Dietary Macronutrient Distribution and Nutrition Outcomes in Persons with Cystic Fibrosis: An Evidence Analysis Center Systematic Review

McDonald, Catherine M.; Bowser, Ellen K.; Farnham, Kristen; Alvarez, Jessica A.; Padula, Laura; Rozga, Mary

doi:10.1016/j.jand.2020.03.016

Cited by 21 publications

(20 citation statements)

References 29 publications

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“…There was no difference in FI based on history of chronic disease. We had postulated that the presence of chronic or complex illness history in a child may present additional financial stressors, as this has been reported in other settings, 22 – 24 but we did not see an association when stratifying by PMCA. This means there was no difference in FI in our sample between children with no past medical history, those with some type of chronic disease, or those with complex chronic disease.…”

Section: Discussionsupporting

confidence: 46%

Food Insecurity in a Pediatric Emergency Department and the Feasibility of Universal Screening

Gonzalez¹,

Hartford

Moore

et al. 2021

WestJEM

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Introduction: Children with food insecurity (FI) experience adverse health outcomes due to inadequate quantity or quality of food. Food insecurity may be high among families seeking emergency care. The Hunger Vital Sign (HVS) is a two-question validated tool used to screen families for FI. Our goal in this study was to assess prevalence of FI among emergency department (ED) patients, patient-level risk factors for FI, and the feasibility of screening. Methods: This was a cross-sectional analysis of FI in the ED. Parents or guardians of ED patients and adult patients (18 years or older) were approached for screening using the HVS during screening periods spanning weekdays/weekends and days/evenings. All ED patients were eligible, excluding siblings, repeat visits, critically ill patients, minors without a guardian, and families that healthcare staff asked us not to disturb. Families answered the HVS questions verbally or in writing, based on preference. Families with positive screens received information about food resources. We summarized patient and visit characteristics and defined medical complexity using a published algorithm. Multivariable logistic regression was used to assess FI risk factors. Results: In July-August 2019, 527 patients presented during screening periods: 439 agreed to screening, 18 declined, 19 met exclusions, and 51 were missed. On average the screening tool required five minutes (range 3-10 minutes) to complete. Most families (328; 75%) preferred to answer in writing rather than verbally. Overall, 77 participants (17.5%) screened positive for FI. In regression analyses, FI was associated with self-reported race/ethnicity (combined variable) of African American or Black (odds ratio [OR] 5.21, 95% confidence interval [CI], 2.13-12.77), Hispanic (OR 3.47, 95% CI, 1.48-8.15), or mixed/other (OR 3.81, 95% CI, 1.54-9.39), compared to non-Hispanic white. FI was also associated with public insurance type (OR 5.74, 95% CI, 2.52-13.07, reference: private insurance), and each year of increasing patient age (OR 1.05, 95% CI, 1.01-1.09). There were no associations between FI and medical complexity or preferred language. Conclusion: Food insecurity was common among our ED patients. Race and ethnicity, insurance status, and increasing patient age were associated with increased odds of FI. Efforts to include universal FI screening for ED patients with immediate connection to resources will enhance overall care quality and address important health needs.

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Section: Discussionsupporting

confidence: 46%

Food Insecurity in a Pediatric Emergency Department and the Feasibility of Universal Screening

Gonzalez¹,

Hartford

Moore

et al. 2021

WestJEM

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“…Due to increased energy expenditure secondary to pulmonary disease and nutrient malabsorption, a high-fat, high-calorie diet has been the traditional nutritional approach in CF to minimise undernutrition [96]. However, contemporary evidence demonstrates that these energy requirements are now more likely to be met via the consumption of saturated fats and energy-dense but nutrient-poor foods [97][98][99][100][101][102]. High-fat diets have been associated with intestinal inflammation in CF as well as in other disease contexts [103][104][105][106][107].…”

Section: Iatrogenic Factors: High-fat Diet and Antibiotic Usementioning

confidence: 99%

Intestinal Inflammation and Alterations in the Gut Microbiota in Cystic Fibrosis: A Review of the Current Evidence, Pathophysiology and Future Directions

Tam

Dorst

McKay

et al. 2022

JCM

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Cystic fibrosis (CF) is a life-limiting autosomal recessive multisystem disease. While its burden of morbidity and mortality is classically associated with pulmonary disease, CF also profoundly affects the gastrointestinal (GI) tract. Chronic low-grade inflammation and alterations to the gut microbiota are hallmarks of the CF intestine. The etiology of these manifestations is likely multifactorial, resulting from cystic fibrosis transmembrane conductance regulator (CFTR) dysfunction, a high-fat CF diet, and the use of antibiotics. There may also be a bidirectional pathophysiological link between intestinal inflammation and changes to the gut microbiome. Additionally, a growing body of evidence suggests that these GI manifestations may have significant clinical associations with growth and nutrition, quality of life, and respiratory function in CF. As such, the potential utility of GI therapies and long-term GI outcomes are areas of interest in CF. Further research involving microbial modulation and multi-omics techniques may reveal novel insights. This article provides an overview of the current evidence, pathophysiology, and future research and therapeutic considerations pertaining to intestinal inflammation and alterations in the gut microbiota in CF.

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“…The authors recommend reducing energy intake and increasing physical activity as the primary weight-loss interventions, extrapolating from general population evidence. While there is no evidence to support a specific weight-loss approach for people with CF, experts generally support consumption of nutrient-rich foods and avoidance of highly processed food [51] . Given the potential risks of reduced pulmonary function or loss of lean body-mass, overly restrictive diets, like a low-carb diet, carry additional risks in people with CF.…”

Section: Treatment Of Obesity In Cfmentioning

confidence: 99%

Obesity in cystic fibrosis

Kutney

Sandouk

Desimone

et al. 2021

Journal of Clinical & Translational Endocrinology

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The prevalence of obesity in patients with cystic fibrosis (CF) is increasing and around one-third of adults with CF are now overweight or obese. The causes of excess weight gain in CF are likely multifactorial, including: adherence to the high-fat legacy diet, reduced exercise tolerance, therapeutic advances, and general population trends. Increased weight has generally been considered favorable in CF, correlating with improved pulmonary function and survival. While the optimal BMI for overall health in CF is unknown, most studies demonstrate minimal improvement in pulmonary function when BMI exceeds 30 kg/m 2 . Dyslipidemia and cardiovascular disease are important co-morbidities of obesity in the general population, but are uncommon in CF. In people with CF, obesity is associated with hypertension and higher cholesterol levels. With longer life expectancy and rising obesity rates, there may be an increase in cardiovascular disease among people with CF in coming years. Overweight CF patients are more likely to be insulin resistant, taking on features of type 2 diabetes. Treating obesity in people with CF requires carefully weighing the metabolic risks of overnutrition with the impact of low or falling BMI on lung function. This article describes current knowledge on the epidemiology, causes, consequence, and treatment of obesity in people with CF.

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Dietary Macronutrient Distribution and Nutrition Outcomes in Persons with Cystic Fibrosis: An Evidence Analysis Center Systematic Review

Cited by 21 publications

References 29 publications

Food Insecurity in a Pediatric Emergency Department and the Feasibility of Universal Screening

Food Insecurity in a Pediatric Emergency Department and the Feasibility of Universal Screening

Intestinal Inflammation and Alterations in the Gut Microbiota in Cystic Fibrosis: A Review of the Current Evidence, Pathophysiology and Future Directions

Obesity in cystic fibrosis

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