Randomized Clinical Trial of Behavioral Intervention and Nutrition Education to Improve Caloric Intake and Weight in Children With Cystic Fibrosis

Stark, Lori J.; Quittner, Alexandra L.; Powers, Scott W.; Opipari-Arrigan, Lisa; Bean, Judy A.; Duggan, Christopher; Stallings, Virginia A.

doi:10.1001/archpediatrics.2009.165

Cited by 48 publications

(49 citation statements)

References 31 publications

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“…Upon entering the trial, the percent RDA for the children in the trial was similar to that seen in previously published studies [20, 21], and more than half (55%) of the preschoolers were not meeting the minimum 110% RDA for energy recommendation, and 44% of children had BMIs <50th percentile. The average daily percent energy from fat consumed for the entire sample was just at the minimum recommendation of 35%, and only 53% of the children were meeting this recommendation, suggesting some children were higher consumers of fat and other children were in need of nutritional tracking and intervention in this key area.…”

Section: Discussionsupporting

confidence: 76%

Macronutrient intake in preschoolers with cystic fibrosis and the relationship between macronutrients and growth

Filigno

Robson

Szczesniak

et al. 2017

Journal of Cystic Fibrosis

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Background Adequate nutrition is essential for growth in children with cystic fibrosis (CF). The new CF Foundation Clinical Practice Guidelines bring attention to monitoring macronutrient intake as well as total energy. Methods Dietary intake of 75 preschool children with CF and pancreatic insufficiency was examined and compared to the Clinical Practice Guidelines. Regression analyses examined relationships between macronutrient intake and growth. Results Approximately 45% of children met the 110% minimum recommended dietary allowance (RDA) recommendation. Children consumed 35.3% (6.1) of total daily energy intake from fat, 12.7% (1.7) from protein, and 52.0% (6.1) from carbohydrate. Percent energy from protein was associated with height growth. Conclusions Many preschoolers with CF are not meeting nutrition benchmarks for total energy and fat. To optimize nutrition early, dietary monitoring with frequent individualized feedback is needed. Optimizing intake of macronutrients that promote growth, especially fat and protein, should be a primary clinical target.

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Section: Discussionsupporting

confidence: 76%

Macronutrient intake in preschoolers with cystic fibrosis and the relationship between macronutrients and growth

Filigno

Robson

Szczesniak

et al. 2017

Journal of Cystic Fibrosis

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“…In the Stark et al study, the improvement over nine weeks in caloric intake and weight was shown to be greater with a combination of behavioral and nutrition education interventions versus the nutrition education alone (28). In follow-up with this cohort, the growth of both the behavioral and nutrition education intervention group and nutrition education group, was similar from 3 to 24 months.…”

Section: Discussionmentioning

confidence: 99%

Effect of a dietary intervention on growth and energy expenditure in children with cystic fibrosis

Groleau

Schall

Dougherty

et al. 2014

Journal of Cystic Fibrosis

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BACKGROUND The study aim was to determine the effect of a dietary intervention on growth, body composition and resting energy expenditure (REE) in children with cystic fibrosis (CF) and pancreatic insufficiency (PI) in a randomized, double blind, placebo-controlled trial. METHODS Subjects (5 to 17 yrs) participated in a 12-month trial of the organized lipid matrix LYM-X-SORB™ (LXS) vs. placebo dietary supplements with similar calories, total fat and fatty acids. Dietary intake was assessed using 3-day weighed food records. Height (HAZ), weight (WAZ), BMI (BMIZ), mid-upper arm muscle (UAMAZ) and fat area (UAFAZ) Z-scores were calculated. Fat mass (FM) and fat free mass (FFM) were obtained by whole body DXA. REE (kcal/d) was evaluated by indirect calorimetry at baseline, 3 and 12 months and %REE calculated using Schofield equations. No growth or REE differences were observed between LXS and placebo groups so data were pooled for analysis. RESULTS 63 children (57% males, age 10.6±2.9 yr, 43% receiving LXS) completed REE measurements. Caloric intake increased from a median of 2502 [1478, 4909] to 2616 [1660, 4125] kcal/d at 12 months. HAZ, WAZ and UAMAZ increased (p < 0.05) over 12 months. Mean REE was 109±8% predicted at baseline and 107±9% at 12 months (p < 0.05). REE (kcal/d) adjusted for FFM and FM decreased over 12 months ([mean±SE] −31±12 kcals, p < 0.01), significant only in males (−49±16 kcals, p < 0.01). CONCLUSIONS Over a 12 month nutrition intervention with either LXS or placebo, the growth status, muscle stores and REE improved. Sustained increased energy intake improved energy metabolism, growth and nutritional status in school age children with CF, PI and mild lung disease.

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“…10, [136][137][138][139] In multiple studies, families consistently reported challenges with mealtime energy-intake goals due to demanding mealtime behaviors, leading to significant stress. 8, 9, 124-127 These mealtime behavioral challenges can predict calorie intake and weight gain.…”

Section: Behaviormentioning

confidence: 99%

“…140 Regular assessment for mealtime behavior challenges should be performed and proactive behavioral assistance should be provided when needed Table 5. 10,136,137,[141][142][143] …”

Section: Behaviormentioning

confidence: 99%

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

et al. 2016

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Cystic fibrosis (CF) clinical care guidelines exist for the care of infants up to age 2 years and for individuals ≥6 years of age. An important gap exists for preschool children between the ages of 2 and 5 years. This period marks a time of growth and development that is critical to achieve optimal nutritional status and maintain lung health. Given that disease often progresses in a clinically silent manner, objective and sensitive tools that detect and track early disease are important in this age group. Several challenges exist that may impede the delivery of care for these children, including adherence to therapies. A multidisciplinary committee was convened by the CF Foundation to develop comprehensive evidence-based and consensus recommendations for the care of preschool children, ages 2 to 5 years, with CF. This document includes recommendations in the following areas: routine surveillance for pulmonary disease, therapeutics, and nutritional and gastrointestinal care.

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Randomized Clinical Trial of Behavioral Intervention and Nutrition Education to Improve Caloric Intake and Weight in Children With Cystic Fibrosis

Cited by 48 publications

References 31 publications

Macronutrient intake in preschoolers with cystic fibrosis and the relationship between macronutrients and growth

Macronutrient intake in preschoolers with cystic fibrosis and the relationship between macronutrients and growth

Effect of a dietary intervention on growth and energy expenditure in children with cystic fibrosis

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

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