Tools and Methods Used for the Assessment of Body Composition in Patients With Cystic Fibrosis: A Systematic Review

Calella, Patrizia; Valerio, Giuliana; Brodlie, Malcolm; Taylor, Jake; Donini, Lorenzo Maria; Siervo, Mario

doi:10.1002/ncp.10247

Cited by 17 publications

(7 citation statements)

References 137 publications

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“…International nutrition guidelines suggest the “consideration” of BC assessment, in addition to anthropometric markers, 10,11 but more evidence is needed to support timing, benefits, and interpretation of routine measurements for all patients with CF. Dual‐energy x‐ray absorptiometry (DXA) has advantages over bioelectrical impedance analysis or magnetic resonance imaging 12 and is recommended as the method of choice in CF, as it combines “the accuracy of a 3‐component model with the opportunity to obtain information on bone health, lean body mass and adiposity.” 13 Measurements of FM and FFM from DXA compare favorably to those from the gold‐standard 4‐component model in children, 1 in which FFM is divided into protein, mineral (bone), and water, whereas appendicular (limb) analyses may provide greater accuracy than whole‐body (WB) analyses, as they assess more soft tissue by excluding the trunk, thereby minimizing bias 1 …”

Section: Introductionmentioning

confidence: 99%

Growth, Body Composition, and Lung Function in Prepubertal Children with Cystic Fibrosis Diagnosed by Newborn Screening

et al. 2020

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Background Children with cystic fibrosis (CF) are at risk of altered body composition (BC). Newborn screening (NBS) may lead to improved BC outcomes. We investigated BC and its relationship with lung function in prepubertal children diagnosed with CF by NBS. Secondary aims explored predictors of fat‐free mass (FFM) and lung function. Methods Thirty‐seven screened (non‐meconium ileus) children with CF (20 boys) born 2007–2012 had a dual‐energy x‐ray absorptiometry scan at 5–8 years to determine whole‐body (WB) and appendicular BC. Anthropometry was performed and routine spirometry recorded. Results were converted to z‐scores, height‐adjusted (fat mass index [FMI] and FFM index [FFMI]) and compared with population mean values. Predictors of forced expiratory volume in 1 second (FEV1) were assessed using linear regression. Results Height, body mass index (BMI), and FEV1 were within normal limits, however, weight and BC were significantly low compared with reference data (weight, P = .03; WB FMI, P = .001; WB FFMI, P = .009). Gender differences were detected, with lower appendicular BC in boys and lower weight, BMI, and BC in girls. The association between FEV1 and WB FFMI (r = 0.38; P = .02) was stronger than with BMI (r = 0.29; P = .08). WB FFMI was the only significant predictor of FEV1 in a multivariable model (95% CI, 0.11–0.99; P = .016). Conclusion In this NBS CF population, gender differences in growth and BC were apparent despite preserved lung function. These results support BC assessment in prepubertal children, particularly girls, with an opportunity to direct interventions to optimize FFM.

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Section: Introductionmentioning

confidence: 99%

Growth, Body Composition, and Lung Function in Prepubertal Children with Cystic Fibrosis Diagnosed by Newborn Screening

et al. 2020

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“…During the study period, 28 children and young people (11 male) were recruited to the study with a median (IQR) age of 15 (12)(13)(14)(15)(16)(17)(18)(19) years. One subject that was recruited in the primary study was excluded from this study as fat-free mass could not be measured as part of the original data collection.…”

Section: Resultsmentioning

confidence: 99%

“…The fat-free mass was measured by bioelectrical impedance analysis [ 13 ] with the InBody S10 Body Composition Analyser (InBody Ltd, Cerritos, CA, USA). Fat-free mass was estimated by impedance using the four compartment model representing the body in terms of water, protein, fat and mineral components.…”

Section: Methodsmentioning

confidence: 99%

Physical activity and liver disease affect the fat-free mass in adolescents with cystic fibrosis

et al. 2022

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Cystic fibrosis (CF) is predominantly a lung disease but is also characterised by impaired skeletal muscularity and a reduction in fat-free mass. We aimed to test the hypothesis that clinical and anthropometric parameters would determine fat-free mass impairment in adolescents with CF. We measured the fat-free mass index (FFMI) using bioelectrical impedance, the lung function using spirometry, the number of shuttles as a measure of exercise tolerance and the reported physical activity in children and young people with CF in a tertiary centre at King’s College Hospital, London, UK. CF-related liver disease was diagnosed by abnormal liver enzymes and/or ultrasonography. We studied 28 children and young people (11 male) with a median (interquartile range (IQR)) age of 15 (13–17) years. They had a median (IQR) FFMI of 13.5 (11.6–15.1) kg/m2. The FFMI significantly correlated with age (rho = 0.568, p = 0.002), number of shuttles (rho = 0.691, p < 0.001) and reported hours of activity per day (rho = 0.426, p = 0.024). The median (IQR) FFMI was significantly higher in male [15.1 (13.1–18.6) kg/m2] compared to female participants [12.7 (11.6–14.1) kg/m2, p = 0.008]. The median (IQR) FFMI was significantly lower in the 10 (36%) participants with liver disease [11.9 (11.5–13.4) kg/m2] compared to the FFMI in the remaining 18 participants without liver disease [14.4 (12.5–15.9) kg/m2, p = 0.027].Conclusion: Fat-free mass increases with increasing age and growth in adolescents with CF. Physical activity exerts a beneficial effect on fat-free mass, and CF-related liver disease negatively affects fat-free mass in adolescents with CF. What is Known:• Health behaviours in adolescence influence lifelong health in cystic fibrosis (CF).• A normal body mass index in CF might fail to reveal a low fat-free mass (FFM), and quality of life in CF is strongly associated with a reduced FFM. What is New:• FFM increases with increasing age and growth in adolescents with CF. • Physical activity exerts a beneficial effect, and liver disease negatively affects FFM in adolescents with CF.

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“…With regards to the relationship between low fat mass and malnutrition risk, very few studies have assessed body composition among children with CF. Although a variety of tools have been proposed for the assessment of body composition in CF [39], the majority of studies have used adult samples. In parallel, a consensus on body composition measurements, diagnoses and thresholds is required to attain a uniform core set of outcomes [40].…”

Section: Discussionmentioning

confidence: 99%

Triage for Malnutrition Risk among Pediatric and Adolescent Outpatients with Cystic Fibrosis, Using a Disease-Specific Tool

et al. 2020

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Malnutrition prevails in considerable proportions of children with Cystic Fibrosis (CF), and is often associated with adverse outcomes. For this, routine screening for malnutrition is pivotal. In the present cross-sectional study, we aimed to assess the risk for malnutrition in pediatric outpatients with CF. A total of 76 outpatients (44 girls, 11.9 ± 3.9 years old, 39.5% adolescents) were recruited and anthropometric, clinical, dietary and respiratory measures were collected. All outpatients were screened for malnutrition risk with a validated disease-specific instrument. Most children exhibited a low risk for malnutrition (78.9%), whereas none of the participants were characterized as having a high malnutrition risk. In the total sample, malnutrition risk was positively associated with age (r = 0.369, p = 0.001), and inversely related to the body mass index (r = −0.684, p < 0.001), height z-score (r = −0.264, p = 0.021), and forced expiratory volume (FEV1%, r = −0.616, p < 0.001). Those classified as having a low malnutrition risk were younger (p = 0.004), heavier (p < 0.001) and taller (p = 0.009) than their counterparts with a moderate risk. On the other hand, patients in the moderate risk group were more likely pubertal (p = 0.034), with a reduced mid-upper arm fat area (p = 0.011), and worse pulmonary function (p < 0.001). Interestingly, none of the children attaining ideal body weight were classified as having a moderate malnutrition. risk, whereas 37.5% of the patients allocated at the moderate risk group exhibited physiological lung function. In this cohort of outpatients with CF that were predominantly well-nourished and attained physiological lung function, malnutrition risk was identified only in small proportions of the sample. Our data support that patients that are older, pubertal, or have diminished fat mass are at greater risk for malnutrition.

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Tools and Methods Used for the Assessment of Body Composition in Patients With Cystic Fibrosis: A Systematic Review

Cited by 17 publications

References 137 publications

Growth, Body Composition, and Lung Function in Prepubertal Children with Cystic Fibrosis Diagnosed by Newborn Screening

Growth, Body Composition, and Lung Function in Prepubertal Children with Cystic Fibrosis Diagnosed by Newborn Screening

Physical activity and liver disease affect the fat-free mass in adolescents with cystic fibrosis

Triage for Malnutrition Risk among Pediatric and Adolescent Outpatients with Cystic Fibrosis, Using a Disease-Specific Tool

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