Hollander Francis M, de Roos Nicole M, Heijerman Harry G M
aDepartment of Dietetics, Internal Medicine and Dermatology, University Medical Center Utrecht, Utrecht bDivision of Human Nutrition and Epidemiology, Wageningen University and Research, Wageningen cDivision Heart and Lung, Pulmonology, University Medical Center Utrecht, Utrecht, The Netherlands.
Curr Opin Pulm Med. 2017 Nov;23(6):556-561. doi: 10.1097/MCP.0000000000000430.
Cystic fibrosis (CF) is a progressive genetic disease that affects multiple organ systems. Therapy is directed to maintain and optimize nutritional status and pulmonary function, as these are key factors in survival. In this review, the most recent findings regarding nutritional management associated with pulmonary function and outcome will be explored.
Evidence-based and expert-based guidelines emphasize the need for adequate nutritional intake to improve nutritional status. For infants and young children, the aim is to achieve the 50th percentile of weight and length for a healthy same-age population up to age 2 years. For older children and adolescents 2-18 years, the target is a BMI of at or above the 50th percentile for healthy children. For CF adults of at least 18 years, the target is a BMI of at or above 22 kg/m for women and at or above 23 kg/m for men. Recently, new drugs are developed with the aim to treat the malfunction of the cystic fibrosis transmembrane conductance regulator gene. This potentiator/corrector therapy improves lung function and nutritional status and decreases the number of infective exacerbations. As survival is improving and the CF population is aging, it is important to focus on micronutrient and macronutrient intake of CF patients in different age and disease stages.
Recent evidence-based nutritional guidelines and improved medical treatment support the nutritional monitoring and interventions in CF patients. Nutritional care should be personalized and provided by a specialized CF dietitian because patients' care needs may change dramatically during their disease progress.
囊性纤维化(CF)是一种影响多个器官系统的进行性遗传疾病。治疗旨在维持和优化营养状况及肺功能,因为这些是生存的关键因素。在本综述中,将探讨与肺功能和预后相关的营养管理的最新研究结果。
基于证据和专家的指南强调了充足营养摄入以改善营养状况的必要性。对于婴幼儿,目标是在2岁前达到健康同龄人群体重和身长的第50百分位数。对于2至18岁的大龄儿童和青少年,目标是健康儿童的BMI处于或高于第50百分位数。对于至少18岁的成年CF患者,女性的目标BMI为22kg/m²及以上,男性为23kg/m²及以上。最近,开发了旨在治疗囊性纤维化跨膜传导调节因子基因突变的新药。这种增效剂/校正剂疗法可改善肺功能和营养状况,并减少感染性加重的次数。随着生存率的提高和CF患者群体的老龄化,关注不同年龄和疾病阶段CF患者的微量营养素和常量营养素摄入非常重要。
最近基于证据的营养指南和改进的医疗支持了对CF患者的营养监测和干预。营养护理应个性化,并由专业的CF营养师提供,因为患者的护理需求在疾病进展过程中可能会发生巨大变化。