Background: Nutritional status is an important prognostic factor in patients with cystic fibrosis (CF) prior to lung transplantation. Objective: To investigate the impact of nutritional status on pulmonary function in CF transplant recipients. Methods: Adult double lung transplanted CF patients were consecutively included. The predictive value of nutritional status on lung function -measured by spirometry -was longitudinally assessed by body composition serially evaluated by a threecompartment model bioelectrical impedance analysis (BIA) in comparison to body mass index (BMI). Results: Overall, 147 spirometries and 147 BIAs were performed in 58 patients (59% female, median age: 30.1 years, median BMI: 19.6 kg/m 2 ). Malnourished patients (BMI < 18.5 kg/m 2 ; 27.6%) had a significantly reduced lung function compared to normal/overweight patients (forced expiratory volume in 1 second in percent (FEV1%pred), 57% vs 77%; p ¼ 0.024). BMI, as well as the BIA parameters phase angle, total body water, fat free mass, body cell mass (BCM) and extracellular mass (ECM)/ BCM ratio, were univariate predictors of FEV1%pred. When included in a linear mixed model, ECM/BCM ratio remained the only significant predictor of lung function (p ¼ 0.012). Conclusion: Nutritional status assessed by BIA predicted lung function in CF transplant recipients. Serial BIA measurements to monitor patients' nutritional status might help to improve or maintain lung function.
KeywordsCystic fibrosis, lung transplantation, bioelectrical impedance analysis, body mass index, pulmonary function Received: 26 January 2018; accepted: 25 April 2018 Key summary . Nutritional status is a key prognostic factor of lung function and survival in patients with cystic fibrosis (CF) prior to lung transplantation, but data are limited on its impact on lung function after transplantation. . This study used serial measurements of body composition by a three-compartment model bioelectrical impedance analysis (BIA) in comparison to body mass index in order to analyse its impact on pulmonary function in adult CF transplant recipients.
This is a consensus of the Austrian working group of IBD (inflammatory bowel diseases) of the ÖGGH on nutrition in IBD. Malnutrition should be assessed in case of IBD (in 20 - 70 % of Crohn's patients) and weight loss(> 5 % within 3 months) or nutritional deficiencies or after extensive bowel resection and afterwards also treated. Malnutrition should be treated with medical therapy of IBD and also adequate - as far as possible - with oral nutritional therapy particularly because of reduced life quality, risk of opportunistic infections, osteopenia/osteoporosis, longer hospitalisations and higher mortality. Iron homeostasis, serum levels of Vitamin B12- and folic acid, 25-hydroxyvitamin D and zinc should be checked. Therapy with enteral liquid diets is only indicated as therapy of first choice in children and adolescents, but only in rare situations in adults with IBD. There is - up to now - no proven oral diet for maintenance of remission in IBD. Probiotics as E. coli Nissle could be used as alternative to mesalazine for maintenance of remission in patients with ulcerative colitis. A specific dietary counselling is mandatory in patients with ileostoma or short bowel syndrome. Malnutrition of short bowel patients is particularly dependent on the function and length of the remaining bowel, therefore the most effective medical therapy should be administered.
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