title: Stunting is an independent predictor of mortality in patients with cystic fibrosis.
abstract: OBJECTIVE
  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 (FEV1), 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%1.10-4.46]), wasting (OR 5.27 [IC 95% 2.66-10.41]), and FEV1 < 40% of predicted (OR 10.60 [IC 95% 5.43-20.67]) 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.
authors.affiliation: Clinical and Biomolecular Hepato-Gastroenterology of Pediatric and Adult Age, University Hospital G. Martino, Messina, Italy.
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Vieni
authors.forename: Simona
authors.initials: S
authors.lastname: Faraci
authors.forename: Mirella
authors.initials: M
authors.lastname: Collura
authors.forename: Mariangela
authors.initials: M
authors.lastname: Lombardo
authors.forename: Gabriella
authors.initials: G
authors.lastname: Traverso
authors.forename: Simona
authors.initials: S
authors.lastname: Cristadoro
authors.forename: Lisa
authors.initials: L
authors.lastname: Termini
authors.forename: Maria Cristina
authors.initials: MC
authors.lastname: Lucanto
authors.forename: Maria Lucia
authors.initials: ML
authors.lastname: Furnari
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Trimarchi
authors.forename: Maria Rita
authors.initials: MR
authors.lastname: Triglia
authors.forename: Stefano
authors.initials: S
authors.lastname: Costa
authors.forename: Salvatore
authors.initials: S
authors.lastname: Pellegrino
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Magazzù
mesh_terms: D000293:Adolescent; D000328:Adult; D019540:Area Under Curve; D001827:Body Height; D015992:Body Mass Index; D016956:Burkholderia cepacia; D016022:Case-Control Studies; D002648:Child; D002675:Child, Preschool; D003550:Cystic Fibrosis / Q000401:mortality* / Q000503:physiopathology; D005260:Female; D005541:Forced Expiratory Volume; D006801:Humans; D016015:Logistic Models; D008297:Male; D015999:Multivariate Analysis; D009752:Nutritional Status; D011550:Pseudomonas aeruginosa; D012189:Retrospective Studies; D012307:Risk Factors; D015996:Survival Rate