Evaluation of body mass index percentiles for assessment of malnutrition in children with cystic fibrosis

Abstract

Objective: To compare the performance of recently released body mass index percentiles (BMIp) with standard anthropometric indexes, including height-for-age percentile (HAP), weight-for-age percentile (WAP) and percent ideal body weight (%IBW), as measures for nutritional failure in children with cystic fibrosis (CF). Design: Cross-sectional analysis of growth and lung function data from 4577 children with CF reported to the German CF quality assurance (CFQA) project from 1995 to 2004. Results: Frequency distribution of HAP (mean7s.d.: male 30.0727.5; female 31.3727.4) and WAP (male 28.9727.0; female 29.6726.7) were skewed, with significant numbers of patients below the fifth percentiles of a healthy reference population. However, because deficits occurred in both measures simultaneously, mean %IBW (male 97.0712.1; female 98.1712.3) assumed subjects weight close to the nominal weight-for-height at all ages. In contrast, mean BMIp was markedly reduced (male 35.7727.9; female 35.6727.2) and steadily declined with age. Ideal weight-for-age was significantly lower when predicted by %IBW compared with BMIp method, particularly in subjects with shorter-than-average stature. Consequently, less CF children were identified with nutritional failure according to %IBW method (male 20.5%; female 22.7%) compared with BMIp method (male 30.4%; female 28.7%). The clinical relevance of these findings was confirmed by stronger correlation of BMIp with impaired %forced expiratory volume/s, a marker for disease progression in CF. Conclusion: BMIp predicts nutritional failure more sensitively and accurately than conventional anthropometric indexes, at least in children with CF. Screening of CF patients by BMIp could provide an early warning sign and allow for timely therapeutic intervention.

From registry to quality management: the German Cystic Fibrosis Quality Assessment project 1995–2006

“…This compares well with data from France and the USA [6,7]. The current analysis of individual factors and early predictors of mortality showed that BMI and FEV1 were predictive [10,16,27,28]. These statistics are valuable in defining alarm signals for early aggressive treatment and also for establishing definition referral criteria for lung transplant [27].…”

“…On the grounds of consistency and long-term follow-up, WH was taken to indicate malnutrition in children and adolescents. However, it must be noted that BMI is a more precise parameter even for younger children [15,16,19]. In the future, BMI based on percentiles for children and adolescents will be applied in the German CFQA project [13,16,18,19].…”

“…The German CFQA project also serves as the backbone in supporting quality assurance groups and a benchmark project. Specific evaluations, such as the development of CF-specific percentiles for key parameters for nutrition and respiratory function, are underway [15,16]. AFFILIATIONS *University of Tübingen, University Children's Hospital, Tübingen, Since 1995, standardised clinical records for each patient are completed on an annual basis.…”

Evolución nutricional y función pulmonar en niños y adolescentes chilenos con fibrosis quística

“…Dada su relevancia, en 2005 la CFF encargó a un grupo de expertos analizar los criterios diagnósticos y objetivos nutricionales, a la luz de la evidencia científi ca disponible 11 . Este comité recomendó utilizar el IMC, por su mayor sensibilidad para detectar desnutrición y asociación más estrecha a la función pulmonar que el IPT 20 . Este último sobre-estima sobrepeso y sub-diagnostica défi cit en niños con talla baja, hecho frecuente en estos pacientes y evidenciado en nuestro análisis 21,22 .…”

Manejo Nutricional en Niños y Adolescentes con Fibrosis Quística

“…Los índices de proporcionalidad del peso para la talla son el índice Peso/Talla (P/T= [peso actual/peso ideal] x 100) para niños de hasta 6 años y el índice de masa corporal (IMC= [peso/ talla 2 ]) en los mayores. La evidencia indica que el IMC es un marcador sensible y de mayor correlación con la evolución de la función pulmonar en los niños con FQ mayores de 2 años 4,14 .…”