© Borgis - New Medicine 2/2014, s. 63-66
*Tímea Tóth1, Erzsèbet Mák1, Szilvia Molnár1, Magdolna Sinka2, Fruzsina Tóth1, István Szabolcs1
Nutrition status of adult patients with cystic fibrosis
1Department of Dietetics and Nutrition Sciences, Institute of Applied Health Sciences, Faculty of Health Sciences, Semmelweis University, Budapest, Hungary
Head of Department: Katalin Tátrai-Nèmeth, PhD
2Department for Epidemiology, Institute of Health Promotion and Clinical Methodology, Faculty of Health Sciences, Semmelweis University, Budapest, Hungary
Head of Department: István Barcs, PhD
Introduction. The number of adults with cystic fibrosis (CF) is gradually increasing. The nutritional status has an important role in the progression of the disease.
Aim. To investigate the malnutrition risk and the nutritional status of adults with CF, and to analyse the obtained data according to gender, transplantation, dominantly affected system organ class, comorbidity, bacterial infection and sports habits.
Material and methods. The nutritional status was assessed by a bioelectrical impedance machine, and the malnutrition risk screening was measured by NRS2002.
Results. Forty-four patients participated (20 males, 24 females). Mean BMI in males was significantly higher compared with females (p = 0.01). The mean muscle percentage of patients doing sport regularly was significantly higher than those who do not do sport (p = 0.0126). Between mean body fat percentages there was no significant difference. There was no significant difference in mean BMI and body fat percentage between patients with and without transplantation, patients who live with one dominantly affected system organ class and patients who live with more dominantly affected system organ classes, patients who have concomitant illness and patients who do not, or patients who have one concomitant illness and patients who have more concomitant illnesses. Moreover, there was no significant difference in mean BMI and body fat percentage between patients who suffer from a bacterial infection and who do not, or patients who suffer from one bacterial infection and patients who have several bacterial infections. The majority of those patients who participated in the malnutrition risk screening were malnourished (77.3%).
Conclusions. The research can prove high prevalence of malnutrition among adult patients with CF, which needs nutrition intervention to recover from.
Cystic fibrosis is one of the most common autosomal recessive metabolic disease. The disorder itself occurred by genetic alteration and shows chronic progression with respiratory aberrations, gastrointestinal symptoms as well as reproductive and endocrine system dysfunctions, and leads to early death (1). This genetic disorder inflicts alterations in the functions of exocrine glands, therefore thick, viscous secretions occurred, which can cause obstructive malformations in the concerned organs (2). In Hungary, incidence of CF is about 1:3500 from the data obtained local screenings. In 2012 the mean age of the 579 registered patients was 16.54 years, and 42.8% (248 men) of them were adults (3, 4). Number of patients shows increasing tendency as well as the mean age owing to the improvement of medical treatment and dietotherapy (5). Nutritional status has got crucial role in the progression of CF, thus dietotherapy is the vital part of the treatment (7, 8). Patients with good nutritional status possess better chances to maintain or improve of good health (9), while bad nutritional status decrease the survival chances (10, 11), hence detection of malnutrition, and evolving of an appropriate nutritional status are essential in the optimal therapy (9). Pulmonary infections evoke intensified resting metabolic rate and lack of appetite, but then again serve pulmonary disease can be found more frequently among patients with malnutrition (10). In contrast, patients with higher body mass index possess better lung condition (12). Furthermore it is proved that body weight and BMI correlate positively with Forced Expiratory Volume (FEV1) and Forced Vital Capacity (FVC) (13).
Malnutrition defined as BMI value lower than 18,5 kg/m2, and body fat% < 10% in men, or < 20% in women (8).
BMI and body fat% are accurate indicators of nutritional status of CF patients. BMI can be applied routinely, because of its easy feasibility and accurate results. Body fat% value determinated by measurements of skinfold thickness and BMI often differ lot from the verity, because in the case of thin people it is unreliable, thus in the case of CF, it isn’t a reliable method. Instead of the classical determination, body fat% can be determinated with bioimpedancy based methods at the highest accuracy (1, 5, 8). Laboratory parameters (haemoglobin, white blood cell number, serum albumin, carbamide, and electrolytes) can also serve as good indicators of nutritional status (5). Because of these two parameters accepted internationally as good indicators of malnutrition, data obtained by them can be used for compare results with other studies, where the same methodology was applied, hence evaluation of the data can be easier.
AIMS AND HYPOTHESISES
Aim of our study was to investigate the correlation of nutritional and clinical parameters among adult patients with cystic fibrosis.
We aimed to search for correlations between nutritional status and clinical conditions among woman and man; out- and inpatients; transplanted and non-transplanted; mono or multi organ affected; and patients with or without accompanied diseases and bacterial infections.
We hypothesised that muscle% and body fat% of physically inactive patients and patients who do sports regularly are differ significantly.
We reckoned that results obtained by NRS2002 validated screening method will show that malnutrition will be occurred at higher number than normal nutritional status among the involved subjects.
MATERIAL AND METHODS
Nutritional status analysis was performed with Inbody 170 and Omron BF500 bioimpedancy meters. Clinical status was recorded with interview based on the self-response of patients. Risk assessment of malnutrition was performed by the NRS2002 validated screening method.
Answer to questions was voluntary, thus item numbers at the case of different results might be different.
Student t-test at 5%-significance level (p = 0.05) was used to compare values of the different groups with the Microsoft Excell 2010 software, respectively (14).
Table 1 contains the physical parameters of patients involved to the study.
Table 1. Physical parameters of patients with cystic fibrosis involved to the study.
| ||Men (n = 20)||Women (n = 24)|
|Age (year)||27.6 (max. 65)||27.83 (max. 47)|
| ||Men (n = 15)||Women (n = 20)|
|Body Fat (%)||14.91||21.01|
44 patients with mean age of 27.8 years and, mean BMI of 19.51kg/m2 were participated in the study. Their distribution by the BMI categories shown in figure 1.
Fig. 1. Patient distribution by BMI categories (n = 44).
BMI means by gender was also different: mean values of men (n = 20) was 20.57 kg/m2 which differed significantly (p = 0.01) from the 18.63 kg/m2 mean value of women (n = 24).
Inpatients (n = 12) had got significantly (p = 0.0114) lower BMI mean(18.05 kg/m2) than outpatients (n = 32, BMI = 20.06 kg/m2). Mean body fat% was not different between them (p = 0.3095): mean of inpatients was 16.38%, while this values was 19.21% among outpatients.
From the investigated subjects, 34 were not transplanted, while 10 people were undergone transplantation surgery (9 lung, 1 liver). BMI mean value of transplanted group was 19.46 kg/m2, while their body fat% was 21.9% (n = 7). Patients without transplantation had got 19.52 kg/m2 BMI mean, and 17.52% body fat% (n = 28). Statistical comparison of these data could not indicate significant difference between groups (BMI p = 0.9406; body fat% p = 0.1009). In the case of comparison of the dominantly pulmonary affected patients (n = 15, BMI = 19.1 kg/m2) with the pulmonary and gastro intestinally affected ones (n = 13, BMI = 19.59 kg/m2), significant differences could not be demonstrated (p = 0.6480).
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