Meal patterns, dietary fat intake and pancreatic enzyme use in preadolescent children with cystic fibrosis.

OBJECTIVES

To describe the usual pattern of intake and adherence to cystic fibrosis (CF) food and pancreatic enzyme replacement therapy (PERT) recommendations in preadolescent children with CF and pancreatic insufficiency (PI).

METHODS

Children, 8 to 11 years old, with CF and PI were assessed for PERT adherence ratio (number taken/number prescribed per day) and energy and fat intake for 7 days (weighed food records), adherence to PERT and dietary recommendations, pulmonary function, growth status and stool fat malabsorption. Using the PERT adherence ratio, children were divided into good (> or =80%), moderate (60% to 79%) and poor (<60%) adherence groups.

RESULTS

Of the 75 children (age, 9.3 +/- 1.0 years; forced expiratory volume in 1 s, 95 +/- 14% predicted), 61% consumed less than 120% of energy intake, and 72% consumed less than 40% of calories as fat recommended for CF. Using the PERT adherence ratio (mean +/- SD, 75 +/- 14%), 29%, 61% and 9% of children had good, moderate and poor adherence, respectively. Better adherence to PERT was significantly associated with missing fewer snacks, higher energy intake, greater fat content of snacks and poorer growth status. About 85% of the children were in the 500 to 4000 lipase unit (LU) of PERT (LU/g fat per day) and 500 to 2500 LU/kg per body weight per meal guidelines, whereas only 58% to 68% were within the guidelines for snacks. Eleven percent of children always took PERT at an inappropriate time after meals.

CONCLUSIONS

Most preadolescent children with CF and PI did not meet dietary recommendations. Future educational and behavioral interventions focused on increasing PERT adherence with snacks, fat content of meals and snacks, appropriate timing of enzymes and adjustment of PERT and meal fat content are suggested.