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Hidden fat-free mass depletion in children with cystic fibrosis: a re-evaluation of the currently used classification of nutritional failure

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Hidden fat-free mass depletion in children with cystic fibrosis: a re-evaluation of the currently used classification of nutritional failure

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Background: Malnutrition commonly occurs in children with cystic fibrosis (CF) and has a negative effect on lung function and survival. Body mass index percentile (BMIp) is the method that is currently recommended to determine the nutritional status of children with CF. However, it is unknown if BMIp adequately reflects changes in body composition in these patients. Objective: The purpose of this study was to determine if fat-free mass (FFM) measured by dual-energy x-ray absorptiometry (DEXA) is a better method for screening malnutrition in children with CF than BMIp, and to determine if FFM depletion is associated with impaired clinical status and increased morbidity in CF patients. Method: This was a cross-sectional study of 75 pediatric patients with CF (mean age 14.8 ± 3.0). FFM, fat mass (FM), bone mineral content (BMC) and bone mineral density (BMD) were determined using DEXA. Nutritional failure was defined as BMIp <10 and as FFM index (FFMI) <5th percentile, according to commonly used standards. Statistical analyses were done using ANOVA and t-tests. Results: Twenty nine percent of the study population was characterized by nutritional failure as defined by the FFMI and/or BMIp criteria. Eleven percent had a low BMIp and a low FFMI, 15% had a low FFMI but a normal BMIp (hidden depletion). Only 42% of the FFM depleted patients were recognized by BMIp as depleted. FFMI was correlated with lung function (measured as forced expiratory volume in 1 second (FEV1 %)) in boys (r: 0.43, p=<0.01), but had a tendency towards correlation in girls (r: 0.30, p=0.057). A stratification of the study population in BMIp groups of 10 percentiles, showed a gradual reduction in FFMI and FEV1 (%) <50th BMIp. Below the 20th BMIp FFMI and FEV1 (%) dropped significantly (p=<0.05) and the prevalence of FFM depletion increased sharply (from 18% at the 30th percentile to 50% at the 20th percentile). The 20th BMIp was also associated with FEV1 % values <80% predicted and a reduction in BMD. Conclusion: FFM depletion was unrecognized in 58% of the patients if only BMIp were used. DEXA is the preferred method for screening for malnutrition in children with CF. BMIp <20 should be considered as the threshold for nutritional failure in children with CF, and can be used if DEXA is not available

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OrganisatieHogeschool van Amsterdam
InstituutBewegen, Sport en Voeding
Gepubliceerd in
Jaar2011
TypeBachelorscriptie
TaalEngels

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