Improving nutritional status in a pediatric cystic fibrosis center.
BACKGROUND
The nutritional status of patients with cystic fibrosis (CF) is strongly associated with pulmonary function, respiratory status and survival. Malnutrition could result from a discrepancy between energy needs and food intake while malabsorption results from pancreatic insufficiency which occurs in 85% of people with CF.


METHODS
A quality improvement (QI) project was designed to improve the nutritional status of patients with CF with low Body Mass Index (BMI) between 3 and 19 years of age. An algorithm was developed which included clinic-based assessments of patients' nutritional status and periodic assessment by a dietitian, social worker and/or psychologist during the project. Gastrostomy tube placement and feeding was offered as a last resort to improve caloric intake.


RESULTS
173 patients seen during January-June, 2010, were included in this project. They were classified into four BMI groups and data were collected quarterly through June, 2012. The project target population (BMI percentile ≤ 24) had a median BMI percentile at the start of the project of 11.8. At the end of the project median BMI percentile was 22 (46% improvement).


CONCLUSIONS
Improving nutrition and BMI for patients with CF is achievable. There must be a motivated, multi-disciplinary team that includes patients and families. A patient-specific combination of interventions must be used. These interventions could be quite basic for patients with BMI percentile ≥ 25, yet more elaborate for patients with BMI percentile <25. Clinic-based algorithms such as ours can successfully improve the BMI percentile in patients with CF.
Department of Pediatrics, Division of Pediatric Pulmonology University of Michigan Hospital and Health System, Ann Arbor, Michigan.
Ixsy
I
Ramírez
Department of Pediatrics, Division of Pediatric Pulmonology University of Michigan Hospital and Health System, Ann Arbor, Michigan.
Amy
A
Filbrun
Wayne State University Medical School, Detroit, Michigan.
Aws
A
Hasan
Department of Biostatistics, University of Michigan, Michigan.
Kelley M
KM
Kidwell
Department of Pediatrics, Division of Pediatric Pulmonology University of Michigan Hospital and Health System, Ann Arbor, Michigan.
Samya Z
SZ
Nasr
D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D003550:Cystic Fibrosis / Q000150:complications* / Q000503:physiopathology; D002149:Energy Intake; D005260:Female; D006801:Humans; D008297:Male; D044342:Malnutrition / Q000150:complications* / Q000503:physiopathology / Q000628:therapy; D009752:Nutritional Status; D055815:Young Adult
body mass index (BMI); cystic Fibrosis; nutrition; pediatric; quality improvement; team approach