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Nutritional decline in cystic fibrosis related diabetes: the effect of intensive nutritional intervention.
White, H Pollard, K Etherington, C Clifton, I Morton, A M Owen, D Conway, S P Peckham, D G
White, H
Pollard, K
Etherington, C
Clifton, I
Morton, A M
Owen, D
Conway, S P
Peckham, D G
Advisors
Editors
Other Contributors
Date
2012-02-01T10:45:19Z
Date Submitted
Keywords
Other Subjects
Subject Mesh
Adult
Age Factors
Body Mass Index
Case-Control Studies
Cystic Fibrosis/*complications
Diabetes Mellitus/*diet therapy/etiology
Dietary Supplements
Disease Progression
Enteral Nutrition
Female
Humans
Male
Nutrition Disorders/etiology/*prevention & control
Nutritional Status
Prediabetic State/*diet therapy/etiology
Young Adult
Age Factors
Body Mass Index
Case-Control Studies
Cystic Fibrosis/*complications
Diabetes Mellitus/*diet therapy/etiology
Dietary Supplements
Disease Progression
Enteral Nutrition
Female
Humans
Male
Nutrition Disorders/etiology/*prevention & control
Nutritional Status
Prediabetic State/*diet therapy/etiology
Young Adult
Planned Date
Start Date
Collaborators
Principal Investigators
Alternative Titles
Publisher
Abstract
BACKGROUND: Reports indicate that nutritional and respiratory decline occur up to four years prior to diagnosis of cystic fibrosis related diabetes (CFRD). Our aim was to establish whether intensive nutritional intervention prevents pre-diabetic nutritional decline in an adult population with CFRD. METHODS: 48 adult patients with CFRD were matched to 48 controls with CF, for age, gender and lung pathogen status. Nutritional and other clinical indices were recorded at annual intervals from six years before until two years after diagnosis. Data were also analysed to examine the impact of early and late acquisition of CFRD. RESULTS: No important differences in weight, height, body mass index (BMI), lung function or intravenous treatment were found between groups in the six years prior to diagnosis, nor any significant deviation over time. In those who developed diabetes, use of overnight enteral tube feeding (ETF) was four times as likely at the time of diagnosis, compared to controls [ETF 43.8% (CFRD) v 18.8% (CF Controls), OR 4.0, CI 1.3 to 16.4, p=0.01]. Age at onset of CFRD played a significant role in determining the pre-diabetic clinical course. Younger diabetics with continued growth at study onset (n=17) had a lower BMI from 2 years prior to diagnosis compared to controls [BMI 18.9 kg/m(2) (CFRD) v 20.8 kg/m(2) (CF Controls), diff=1.9, CI -0.1 to 3.7 p=0.04]. The BMI of older diabetics (completed growth at study onset) was equal to that of controls throughout. CONCLUSION: Pre-diabetic nutritional decline is not inevitable in adults with CFRD, but is influenced by age of onset. In the group overall, those with CFRD are more likely to require ETF from 2 years prior to diagnosis. Despite intensive nutritional intervention, patients who continue to grow throughout the pre-diabetic years, show a level of nutritional decline absent in older adults.
Language
eng
Citation
ISSN
1873-5010 (Electronic)
1569-1993 (Linking)
1569-1993 (Linking)
eISSN
ISBN
DOI
10.1016/j.jcf.2008.12.002
PMID
19179122