title: Enteral tube feeding in adults with cystic fibrosis; patient choice and impact on long term outcomes.
abstract: BACKGROUND
  Enteral tube feeding (ETF) has been evaluated in paediatric and mixed child and adult populations with cystic fibrosis, demonstrating positive outcomes from 6 months to 2 years post insertion. No studies have examined the longer term nutritional and clinical outcomes in an exclusively adult population with cystic fibrosis or compared the outcomes for those who meet standard criteria and opt to undertake or decline ETF.
  
  
  METHODS
  Twenty three out of 380 patients attending the Leeds Regional Adult CF unit fulfilled the standard criteria for commencing ETF (CF Trust, 2002) between 2004 and 2008. Weight, BMI, FEV1, FVC, CFRD, and number of intravenous antibiotic treatment days were collected at 1 year pre baseline, at baseline, and at 1, 2, and 3 years post baseline for all these patients whether they accepted or declined ETF.
  
  
  RESULTS
  Seventeen of the 23 patients agreed to accept a programme of ETF, two of whom died within the first year of ETF. In the remaining patients (n=15), weight increased by 19.5% from baseline (p<0.001), BMI increased to within the normal range and lung function stabilised. There was no reduction in the requirement for intravenous antibiotic treatment. The six patients who declined ETF had a decline in lung function and no weight gain.
  
  
  CONCLUSIONS
  Supplemental enteral tube feeding improves clinical outcomes when administered over 3 years, resulting in significant weight gain, a normal BMI and stabilisation of lung function. It does not reduce intravenous antibiotic treatment days. In contrast those patients eligible for, but who declined ETF, showed a deterioration in lung function and a failure to gain weight and to achieve normal BMI status.
authors.affiliation: Adult Cystic Fibrosis Unit, Ward J6, Level 6, Gledhow Wing, St. James's Hospital, Beckett Street, Leeds LS9 7TF, UK; Leeds Metropolitan University, Nutrition and Dietetic Group, School of Health and Wellbeing, Faculty of Health, Calverley Building, Room CL1007a, Civic Quarter, Calverley Street, Leeds LS1 3HE, UK. Electronic address: H.White@leedsmet.ac.uk.
authors.forename: H
authors.initials: H
authors.lastname: White
authors.forename: A M
authors.initials: AM
authors.lastname: Morton
authors.forename: S P
authors.initials: SP
authors.lastname: Conway
authors.forename: D G
authors.initials: DG
authors.lastname: Peckham
mesh_terms: D000293:Adolescent; D000328:Adult; D015992:Body Mass Index; D003550:Cystic Fibrosis / Q000503:physiopathology / Q000628:therapy*; D004750:Enteral Nutrition / Q000592:standards; D005260:Female; D005541:Forced Expiratory Volume; D019983:Guideline Adherence; D006801:Humans; D008297:Male; D009752:Nutritional Status; D012189:Retrospective Studies; D016896:Treatment Outcome; D015430:Weight Gain; D055815:Young Adult
keywords: Adult; Cystic fibrosis; Enteral tube feeding; Outcome