Early Life Growth Trajectories in Cystic Fibrosis are Associated with Pulmonary Function at Age 6 Years.
OBJECTIVE
To determine whether severity of lung disease at age 6 years is associated with changes in nutritional status before age 6 within individual children with cystic fibrosis (CF).


METHODS
Children with CF born between 1994 and 2005 and followed in the CF Foundation Patient Registry from age ≤2 through 7 years were assessed according to changes in annualized weight-for-length (WFL) percentiles between ages 0 and 2 years and body mass index (BMI) percentiles between ages 2 and 6 years. The association between growth trajectories before age 6 and forced expiratory volume in 1 second (FEV1)% predicted at age 6-7 years was evaluated using multivariable linear regression.


RESULTS
A total of 6805 subjects met inclusion criteria. Children with annualized WFL-BMI always >50th percentile (N = 1323 [19%]) had the highest adjusted mean (95% CI) FEV1 at 6-7 years (101.8 [100.1, 103.5]). FEV1 at 6-7 years for children whose WFL-BMI increased >10 percentile points by age 6 years was 98.3 (96.6, 100.0). This was statistically significantly higher than FEV1 for children whose WFL-BMI was stable (94.4 [92.6, 96.2]) or decreased >10 percentile points (92.9 [91.1, 94.8]). Among children whose WFL-BMI increased >10 percentile points, achieving and maintaining WFL-BMI >50th percentile at younger ages was associated with significantly higher FEV1 at 6-7 years.


CONCLUSIONS
Within-patient changes in nutritional status in the first 6 years of life are significantly associated with FEV1 at age 6-7 years. The establishment of a clear relationship between early childhood growth measurements and later lung function suggests that early nutritional interventions may impact on eventual lung health.
Department of Pediatrics, University of Wisconsin School of Medicine and Public Health, Madison, WI. Electronic address: dbsanders@pediatrics.wisc.edu.
Don B
DB
Sanders
Cystic Fibrosis Foundation, Bethesda, MD.
Aliza
A
Fink
Department of Biostatistics, University of Washington, Seattle, WA; Department of Pediatrics, University of Washington, Seattle, WA.
Nicole
N
Mayer-Hamblett
Department of Pediatrics, Virginia Commonwealth University, Richmond, VA.
Michael S
MS
Schechter
Department of Pediatrics, Boston Children's Hospital, Boston, MA.
Gregory S
GS
Sawicki
Department of Pediatrics, University of Washington, Seattle, WA.
Margaret
M
Rosenfeld
Departments of Medicine and Pediatrics, Medical University of South Carolina, Charleston, SC.
Patrick A
PA
Flume
Department of Pediatrics, University of Arizona, Tucson, AZ.
Wayne J
WJ
Morgan
D001827:Body Height / Q000502:physiology*; D015992:Body Mass Index; D001835:Body Weight / Q000502:physiology*; D002648:Child; D002675:Child, Preschool; D003550:Cystic Fibrosis / Q000503:physiopathology*; D018450:Disease Progression; D005260:Female; D005500:Follow-Up Studies; D005541:Forced Expiratory Volume / Q000502:physiology*; D006801:Humans; D007223:Infant; D008168:Lung / Q000503:physiopathology*; D008297:Male; D009752:Nutritional Status; D012129:Respiratory Function Tests; D012189:Retrospective Studies; D013997:Time Factors