BMI fails to identify poor nutritional status in stunted children with CF (original) (raw)
Related papers
Clinical Nutrition, 2012
Background & aims: Nutritional failure in children with cystic fibrosis (CF) has a negative effect on their morbidity and survival. It is unknown if determination of fat-free mass is a better screening method for nutritional failure than the currently recommended body mass index (BMI) alone. Methods: This cross-sectional study in 77 children with CF (age: 14.8 AE 2.9 y) measured fat-free mass, fat mass, bone mineral content and density using dual-energy X-ray absorptiometry. Nutritional failure was defined as BMI <10 percentile and/or fat-free mass index <5th percentile. Statistics were done using ANOVA and t-tests. Results: Thirty-one percent (31%) of the patients with CF was characterized by nutritional failure, and 14% had low fat-free mass index with preserved values for BMI (hidden depletion). Only 52% of the patients with fat-free mass depletion was detected when using the criteria BMI <10 percentile. Patients with fatfree mass depletion had reduced values for forced expiratory volume in 1 s (FEV 1 ), independent of body mass index (P < 0.05), and lower values for bone mineral density in whole body, spine and hip, and spine bone mineral apparent density (P < 0.01). BMI 20 percentile was associated with a large drop in fat-free mass, a reduced FEV 1 , and in bone mineral loss. Conclusions: Depletion of fat-free mass enhances morbidity in children with CF and is undetected in many of these children when only BMI percentile is used as screening method. BMI percentile of 20 should be considered as the new critical threshold for nutritional failure in CF if body composition techniques are not available.
Growth assessment in Egyptian children with cystic fibrosis: A single center study
The Gazette of the Egyptian Paediatric Association, 2017
Background: Poor clinical outcomes in cystic fibrosis are often associated with undernutrition. Nutritional status is an important prognostic marker, regardless of the level of respiratory function in the patient. Careful and repeated nutritional assessments allow for early detection of nutritional deterioration. Objectives: To assess the growth of cystic fibrosis children using different parameters as body mass index percentiles (BMIP) and standard anthropometric indexes, including height-forage percentile (HAP), weight-forage percentile (WAP) and compare between them as measures for nutritional failure in children with cystic fibrosis (CF). Methodology: This was a cross sectional study including fifty children of both sexes with CF below 12 years of age, recruited from the cystic fibrosis clinic, Specialized Children's Hospital, Cairo University. Patients were subjected to full history taking including age at diagnosis, frequency of hospital admissions (per year), current medications and presence of complications. Thorough clinical examination was performed with special emphasis on anthropometric measurements including body weight, length/ height, BMI calculation. Results: This study included 30 boys and 20 girls between 2 and 11 years old with a mean of 4.25 ± 2.30 yrs. Pancreatic insufficiency was found in 36% of patients, 28% had failure to thrive as the main complaint while 72% had recurrent chest infection as the main complaint. Growth assessment revealed that 21 patients (42%) were below À2 SDS for weight. As for BMI, 14 patients (28%) were below the 10th percentile. A highly significant negative correlation was reported between the weight SDS and the frequency of hospital admission (r = À0.412, p = 0.003). Furthermore, there was a highly statistical significant difference between the malnourished patients and the patients with average weight regarding the frequency of hospital admission (p < 0.01). As for BMI, there was a statistically significant negative correlation between the BMI and the frequency of hospital admission (r = À0.350, p = 0.013), with the different categories of BMI (malnourished, those who need nutritional reassessment, normal and obese) having highly statistical significant difference as regards the frequency of hospital admission (p < 0.01). Conclusion: Malnourished CF patients had the highest frequency of hospital admission. BMIP predicts nutritional failure more sensitively and accurately than conventional anthropometric indexes (WAP and HAP) in children with CF.
The Prospective Assessment of Nutrition in Children with Cystic Fibrosis
International Journal of Child Health and Nutrition, 2015
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, particularly in developing countries with fewer resources.
The nutritional status of children with cystic fibrosis
British Journal of Nutrition, 2006
The importance of nutritional intervention for children with cystic fibrosis (CF) is well recognised. It would be expected that the increase in knowledge over the past decade would be reflected in improvements in nutritional status for the CF paediatric population. The aim of the present paper was to evaluate the nutritional status of children with CF, cross-sectionally and longitudinally. Body cell mass adjusted for gender and size (BCM/Ht p ) was measured in sixty-four children with CF to represent nutritional status and expressed as a Z-score. The cross-sectional results showed a mean BCM/Ht p Z-score of 0·54 (SD 1·21), with males having a slightly higher Z-score than females but with a larger variation. At the initial measurement, only one female and one male were considered sub-optimally nourished. The longitudinal analysis after 2 years showed that the mean population had a significantly decreased BCM/Ht p Z-score; however, when each gender was analysed separately, this decrease was significant only in the males. At the final measurement, only two females and three males were considered sub-optimally nourished. It is evident from our results that children with CF are well nourished, with only a small percentage considered malnourished. It appears that nutritional status decreases with age, with this decline being more evident in males. These results signify that although children with CF are better nourished with current treatment support, intervention needs to continue throughout a CF patient's life to counteract the changes that occur with age.
Clinical Nutrition, 2018
(BMI) and results as Z-scores in pediatric population. Statistical analysis by SPSS v.20. Results: Mean of FEV 1 and FVC were 88.4±22 and 89±21.5, with respiratory colonization by Pseudomonas aeruginosa and Methicillin-sensitive Staphylococcus aureus (6,5%). FEV 1 was positively correlated with weight Z-score (r¼0.37), WI for height (r¼0.29) and inversely correlated with age (r¼À0.32), and serum C-reactive protein (CRP) (r¼À0.46) (all, at least p<0.05). FEV 1 < 65% was found in 31 CF-patients. By comparing cutoff points of FEV 1 (moderate to severe; <65% and mild: >65%), significant differences with Z-scores for height (p¼0.016), BMI Z-scores (p¼0.012) and CRP (p<0.001) were found. Age, BMI Z-score and CRP were significant predictors of lung function in linear regression analysis (R 2 : 0.31; p<0.001). Conclusions: Pulmonary function is significantly related with nutritionalinflammatory status in CF pediatric patients. Early CF diagnosis and monitoring play a pivotal role in CF-pediatric patients.
2020
Malnutrition prevails in considerable proportions of children with Cystic Fibrosis (CF), and is often associated with adverse outcomes. For this, routine screening for malnutrition is pivotal. In the present cross-sectional study, we aimed to assess the risk for malnutrition in pediatric outpatients with CF. A total of 76 outpatients (44 girls, 11.9 ± 3.9 years old, 39.5% adolescents) were recruited and anthropometric, clinical, dietary and respiratory measures were collected. All outpatients were screened for malnutrition risk with a validated disease-specific instrument. Most children exhibited a low risk for malnutrition (78.9%), whereas none of the participants were characterized as having a high malnutrition risk. In the total sample, malnutrition risk was positively associated with age (r = 0.369, p = 0.001), and inversely related to the body mass index (r = −0.684, p < 0.001), height z-score (r = −0.264, p = 0.021), and forced expiratory volume (FEV 1 %, r = −0.616, p < 0.001). Those classified as having a low malnutrition risk were younger (p = 0.004), heavier (p < 0.001) and taller (p = 0.009) than their counterparts with a moderate risk. On the other hand, patients in the moderate risk group were more likely pubertal (p = 0.034), with a reduced mid-upper arm fat area (p = 0.011), and worse pulmonary function (p < 0.001). Interestingly, none of the children attaining ideal body weight were classified as having a moderate malnutrition. risk, whereas 37.5% of the patients allocated at the moderate risk group exhibited physiological lung function. In this cohort of outpatients with CF that were predominantly well-nourished and attained physiological lung function, malnutrition risk was identified only in small proportions of the sample. Our data support that patients that are older, pubertal, or have diminished fat mass are at greater risk for malnutrition.
Stunting is an independent predictor of mortality in patients with cystic fibrosis
Clinical Nutrition, 2013
Background & aims: Some studies have shown a direct relationship between nutritional status and survival in Cystic Fibrosis (CF) patients. Body wasting, defined as a percentage of the ideal body weight for age, has been shown to be an independent predictor of mortality in CF. With respect to height only two studies were performed and these studies suggested that stunting is an important determinant of survival but both did not adjust statistical analysis for confounding variables. We aimed at determining the association between stunting and risk of mortality in CF patients. Methods: 393 CF patients older than 6 years of age, 95 deceased, as cases, and 298 live, as controls, were enrolled in a nested case-control study. Stunting was defined by a height percentile < 5th. We performed a multivariate statistical analysis including height percentile and the following possible confounding variables: age, gender, Body Mass Index (BMI), Forced Expiratory Volume in 1 s (FEV 1), genotype, pancreatic status, CF-related diabetes, colonization with Pseudomonas aeruginosa and/or Burkholderia cepacia. Results: In the adjusted analyses stunting (OR 2.22 [IC 95%1.10e4.46]), wasting (OR 5.27 [IC 95% 2.66e10.41]), and FEV 1 < 40% of predicted (OR 10.60 [IC 95% 5.43e20.67]) resulted the covariates that significantly predict the risk of mortality. Conclusions: Our study shows, for the first time, that stunting is a significant and independent risk factor for mortality in CF patients, and warrants an intervention of nutritional rehabilitation. Considering that nutritional interventions in stunted patients should be prolonged, are invasive and expensive, and might affect self-esteem and body image, their efficacy should be fully assessed by Randomised Controlled Trials.
Body composition and lung function in young children with cystic fibrosis
Journal of Cystic Fibrosis, 2010
Background: Malnutrition is an indicator of a poor prognosis in patients with cystic fibrosis (CF). Previous body-composition (BC) studies in children with CF used 2-component models (2CMs) to assess fat mass (FM) and fat-free mass (FFM), but to our knowledge no study has used the gold-standard 4-component model (4CM), which allows for a more accurate evaluation of the nature of both elements. Objective: We measured BC by using the 4CM in 6-12-y-old children with CF to 1) compare findings with those of healthy, matched control children and reference data; 2) relate BC to lung spirometry [forced expired volume in 1 s (FEV 1 )]; and 3) compare findings with those from more commonly used 2CM techniques. Design: One hundred clinically stable children with CF (57% girls) aged 6-12 y were measured by using the 4CM. Children with CF underwent spirometry (FEV 1 ). Results: Girls with CF had significantly less FM than did healthy girls, even after adjustment for height and pubertal status; boys with CF had higher body mass index SD scores than did healthy boys. FM in girls was positively associated with the FEV 1 percentage predicted. The 2CM FM was significantly different from the 4CM FM, with differences dependent on sex and condition, although most techniques identified a relation between FM and FEV 1 in girls. Conclusions: Although shorter than healthy children, boys with CF were heavier and had a BC within the normal range; however, girls with CF had lower FM than did healthy girls, and this was associated with poorer lung function. Given the worse prognosis in girls, this finding merits more attention. The reliability of 2CM techniques varied with sex and health status.
Assessment of body composition in pediatric patients with cystic fibrosis
Pediatric Pulmonology, 2008
Rationale: Cystic fibrosis (CF) leads to pathological changes in organs that express the cystic fibrosis transmembrane conductance regulator (CFTR), including secretory cells of the digestive tract and the pancreas. Maintaining nutritional sufficiency is challenging for CF patients and therefore accurate monitoring is important for their clinical management. Purpose: The objectives of this study were to evaluate the effectiveness of skinfold measurements as an accurate method for determining body composition (fat mass (FM) and lean body mass (LBM)) of this population, using dual-energy X-ray absorptiometry (DEXA) as a gold standard comparison and to determine the most accurate equation for this calculation in children with CF. Methods: Fifty-five pediatric patients with CF participated in the study. FM and LBM calculated via four methods: Slaughter, Durnin, Durenberg (2-site and 4-site). The relationship between the methods and DEXA results were estimated by intraclass-correlation coefficient (ICC) and Bland and Altman analyses. Results: The Slaughter method was the most accurate (ICC of 0.92 for FM and 0.99 for LBM) and displayed the least bias over the range of FM and LBM in CF patients. In addition, the results of Bland Altman analyses comparing each skinfold method to DEXA, revealed that the results were evenly distributed along the range of values for the Slaughter calculation, whereas the other three methods under and over estimated % fat results at the upper and lower ends of the range respectively. Conclusion: We therefore conclude that the Slaughter method may be used for body composition assessment of pediatric CF patients. This provides clinical teams with a simple, accurate and non-invasive method that can be used to monitor nutritional status in pediatric patients with CF.