Nutritional status, nutrient intake and use of enzyme supplements in paediatric patients with Cystic Fibrosis; a European multicentre study with reference to current guidelines.
BACKGROUND
The New European guidelines have established the most updated recommendations on nutrition and pancreatic enzyme replacement therapy (PERT) in CF. In the context of MyCyFAPP project - a European study in children with CF aimed at developing specific tools for improvement of self-management - the objective of the current study was to assess nutritional status, daily energy and macronutrient intake, and PERT dosing with reference to these new guidelines.


METHODS
Cross sectional study in paediatric patients with CF from 6 European centres. SD-scores for weight-for-age (WFA), height-for-age (HFA) and body mass index-for-age (BMI) were obtained. Through a specific 4-day food and enzyme-dose record, energy and macronutrients intake and PERT-use (LU/g lipids) were automatically calculated by the MyCyFAPP system. Comparisons were made using linear regression models.


RESULTS
The lowest quartiles for BMI and HFA were between 0 and -1SD in all the centres with no significant differences, and 33.5% of the patients had a SD-score <0 for all three parameters. The minimum energy intake recommendation was not reached by 40% of the children and mean nutrients intake values were 14%, 51% and 34% of the total energy for protein, carbohydrates and lipids respectively. When assessed per centre, reported PERT doses were in the recommended range in only 13.8% to 46.6% of the patients; from 5.6% up to 82.7% of children were above the recommended doses and 3.3% to 75% were below.


CONCLUSIONS
Among the 6 centres, a large variability and inconsistency with new guidelines on nutrition and PERT-use was found. Our findings document the lack of a general criterion to adjust PERT and suggest the potential benefit of educational and self-managerial tools to ensure adherence to therapies, both for clinical staff and families. They will be taken into account when developing these new tools during the next stages of MyCyFAPP Project.
Instituto de Investigación Sanitaria La Fe, Avenida Fernando Abril Martorell, 106, Torre A, planta 0, 46026 Valencia, Spain.
Joaquim
J
Calvo-Lerma
Erasmus Medical Center, Sophia Children's Hospital, Rotterdam, the Netherlands.
Jessie M
JM
Hulst
Associação para a Investigação e Desenvolvimento da Faculdade de Medicina, Avenida Professor Egas Moniz, 1649-028 Lisboa, Portugal.
Inês
I
Asseiceira
Pediatric Pulmonology and Cystic Fibrosis Unit, Department of Pediatrics, University Hospitals Leuven, Belgium.
Ine
I
Claes
Hospital Universitario Ramón y Cajal, Carretera Colmenar Viejo km 9, 100, 28034 Madrid, Spain.
Maria
M
Garriga
CF Center, Università degli Studi di Milano, Fondazione IRCCS Ca' Granda, Ospedale Maggiore Policlinico, Via Commenda 9, 20122 Milan, Italy.
Carla
C
Colombo
Instituto de Investigación Sanitaria La Fe, Avenida Fernando Abril Martorell, 106, Torre A, planta 0, 46026 Valencia, Spain.
Victoria
V
Fornés
Erasmus Medical Center, Sophia Children's Hospital, Rotterdam, the Netherlands.
Sandra
S
Woodcock
Associação para a Investigação e Desenvolvimento da Faculdade de Medicina, Avenida Professor Egas Moniz, 1649-028 Lisboa, Portugal.
Tiago
T
Martins
Pediatric Pulmonology and Cystic Fibrosis Unit, Department of Pediatrics, University Hospitals Leuven, Belgium.
Mieke
M
Boon
Hospital Universitario Ramón y Cajal, Carretera Colmenar Viejo km 9, 100, 28034 Madrid, Spain.
Mar
M
Ruperto
Erasmus Medical Center, Sophia Children's Hospital, Rotterdam, the Netherlands.
Sylvia
S
Walet
CF Center, Università degli Studi di Milano, Fondazione IRCCS Ca' Granda, Ospedale Maggiore Policlinico, Via Commenda 9, 20122 Milan, Italy.
Chiara
C
Speziali
Pediatric Pulmonology and Cystic Fibrosis Unit, Department of Pediatrics, University Hospitals Leuven, Belgium.
Peter
P
Witters
Instituto de Investigación Sanitaria La Fe, Avenida Fernando Abril Martorell, 106, Torre A, planta 0, 46026 Valencia, Spain.
Etna
E
Masip
Associação para a Investigação e Desenvolvimento da Faculdade de Medicina, Avenida Professor Egas Moniz, 1649-028 Lisboa, Portugal.
Celeste
C
Barreto
Pediatric Pulmonology and Cystic Fibrosis Unit, Department of Pediatrics, University Hospitals Leuven, Belgium.
Kris
K
de Boeck
Instituto de Investigación Sanitaria La Fe, Avenida Fernando Abril Martorell, 106, Torre A, planta 0, 46026 Valencia, Spain.
Carmen
C
Ribes-Koninckx
D015992:Body Mass Index; D002648:Child; D003430:Cross-Sectional Studies; D003550:Cystic Fibrosis / Q000175:diagnosis / Q000201:enzymology / Q000628:therapy; D019587:Dietary Supplements; D002149:Energy Intake; D056947:Enzyme Replacement Therapy / Q000379:methods*; D005060:Europe / Q000453:epidemiology; D005260:Female; D006801:Humans; D008297:Male; D020380:Needs Assessment; D009751:Nutritional Requirements; D009752:Nutritional Status; D010186:Pancreatic Function Tests; D064167:Recommended Dietary Allowances; D000073278:Self-Management / Q000379:methods / Q000706:statistics & numerical data
Cystic fibrosis; Guidelines; Nutritional requirements macronutrients; Nutritional status; PERT; Paediatrics; Pancreatic insufficiency; Self-management; Telemedicine