Nutritional outcomes following gastrostomy in children with cystic fibrosis

Abstract

Objective In 2005 the Cystic Fibrosis (CF) Foundation recommended that children with CF maintain a body mass index (BMI) ≥50th percentile. Our study evaluated if gastrostomy (GT) placement increases the likelihood of reaching that goal compared to a standardized nutrition protocol. Study design Retrospective study of 20 children with CF ages 2–20 years with GTs placed from 2005–2010. Each case was pair-matched on age, sex, pancreatic status, BMI and lung function with a non-GT child with CF. Outcome measures included nutritional status and lung function at 6 months and 1 year. Results At baseline, mean±SD BMI Z-scores were similar (cases −1.19±0.60, controls −1.10±0.50; p=0.10). Cases had a significant 6-month increase in mean BMI Z-score to −0.29±0.84 compared to −1.02±0.67 for controls (p<0.001). By 1 year, the change in mean BMI Z-score was less different (cases −0.41±0.76, controls −0.71±0.51; p=0.07). Both groups had stable lung function. From exact logistic regression analysis, the odds ratio for cases compared to controls of reaching BMI≥50th percentile was 9.70 (95% CI:1.05–484.7;p=0.04) at 6 months and 3.65 (95%CI:0.69–25.86;p=0.16) at 1 year. Conclusion Our study suggests that children with CF who receive GTs are more likely to achieve BMI≥50th percentile than matched children without GTs.

Clinical Practice Guidelines From the Cystic Fibrosis Foundation for Preschoolers With Cystic Fibrosis

“…Gastrostomy tube feedings have been shown in older children and adults with CF to improve weight and pulmonary function. [128][129][130][131] …”

Genetic modifiers of nutritional status in cystic fibrosis

“…The following covariates have been previously shown to confound nutritional status in CF so were evaluated for their contributions to the variability in BMI-z 5to10 phenotype: sex (4), birth cohort (19), age at CF diagnosis (y) (21), diagnosis by NBS (9), homozygosity for the F508del CFTR mutation (21), severe exocrine PI (12), history of MI (11), presence of a gastrostomy (10), pulmonary function (forced expiratory volume in 1 s) (19), and socioeconomic status (22). Birth cohorts of subjects were defined according to the year in which subjects were born by using the following intervals: ,1980 (1), 1980-1984 (2), 1985-1989 (3), 1990-1994 (4), 1995-1999 (5), and .1999 (6).…”

“…Nutritional status is not well correlated with the CFTR genotype (6,7), which suggests the additional influence of environmental, genetic, or stochastic factors (8). Identified nongenetic influences include the diagnosis of CF via a newborn screen (NBS) and placement of a gastrostomy, which are both associated with improved nutritional status (9,10). Alternately, pancreatic insufficiency (PI) and meconium ileus (MI) negatively influence nutrition and growth in CF patients (11,12).…”

Clinical audit results in earlier nutritional intervention in malnourished children with cystic fibrosis with improved outcome

“…The close association between nutritional status, pulmonary function and survival in cystic fibrosis (CF) is generally accepted . Children and adolescents with advanced CF are often unable to meet their rapidly increasing energy requirements .…”