Department of Paediatric Gastroenterology, Cystic Fibrosis Centre Utrecht, University Medical Centre Utrecht, Internal address KE.04.133.1, P.O. Box 85500, 3508 GA Utrecht, The Netherlands.
Julius Centre for Health Sciences and Primary Care, University Medical Center Utrecht, 3584 CX Utrecht, The Netherlands.
Clin Nutr. 2019 Apr;38(2):920-925. doi: 10.1016/j.clnu.2018.02.005. Epub 2018 Feb 15.
BACKGROUND & AIMS: Body-growth, expressed as weight- and height gain, is a strong predictor of morbidity and mortality in patients with cystic fibrosis (CF). Whether current historically based recommendations on a high-energy diet are sufficient for optimal growth is questionable. We therefore assessed the longitudinal relation between body-growth and routine energy intake in paediatric CF patients.
Included were patients with CF, aged 2-10 years of whom we obtained 969 measurements of weight and height along with dietary records, and 786 coefficient of fat absorption measurements (CFA). We described body-growth, energy intake, macronutrient intake and the long-term effect of energy intake and coefficient of fat absorption on body-growth during the 8-year follow-up period.
Enrolled were 191 children with CF who had a compromised growth when compared to healthy children. The dietary intake was ≥110% estimated average requirement (EAR) in 47% of the measurements (457/969) and did not (fully) achieve the recommended high-energy level (110-200% EAR). Further, the intake expressed as EAR decreased with increasing age. Cross-sectionally, boys and girls with higher caloric intakes had higher weight-for-age (WFA). The caloric intake explained 18 and 6% of the variation. Further, boys with higher caloric intakes had also higher height-for-age-adjusted-for-target-height (HFA/TH) or BMI. The caloric intake explained 6 or 7% of the variation. Longitudinally, caloric intake was associated with both WFA in boys and girls, and with BMI in boys. Each 100 calories increased intake would result in a 0.01 (girls)-0.02 increase in z-score WFA and 0.03 increase in z-score BMI. We found no significant association between CFA and WFA, HFA/TH or BMI. The contribution of protein, fat and carbohydrates was not associated with WFA, nor with HFA/TH or BMI.
Even at this relatively early age, a compromised growth in children with CF was found when compared to healthy children. The energy intake was below 110% EAR in 47% of the measurements, and appeared to be insufficient to prevent suboptimal body-growth over the 8-years of follow-up.
体重和身高的增长（即身体生长）是囊性纤维化（CF）患者发病率和死亡率的强有力预测指标。目前基于历史数据的高能量饮食建议是否足以实现最佳生长值得怀疑。因此，我们评估了儿科 CF 患者身体生长与常规能量摄入之间的纵向关系。
纳入年龄在 2-10 岁之间的 CF 患者，共获得 969 次体重和身高测量值以及 786 次脂肪吸收系数（CFA）测量值，并记录饮食情况。我们描述了身体生长、能量摄入、宏量营养素摄入以及在 8 年随访期间能量摄入和脂肪吸收系数对身体生长的长期影响。
共纳入 191 名 CF 患儿，与健康儿童相比，他们的生长发育受到影响。在 47%的测量值中（457/969），饮食摄入量≥估计平均需求量（EAR）的 110%，但未达到推荐的高能量水平（110-200%EAR）。此外，随着年龄的增长，以 EAR 表示的摄入量逐渐减少。在横截面上，热量摄入较高的男孩和女孩体重与年龄的比值（WFA）较高。热量摄入可解释 18%和 6%的变异。此外，热量摄入较高的男孩身高与靶身高调整后的身高（HFA/TH）或 BMI 也较高。热量摄入可解释 6%或 7%的变异。纵向分析显示，热量摄入与男孩和女孩的 WFA 以及男孩的 BMI 均相关。每增加 100 卡路里的摄入量，WFA 的 z 评分将增加 0.01（女孩）-0.02，BMI 的 z 评分将增加 0.03。我们未发现 CFA 与 WFA、HFA/TH 或 BMI 之间存在显著相关性。蛋白质、脂肪和碳水化合物的摄入量与 WFA 以及 HFA/TH 或 BMI 均无关联。
即使在这个相对较早的年龄，与健康儿童相比，CF 患儿的生长发育仍然受到影响。47%的测量值中能量摄入低于 EAR 的 110%，且似乎不足以防止 8 年随访期间身体生长不理想。
