Triage for Malnutrition Risk among Pediatric and Adolescent Outpatients with Cystic Fibrosis, Using a Disease-Specific Tool

Abstract

Malnutrition prevails in considerable proportions of children with Cystic Fibrosis (CF), and is often associated with adverse outcomes. For this, routine screening for malnutrition is pivotal. In the present cross-sectional study, we aimed to assess the risk for malnutrition in pediatric outpatients with CF. A total of 76 outpatients (44 girls, 11.9 ± 3.9 years old, 39.5% adolescents) were recruited and anthropometric, clinical, dietary and respiratory measures were collected. All outpatients were screened for malnutrition risk with a validated disease-specific instrument. Most children exhibited a low risk for malnutrition (78.9%), whereas none of the participants were characterized as having a high malnutrition risk. In the total sample, malnutrition risk was positively associated with age (r = 0.369, p = 0.001), and inversely related to the body mass index (r = −0.684, p < 0.001), height z-score (r = −0.264, p = 0.021), and forced expiratory volume (FEV1%, r = −0.616, p < 0.001). Those classified as having a low malnutrition risk were younger (p = 0.004), heavier (p < 0.001) and taller (p = 0.009) than their counterparts with a moderate risk. On the other hand, patients in the moderate risk group were more likely pubertal (p = 0.034), with a reduced mid-upper arm fat area (p = 0.011), and worse pulmonary function (p < 0.001). Interestingly, none of the children attaining ideal body weight were classified as having a moderate malnutrition. risk, whereas 37.5% of the patients allocated at the moderate risk group exhibited physiological lung function. In this cohort of outpatients with CF that were predominantly well-nourished and attained physiological lung function, malnutrition risk was identified only in small proportions of the sample. Our data support that patients that are older, pubertal, or have diminished fat mass are at greater risk for malnutrition.

Disease-Related Malnutrition in Pediatric Patients with Chronic Disease: A Developing Country Perspective

“…A study by Poulimeneas et al. [ 58 ] also highlighted the importance of malnutrition screening tools specific for each underlying disease, which considers the pathophysiology of the disease and other disease-related factors contributing to the development of malnutrition.…”

Standards of Nutritional Care for Patients with Cystic Fibrosis: A Methodological Primer and AGREE II Analysis of Guidelines

“…As Hollander noted [ 54 ], with nutrient needs changing dramatically during the disease progress, nutritional care should be personalized and provided by a specialized CF dietitian. Moreover, research has shown that pediatric patients with CF, in particular, are prone to malnutrition [ 55 ], often under-consuming several nutrients [ 56 ].…”

Current and Future Therapeutic Approaches of Exocrine Pancreatic Insufficiency in Children with Cystic Fibrosis in the Era of Personalized Medicine

“…Increasing caloric and supplements intake, optimizing PERT and pulmonary management, in order to obtain an adequate nutritional status, still remain an important goal of treatment [ 76 ]. Very few studies have examined the risk factors for malnutrition among pediatric population with CF, and most of them refers to BMI status and impairment pulmonary function [ 77 ].…”