title: Nutritional decline in cystic fibrosis related diabetes: the effect of intensive nutritional intervention.
abstract: BACKGROUND
  Reports indicate that nutritional and respiratory decline occur up to four years prior to diagnosis of cystic fibrosis related diabetes (CFRD). Our aim was to establish whether intensive nutritional intervention prevents pre-diabetic nutritional decline in an adult population with CFRD.
  
  
  METHODS
  48 adult patients with CFRD were matched to 48 controls with CF, for age, gender and lung pathogen status. Nutritional and other clinical indices were recorded at annual intervals from six years before until two years after diagnosis. Data were also analysed to examine the impact of early and late acquisition of CFRD.
  
  
  RESULTS
  No important differences in weight, height, body mass index (BMI), lung function or intravenous treatment were found between groups in the six years prior to diagnosis, nor any significant deviation over time. In those who developed diabetes, use of overnight enteral tube feeding (ETF) was four times as likely at the time of diagnosis, compared to controls [ETF 43.8% (CFRD) v 18.8% (CF Controls), OR 4.0, CI 1.3 to 16.4, p=0.01]. Age at onset of CFRD played a significant role in determining the pre-diabetic clinical course. Younger diabetics with continued growth at study onset (n=17) had a lower BMI from 2 years prior to diagnosis compared to controls [BMI 18.9 kg/m(2) (CFRD) v 20.8 kg/m(2) (CF Controls), diff=1.9, CI -0.1 to 3.7 p=0.04]. The BMI of older diabetics (completed growth at study onset) was equal to that of controls throughout.
  
  
  CONCLUSIONS
  Pre-diabetic nutritional decline is not inevitable in adults with CFRD, but is influenced by age of onset. In the group overall, those with CFRD are more likely to require ETF from 2 years prior to diagnosis. Despite intensive nutritional intervention, patients who continue to grow throughout the pre-diabetic years, show a level of nutritional decline absent in older adults.
authors.affiliation: Adult Cystic Fibrosis Unit, St James' Hospital, Leeds, UK; Leeds Metropolitan University, Leeds, UK. H.White@leedsmet.ac.uk
authors.forename: H
authors.initials: H
authors.lastname: White
authors.forename: K
authors.initials: K
authors.lastname: Pollard
authors.forename: C
authors.initials: C
authors.lastname: Etherington
authors.forename: I
authors.initials: I
authors.lastname: Clifton
authors.forename: A M
authors.initials: AM
authors.lastname: Morton
authors.forename: D
authors.initials: D
authors.lastname: Owen
authors.forename: S P
authors.initials: SP
authors.lastname: Conway
authors.forename: D G
authors.initials: DG
authors.lastname: Peckham
mesh_terms: D000328:Adult; D000367:Age Factors; D015992:Body Mass Index; D016022:Case-Control Studies; D003550:Cystic Fibrosis / Q000150:complications*; D003920:Diabetes Mellitus / Q000178:diet therapy* / Q000209:etiology; D019587:Dietary Supplements; D018450:Disease Progression; D004750:Enteral Nutrition; D005260:Female; D006801:Humans; D008297:Male; D009748:Nutrition Disorders / Q000209:etiology / Q000517:prevention & control*; D009752:Nutritional Status; D011236:Prediabetic State / Q000178:diet therapy* / Q000209:etiology; D055815:Young Adult