Impact of Intravenous Antibiotic Therapy on Total Daily Energy Expenditure and Physical Activity in Cystic Fibrosis Children with Pseudomonas aeruginosa Pulmonary Exacerbation

Abstract

Resting energy expenditure (REE) increases during pulmonary exacerbation by Pseudomonas aeruginosa in cystic fibrosis (CF) patients, and decreases after i.v. anti-Pseudomonas aeruginosa antibiotic therapy (IVAT). However, the impact of IVAT on total energy expenditure (TEE) is unknown. The aim of this study was to assess the changes in TEE and its main components after IVAT administered at home. Body composition measured by skinfold thickness and bio-impedance analysis, energy intake (EI) assessed by a weekly diary, REE measured by indirect calorimetry (IC), TEE assessed by a technique using 24-h heartrate monitoring method and physical activity (PA) monitored using an activity diary (AD) were assessed in 16 patients (9 boys and 7 girls) aged 12.1 Ϯ 2.3 y (range, 7.1-14.6 y), before and after 28 Ϯ 4 d including a 14-d IVAT course. After IVAT, weight increased significantly by 1.9% (32.1 Ϯ 7.5 versus 32.7 Ϯ 7.6 kg; p Ͻ 0.05), while fat mass and fat free mass increased non significantly. EI increased by 4.6% (10,797 Ϯ 3,039 versus 11,320 Ϯ 3,074 kJ/d; p Ͻ 0.05). TEE was not affected by IVAT (7,014 Ϯ 1,929 versus 7,081 Ϯ 1,478 kJ/d) whereas REE decreased by 4.1% (5,295 Ϯ 909 versus 5,093 Ϯ 837 kJ/d; p Ͻ 0.05), resulting in 9.3% increase in PA assessed by AD converted to metabolic equivalent tasks (MET) (37.0 Ϯ 3.1 versus 40.7 Ϯ 4.5 MET; p Ͻ 0.05). The improvement in nutritional status after IVAT is not related to a decrease in TEE, but probably to an increase in EI and a decrease of REE after IVAT. After IVAT, the reduction in REE is probably compensated by an increase in PA in CF patients. Prognosis and pulmonary function are highly correlated with nutritional status in patients with cystic fibrosis (CF) (1). Many factors, alone or combined, contribute to malnutrition in CF: 1) reduced energy intake according to recommended dietary allowances (2) increased energy loss (3) increased resting energy expenditure (REE) with or without changes in total energy expenditure (TEE) (4 -8). Nutritional status correlates with the severity of the disease (9), and is one of the central considerations in CF management (3). In 50% of CF patients, chronic pulmonary infection by Pseudomonas aeruginosa is present and may also play a role in malnutrition (10 -12

Influence of Esophageal pH Recording on Physical Activity in Children

“…Third, although the electrodes and pH-meter were small, the need to carry the relatively voluminous, heavy material (260 g) could have affected the children's physical activity, especially in running, jumping, and other complex activities. Triaxial accelerometry has been used in several pediatric populations (14)(15)(16)(17)(18); however, to our knowledge, no study has assessed physical activity objectively in children during 24-hour pH-metry. One pediatric study published in 1995 evaluated the impact of ambulatory pH-metry on the family's daily living pattern (4).…”

“…Triaxial accelerometry has been used in several pediatric populations (14)(15)(16)(17)(18); however, to our knowledge, no study has assessed physical activity objectively in children during 24-hour pH-metry. One pediatric study published in 1995 evaluated the impact of ambulatory pH-metry on the family's daily living pattern (4).…”

“…Accelerometry is a valid, reproducible, and noninvasive diagnostic tool for children. Accelerometry facilitates the objective and prolonged assessment of physical activity (9–17) by recording the time spent at each level of activity. Day‐to‐day variability in the physical activity level occurs in children and could be a confounding factor in our study.…”

Physical activity as a determinant of total energy expenditure in critically ill children

“…A good prognosis is most likely associated with nutritional status as shown in children with cystic fibrosis. 30 We found a large inter-individual variation between resting EE and total EE. To explain these differences and to possibly tailor nutritional support of individual patients, it is of paramount importance to know whether this difference can be attributed to the energy cost of physical activity over time.…”

Antibiotic therapy and fat digestion and absorption in cystic fibrosis.

“…Bronchopulmonary disease is the major clinical manifestation which frequently demands antibiotic therapy. Available data suggests that such treatment applied in CF patients improves not only respiratory function but also nutritional status, which has been related to increased energy intake and decreased energy expenditure (Vic et al, 1997;Castro et al, 2002;Hankard et al, 2002;Béghin et al, 2003). Interestingly, antibiotic therapy in the CF mouse model resulted in the reduction of bacterial load of the small intestine, decreased intensity of intestinal inflammation and significant body mass gain.…”