Height Assessment in the Dutch-Origin Pediatric Cystic Fibrosis Population
Janna W Woestenenk1, Vincent A M Gulmans2, Cornelis K van der Ent3
11 Internal Medicine and Dermatology, Dietetics, and Cystic Fibrosis Center Utrecht, University Medical Center Utrecht, Utrecht, the Netherlands.
Insights
Height evaluation in cystic fibrosis (CF) care using height-for-age (HFA) z scores may inaccurately estimate growth. Adjusting for target height (TH) provides a more accurate assessment, preventing potential misinterpretations in clinical practice.
Area of Science:
- Pediatrics
- Endocrinology
- Genetics
Background:
- Height assessment is crucial in cystic fibrosis (CF) patient care.
- Current methods use height-for-age (HFA) z scores, which do not account for genetic height potential (target height, TH).
- This omission may lead to inaccurate height estimations in children with CF.
Purpose of the Study:
- To evaluate the discrepancy between standard HFA z scores and HFA z scores adjusted for TH (HFA/TH) in Dutch children with CF.
- To determine the clinical significance of using HFA z scores versus HFA/TH z scores for growth monitoring.
Main Methods:
- A study was conducted on 474 Dutch children diagnosed with cystic fibrosis.
- The agreement between HFA z scores and HFA/TH z scores was analyzed.
- Measurements were categorized into four groups to compare classification differences.
Main Results:
- HFA z scores were found to be slightly lower (-0.07) than HFA/TH z scores in the study sample.
- A moderate agreement was observed between the two scoring methods when categorized.
- HFA z scores underestimated height in 21% and overestimated in 15% of measurements compared to HFA/TH.
Conclusions:
- Standard HFA z score evaluation in clinical settings may lead to under- or overestimation of growth in children with CF.
- Inaccurate height assessments can potentially result in inappropriate nutritional interventions.
- Incorporating target height adjustment is recommended for more precise growth monitoring in CF care.
Background:
Height evaluation is an integral part of cystic fibrosis (CF) care. Height is compared with reference values by converting it to height-for-age (HFA) z scores. However, HFA z scores do not adjust for genetic potential (ie, target height [TH]), which could result in an incorrect estimation of the height.
Materials And Methods:
To evaluate the magnitude of this potential problem, we assessed the agreement between HFA and HFA-adjusted-for-TH (HFA/TH) z scores in 474 Dutch children with CF.
Results:
In this study sample, HFA z scores were -0.07 (95% confidence interval, -0.02 to -0.12) lower than HFA/TH z scores. When HFA and HFA/TH z scores were subdivided into 4 categories (≥0, <0 and ≥-1, <-1 and ≥-2, and ≤-2), a moderate agreement was found. HFA z scores were classified lower than HFA/TH z scores in 21% of the measurements and higher in 15% of the measurements.
Conclusion:
In clinical routine, height evaluation based on HFA may result in underestimation or overestimation of height growth, which may induce inappropriate nutrition interventions.
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