Improvements in body mass index of children with cystic fibrosis following implementation of a standardized nutritional algorithm: A quality improvement project

Abstract

Background: A collaboration between the University of Michigan (UM) Cystic Fibrosis Center (CFC) and Marmara University (MU) CFC was initiated in MU through conducting Quality Improvement projects (QIP). The global aim was to improve nutritional status of children with CF (cwCF), with a specific aim to increase the mean BMI percentile (BMIp) for cwCF by 10 percentile points in 12 months.Methods: Body mass index (BMI) percentiles of cwCF were categorized as: nutritionally adequate (BMIp ≥ 50%); at risk (BMIp 25%-49%); urgently at risk (BMIp 10%-25%); critically at risk (BMIp < 10%). Appropriate interventions were made according to BMIp category every three months. Forced expiratory volume in one-second percent predicted (FEV1pp), and health-related quality of life (HRQoL) were evaluated.Results: One hundred and eight-two cwCF with a mean age of 9.1 ± 4.3 years were included in the project. Baseline BMIp increased from 25.6 to 37.2 at the 12th month (p < 0.001). In the critically at-risk group BMIp increased from 3.6 to 20.5 (p < 0.001), in the urgently at risk group from 15.9 to 30.8 (p < 0.001), in the at risk group from 37.0 to 44.2 (p < 0.079) and in the nutritionally adequate group the increase was from 66.8 to 69.5 (p < 0.301). FEV1pp also improved significantly, from 81.3 ± 20.6 to 85.9 ± 20.8 (p < 0.001). Physical functioning, eating problems, and respiratory symptoms domains of the HRQoL evaluation improved (p < 0.05). Conclusion:This project has led to significant improvements in BMIp, FEV1pp and HRQoL of cwCF; similar projects could easily be implemented by centers in other developing countries.

Evaluation of the Use of Appetite Stimulants in Pediatric Patients with Cystic Fibrosis

“…Conversely, optimized nutritional status in childhood has been associated with improved pulmonary function and fewer CF-associated complications (4). Appetite stimulant therapy has been shown to help augment growth potentially delaying the need for more invasive measures such as long-term enteral feeds or parenteral nutrition (5,6). The Cystic Fibrosis Foundation, European Society for Clinical Nutrition and Metabolism-European Society for Paediatric Gastroenterology Hepatology and Nutrition-European Cystic Fibrosis Society, and the Australia and New Zealand CF nutrition guidelines do not make recommendations for routine use of appetite stimulants citing insufficient evidence (7)(8)(9).…”