Darukhanavala Amy, Merjaneh Lina, Mason Kelly, Le Trang
Division of Pediatric Endocrinology, University of Massachusetts Medical Center, 55 Lake Ave North, Worcester, MA, USA.
Division of Pediatric Endocrinology and Diabetes, Seattle Children's Hospital, Seattle, WA, USA.
J Clin Transl Endocrinol. 2021 Nov 26;26:100280. doi: 10.1016/j.jcte.2021.100280. eCollection 2021 Dec.
Eating disorders and disturbed body image have been reported in individuals with cystic fibrosis (CF) and may contribute to poor weight gain, reduced lung function and increased mortality. CF individuals often look and feel different from their peers and bear the additional burden of body-altering side effects of treatment. As a result, the impact of disorders such as binge eating, anorexia nervosa, and bulimia nervosa may adversely affect the social, emotional, and physical development of those with CF. Multiple risk factors may contribute to the development of an eating disorder in CF. Growth failure is affected by the physical impairments of CF, including pancreatic insufficiency, high energy demands, respiratory infections, and delayed and stunted growth and puberty. Psychological factors, such as CF associated depression and anxiety, intense focus on BMI, lack of control in a chronic disease, and preoccupation with morbidity and mortality, likely further contribute. Exercise inefficiency, secondary to poor lung function, low BMI and pulmonary exacerbations, and the potential for medication manipulation are also additional risk factors. The intense scrutiny around BMI may lead to a poor relationship with food, including disordered eating habits, abnormal mealtime behaviors, and stressful caregiver-patient interactions regarding meals. This further contributes to a discrepancy between ideal CF nutritional standards and the reality of the challenges of appropriate daily energy intake for an individual with CF. It is imperative that CF providers are equipped to identify potential eating disorders and disturbed body image in their CF patients. Improved screening and monitoring practices should be developed and implemented, with multidisciplinary support from all CF care team members, including dietitians, mental health professionals, and social workers, to best support holistic care and optimize outcomes. Increased attention to these concerns may help reduce CF related morbidity and mortality.
据报道，囊性纤维化（CF）患者存在饮食失调和身体形象紊乱的问题，这可能导致体重增加不佳、肺功能下降和死亡率上升。CF患者通常在外表和感觉上与同龄人不同，还要承受治疗带来的身体改变副作用的额外负担。因此，暴饮暴食、神经性厌食症和神经性贪食症等疾病的影响可能会对CF患者的社交、情感和身体发育产生不利影响。多种风险因素可能导致CF患者出现饮食失调。生长发育不良受到CF身体损伤的影响，包括胰腺功能不全、高能量需求、呼吸道感染以及生长发育迟缓和青春期发育迟缓。心理因素，如与CF相关的抑郁和焦虑、对体重指数（BMI）的过度关注、慢性病中缺乏控制感以及对发病率和死亡率的过度担忧，可能也会进一步加剧这种情况。由于肺功能差、BMI低和肺部病情加重导致运动效率低下，以及药物操纵的可能性，也是额外的风险因素。对BMI的严格审查可能导致与食物的不良关系，包括饮食紊乱习惯、异常的用餐行为以及护理人员与患者在进餐问题上紧张的互动。这进一步导致了理想的CF营养标准与CF患者每日适当能量摄入挑战的现实之间的差异。CF医疗服务提供者必须有能力识别其CF患者潜在的饮食失调和身体形象紊乱问题。应制定并实施改进的筛查和监测措施，在所有CF护理团队成员（包括营养师、心理健康专业人员和社会工作者）的多学科支持下，以最好地支持整体护理并优化治疗效果。对这些问题的更多关注可能有助于降低与CF相关的发病率和死亡率。
