The aims of this project were to define the nutritional status of CF patients in Iran and New Zealand, compare and contrast the McDonald Nutritional Risk Screening (NRS) tool with the Australasian Guidelines for Nutrition in Cystic Fibrosis, and validate these results with each patient’s evaluation by their CF clinical team.

Methods: Children with CF (2 - 18 years) were assessed during routine outpatient visits over one year. Anthropometric measurements were obtained. Both tools were applied and the results compared to their clinical evaluation (as gold standard) with calculation of specificity and sensitivity.

Results: Under-nutrition was seen more frequent in the 33 Iranian children than in the 36 New Zealand (NZ) patients (39% versus 0%, p=0.0001), whereas over-nutrition was more prevalent in NZ children (9% versus 17%, p=0.05). At the first visit, both guidelines were able to recognize 77% and 61% of under-nourished Iranian patients, respectively. The mean sensitivity and specificity for all visits for the McDonald tool were 83% & 73% (Iran) and 65% & 86% (NZ). Sensitivity and specificity for the Australasian guidelines were 79% & 79% (Iran) and 70% & 90% (NZ).

Conclusions: Both tools successfully recognised patients at risk of malnutrition. The McDonald tool had comparable sensitivity and specificity to that described previously, especially in Iranian patients. This tool may be helpful in recognizing at risk CF patients, particularlyin developing countries with fewer resources.

References

National Library of Australia. Cystic Fibrosis in Australia and New Zealand 2002: Annual report from the Australasian cystic fibrosis data registry 2004 ISSN/MAY2013.

Department of Paediatrics Christchurch Hospital. Cystic Fibrosis in children, guidelines for care 2011.

Dietitians Association of Australia National Cystic Fibrosis Group. Australasian clinical practice guidelines for nutrition in cystic fibrosis [Guideline on the Internet] Sydney 2006 [cited 2011 Nov 16]. Available from: daa.asn.au/wp-content/uploads/2012/09/Guidelines_CF-Final.pdf.

Mayo Clinic Staff [Homepage on the Internet] Cystic Fibrosis 2013 [updated 2013 July 13; cited 2013 Oct 17]. Available from: http://www.mayoclinic.com/health/cystic-fibrosis/DS00287

Steinkamp G, Wiedeman B, CFQA Group. Relationship between nutritional status and lung function in cystic fibrosis: cross sectional and longitudinal analyses from the German CF quality assurance (CFQA) project. Thorax 2002; 57: 596-601. http://dx.doi.org/10.1136/thorax.57.7.596

Vieni G, Faraci S, Collura M, et al. Stunting is an independent predictor of mortality in patients with cystic fibrosis. Clin Nutr 2013; 32: 382-5. http://dx.doi.org/10.1016/j.clnu.2012.08.017

Borowitz D, Baker RD, Stallings V. Consensus report on nutrition for pediatric patients with cystic fibrosis. J Pediatr Gastroenterol Nutr 2002; 35: 246-59. http://dx.doi.org/10.1097/00005176-200209000-00004

Center for Disease Control and prevention [Homepage on Internet]. National Health and Nutrition Examination Survey National Center for Health Statistics; 2006 [updated 2010 Sept 10; cited 2011 Nov 27]. Available from: http://www.cdc.gov/growthcharts

McDonald CM. Validation of a nutrition risk screening tool for children and adolescents with cystic fibrosis ages 2–20 years. J Pediatr Gastroenterol Nutr 2008; 46: 438-46. http://dx.doi.org/10.1097/MPG.0b013e318156c2db

Zemel BS, Jawad AF, FitzSimmons S, et al. Longitudinal relationship among growth, nutritional status, and pulmonary function in children with cystic fibrosis: analysis of the Cystic Fibrosis Foundation National CF Patient Registry. J Pediatr 2000; 137: 374-80. http://dx.doi.org/10.1067/mpd.2000.107891

Baumgartner RN, Roche AF, Himes JHI. Incremental growth tables: supplementary to previously published charts. Am J Clin Nutr 1986; 43: 711-22.

Corey M, McLaughlin FJ, Williams M, et al. A comparison of survival, growth, and pulmunary function in patients with cystic fibrosis. J Clin Epidemiol 1988; 41: 583-91. http://dx.doi.org/10.1016/0895-4356(88)90063-7

Salvatore D, Buzzetti R, Baldo E, et al. An overview of international literature from cystic fibrosis registries 2. Neonatal screening and nutrition/growth. J Cyst Fibros 2010; 9: 75-83. http://dx.doi.org/10.1016/j.jcf.2009.11.002

Dodge JA, Turck D. Cystic fibrosis: nutritional consequences and management. Best Pract Res Clin Gastroenterol 2006; 20: 531-46. http://dx.doi.org/10.1016/j.bpg.2005.11.006

Borowitz D. Update on the evaluation of pancreatic exocrine status in cystic fibrosis. Curr Opin Pul Med 2005; 11: 524-7. http://dx.doi.org/10.1097/01.mcp.0000181474.08058.b3

Walkowiak J, Lisowska A, Blaszczyński M. The changing face of the exocrine pancreas in cystic fibrosis: pancreatic sufficiency, pancreatitis and genotype. Eur J Gastroenterol Hepatol 2008; 20: 157-60. http://dx.doi.org/10.1097/MEG.0b013e3282f36d16

Downloads

Published

2015-09-01

How to Cite

Moeeni, V., Shojaee, P., Kianifar, H., Walls, T., Pattemore, P., & Day, A. S. (2015). The Prospective Assessment of Nutrition in Children with Cystic Fibrosis. International Journal of Child Health and Nutrition, 4(3), 129–134. https://doi.org/10.6000/1929-4247.2015.04.03.1

Issue

Vol. 4 No. 3 (2015)

Section

General Articles

License

Policy for Journals/Articles with Open Access

Authors who publish with this journal agree to the following terms:

  • Authors retain copyright and grant the journal right of first publication with the work simultaneously licensed under a Creative Commons Attribution License that allows others to share the work with an acknowledgement of the work's authorship and initial publication in this journal.

  • Authors are permitted and encouraged to post links to their work online (e.g., in institutional repositories or on their website) prior to and during the submission process, as it can lead to productive exchanges, as well as earlier and greater citation of published work

Policy for Journals / Manuscript with Paid Access

Authors who publish with this journal agree to the following terms:

  • Publisher retain copyright .

  • Authors are permitted and encouraged to post links to their work online (e.g., in institutional repositories or on their website) prior to and during the submission process, as it can lead to productive exchanges, as well as earlier and greater citation of published work .
Crossref
Scopus
Google Scholar
Europe PMC