Effectiveness of enteral nutrition by percutaneous endoscopic gastrostomy in malnourished patients with cystic fibrosis: Does the gender gap play a role?

Abstract

Cystic fibrosis (CF) is an autosomal recessive genetic disease characterized by mutations in the CF transmembrane conductance regulator (CFTR) gene. The CF phenotype is characterized by lung disease, exocrine pancreatic insufficiency, impaired growth, hepatobiliary manifestations, and male infertility. A disadvantage in survival and morbidity, called the "CF gender gap," is known in women with CF. They more commonly acquire infections at an earlier age than men with CF, have shorter life expectancies, and are more frequently malnourished. 1 Malnutrition is a common management problem in patients with CF and is defined as having a body mass index (BMI) <18.5 kg/mš for adults and a BMI percentile <10th in children and adolescents up to 20 years of age. 2 Compared with well-nourished individuals, malnourished patients show a steeper lung function decline, whereas improvements in weight gain and BMI are associated with a slower decline in lung function. 3,4 Enteral nutrition (EN) administered via a percutaneous endoscopic gastrostomy (PEG) tube is a well-tolerated method to improve nutrition status, with a low incidence of complications. 5,6 There are no data on sex-related differences in the efficacy of EN via PEG in this population. We conducted a retrospective observational study in a cohort of 18 CF patients (11 male patients, 5/18 children) followed at a CF center in Florence, Italy, and requiring EN via PEG after the failure of conservative dietary measures. All patients (or their legal guardian) provided informed consent to use anonymized clinical data for research purposes.No significant differences in pancreatic and microbiological status were identified by sex. All patients had exocrine pancreatic insufficiency, and chronic Pseudomonas aeruginosa infection was present in 6 (54.5%) of 11 male patients and four (57.1%) of seven female patients. We evaluated the effect of EN on BMI and forced expiratory volume in 1 s (FEV 1 %) values after 6 months of treatment. Comparisons between independent samples were assessed by two-tailed Student t-test for the equality of the means.