title: Effects of nutritional status and dietetic interventions on survival in Cystic Fibrosis patients before and after lung transplantation.
abstract: BACKGROUND
  This study retrospectively investigated nutritional status, dietetic intervention and intake in Cystic Fibrosis (CF) patients before and after lung transplantation (LTX).
  
  
  METHODS
  Body Mass Index (BMI), Fat Free Mass Index (FFMI) and nutritional intake were retrieved from 75 out-patients aged 15-53 years. Patients were seen every 3-4 months during the waiting list time (range 0-81 months) and up to 116 months after LTX. Survival was measured in months.
  
  
  RESULTS
  The median BMI at baseline was 19.2 kg/m(2) (range: 15.3 to 28.4 kg/m(2)) with 29 patients (39%) below ≤18.5 kg/m(2). FFMI (measured in 65 patients) had a median of 15.2 kg/m(2) (range: 11.1 to 22.4 kg/m(2)) with 39 patients (60%) ≤16.7 kg/m(2) (men) or ≤14.6 kg/m(2) (women). Median energy intake was 2800 kcal, 239 kcal higher than the estimated energy requirement. However, 8 patients consumed ≥500 kcal less than recommended. Protein intake was 104 (range 60-187) g or 1.9 g/kg per day. Despite dietetic intervention with oral nutritional supplements (ONS) (36 patients), tube feeding (12 patients), or both (13 patients), BMI and FFMI hardly improved pre-LTX. LTX was performed in 51 patients (68%); 10 patients died during follow-up, median survival time was 41 months. A BMI ≤18.5 kg/m(2) was more prevalent in patients who died before LTX (6/9) or who died after LTX (4/10) than in patients who were still alive on the waiting list (5/15) or who survived LTX (14/41). Results for FFMI were comparable. From 6-12 months post-LTX, BMI and FFMI markedly improved, especially in underweight patients.
  
  
  CONCLUSIONS
  A BMI ≤18.5 kg/m(2) and an FFMI ≤16.7 kg/m(2) (men) or ≤14.6 kg/m(2) (women) appears to impair survival in LTX candidates with CF. Patients maintained a low body weight before LTX. After LTX weight gain is achieved.
authors.affiliation: Internal Medicine and Dermatology, Department of Dietetics, University Medical Center Utrecht, The Netherlands; Cystic Fibrosis and Lung Transplantation Center, University Medical Center Utrecht, The Netherlands. Electronic address: F.Hollander@umcutrecht.nl.
authors.forename: F M
authors.initials: FM
authors.lastname: Hollander
authors.affiliation: Division of Human Nutrition, Wageningen University, The Netherlands.
authors.forename: D D
authors.initials: DD
authors.lastname: van Pierre
authors.affiliation: Division of Human Nutrition, Wageningen University, The Netherlands.
authors.forename: N M
authors.initials: NM
authors.lastname: de Roos
authors.affiliation: Cystic Fibrosis and Lung Transplantation Center, University Medical Center Utrecht, The Netherlands.
authors.forename: E A
authors.initials: EA
authors.lastname: van de Graaf
authors.affiliation: Julius Centre for Health Sciences and Primary Care, Department of Public Health, University Medical Center Utrecht, The Netherlands.
authors.forename: J A
authors.initials: JA
authors.lastname: Iestra
mesh_terms: D000293:Adolescent; D000328:Adult; D001824:Body Constitution; D003550:Cystic Fibrosis / Q000150:complications / Q000175:diagnosis / Q000401:mortality / Q000503:physiopathology / Q000601:surgery; D019587:Dietary Supplements; D002149:Energy Intake; D005260:Female; D005541:Forced Expiratory Volume; D006801:Humans; D016040:Lung Transplantation / Q000379:methods*; D008297:Male; D044342:Malnutrition / Q000175:diagnosis / Q000178:diet therapy / Q000209:etiology / Q000503:physiopathology; D008875:Middle Aged; D009426:Netherlands / Q000453:epidemiology; D044623:Nutrition Therapy / Q000379:methods / Q000706:statistics & numerical data; D009751:Nutritional Requirements; D009752:Nutritional Status; D010045:Outpatients; D059035:Perioperative Period; D012189:Retrospective Studies; D016019:Survival Analysis; D016896:Treatment Outcome; D014850:Waiting Lists
keywords: Body Mass Index; Cystic Fibrosis; Fat Free Mass; Lung transplantation; Nutritional intervention; Nutritional status