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Nutritional growth retardation is associated with defective lung growth in cystic fibrosis: a preventable determinant
M A Thomson1, P Quirk, C E Swanson
1Children's Nutrition Research Centre, Brisbane, Australia.
Insights
Nutritional growth retardation in cystic fibrosis (CF) is linked to worsening lung function. Optimizing nutrition and body cell mass (BCM) growth may help slow pulmonary decline in CF patients.
Area of Science:
- Pediatrics
- Pulmonology
- Nutritional Science
Background:
- Cystic Fibrosis (CF) is associated with nutritional challenges and progressive lung disease.
- The relationship between nutritional status and pulmonary function decline in CF requires further elucidation.
Purpose of the Study:
- To investigate the association between nutritional growth parameters and changes in pulmonary function in children with CF.
- To identify predictors of pulmonary function decline related to nutritional status.
Main Methods:
- A prospective longitudinal study of 61 moderately affected CF patients (aged 5-17 years).
- Nutritional parameters including body cell mass (BCM) via total-body potassium (TBK) were assessed.
- Changes in forced expiratory volume in 1 second (FEV1) and forced vital capacity (FVC) were analyzed in relation to nutritional changes, excluding exacerbations.
Main Results:
- Changes in BCM (measured by TBK) significantly predicted changes in FVC (p < 0.01).
- Standard anthropometric measures did not predict FVC changes.
- A relative decline in TBK for age predicted FVC decline, accounting for 23% of the change.
- Patients with normal BCM growth showed less FVC decline (2.5%/yr) compared to those with retarded BCM growth (6.8%/yr).
Conclusions:
- Impaired growth of metabolically active BCM is associated with progressive lung dysfunction in CF.
- Optimal nutrition and BCM growth may mitigate pulmonary function decline in CF.
- This suggests a potential role for nutritional interventions in managing CF progression.
Abstract:
Evidence for a relationship between nutritional growth retardation in cystic fibrosis (CF) and progressive pulmonary dysfunction was evaluated by a prospective longitudinal study of changes in nutritional growth parameters, in relation to changes in pulmonary function data, in 61 moderately affected CF patients, aged 5-17 yr, during the equilibrated phase of lung growth. Age, sex, initial and serial weight and height Z scores, body cell mass (BCM) by total-body potassium (TBK) analysis, and changes in forced expiratory volume in 1 s (FEV1) and forced vital capacity (FVC), excluding data during pulmonary exacerbations, were analyzed by multiple regression analyses. The only significant predictor of change in FVC (best-fit model) was change in BCM, expressed as TBK (g/yr), TBK for age (percentage predicted), and TBK for height (percentage predicted) (p < 0.01). Standard anthropometric variables were not predictive. No reliable predictive model emerged for changes in FEV1. Relative decline in TBK for age was strongly predictive of decline in FVC (percentage predicted) accounting for 23% of this change. Patients with normal growth of the BCM had significantly less decline in FVC than those with retarded growth of the BCM (a fall of 2.5 vs. 6.8%/yr, p < 0.01). Impaired growth of the metabolically active BCM appears to be associated with progressive lung dysfunction in CF, possibly mediated by impaired lung growth. Achieving optimal nutrition and growth may minimize the progressive decline in pulmonary function commonly seen in this disease.