Clinical and Biomolecular Hepato-Gastroenterology of Pediatric and Adult Age, University Hospital G. Martino, Messina, Italy.
Clin Nutr. 2013 Jun;32(3):382-5. doi: 10.1016/j.clnu.2012.08.017. Epub 2012 Aug 31.
BACKGROUND & AIMS: Some studies have shown a direct relationship between nutritional status and survival in Cystic Fibrosis (CF) patients. Body wasting, defined as a percentage of the ideal body weight for age, has been shown to be an independent predictor of mortality in CF. With respect to height only two studies were performed and these studies suggested that stunting is an important determinant of survival but both did not adjust statistical analysis for confounding variables. We aimed at determining the association between stunting and risk of mortality in CF patients.
393 CF patients older than 6 years of age, 95 deceased, as cases, and 298 live, as controls, were enrolled in a nested case-control study. Stunting was defined by a height percentile < 5th. We performed a multivariate statistical analysis including height percentile and the following possible confounding variables: age, gender, Body Mass Index (BMI), Forced Expiratory Volume in 1 s (FEV1), genotype, pancreatic status, CF-related diabetes, colonization with Pseudomonas aeruginosa and/or Burkholderia cepacia.
In the adjusted analyses stunting (OR 2.22 [IC 95%1.10-4.46]), wasting (OR 5.27 [IC 95% 2.66-10.41]), and FEV1 < 40% of predicted (OR 10.60 [IC 95% 5.43-20.67]) resulted the covariates that significantly predict the risk of mortality.
Our study shows, for the first time, that stunting is a significant and independent risk factor for mortality in CF patients, and warrants an intervention of nutritional rehabilitation. Considering that nutritional interventions in stunted patients should be prolonged, are invasive and expensive, and might affect self-esteem and body image, their efficacy should be fully assessed by Randomised Controlled Trials.
一些研究表明，营养状况与囊性纤维化（CF）患者的生存直接相关。身体消瘦，定义为按年龄计算的理想体重百分比，已被证明是 CF 患者死亡的独立预测因子。关于身高，仅进行了两项研究，这些研究表明生长迟缓是生存的重要决定因素，但两者都没有对混杂变量进行统计分析调整。我们旨在确定 CF 患者生长迟缓与死亡风险之间的关联。
393 名年龄大于 6 岁的 CF 患者，95 例死亡，作为病例，298 例存活，作为对照，纳入了一项巢式病例对照研究。生长迟缓定义为身高百分位数<5 。我们进行了多变量统计分析，包括身高百分位数和以下可能的混杂变量：年龄、性别、体重指数（BMI）、1 秒用力呼气量（FEV1）、基因型、胰腺状态、CF 相关糖尿病、铜绿假单胞菌和/或洋葱伯克霍尔德菌定植。
在调整分析中，生长迟缓（OR 2.22 [95%CI 1.10-4.46]）、消瘦（OR 5.27 [95%CI 2.66-10.41]）和 FEV1<40%预计值（OR 10.60 [95%CI 5.43-20.67]）是显著预测死亡风险的协变量。
我们的研究首次表明，生长迟缓是 CF 患者死亡的一个重要且独立的危险因素，需要进行营养康复干预。考虑到对生长迟缓患者进行营养干预应该是长期的、侵入性的和昂贵的，并且可能会影响自尊心和身体形象，应该通过随机对照试验充分评估其疗效。
