Gokdemir Yasemin, Eralp Ela Erdem, Ergenekon Almala Pinar, Yegit Cansu Yilmaz, Yanaz Muruvvet, Mursaloglu Hakan, Uzunoglu Burcu, Kocamaz Damla, Tastan Gamze, Filbrun Amy, Enochs Catherine, Bouma Sandra, Iwanicki Courtney, Karakoc Fazilet, Nasr Samya Z, Karadag Bulent
Division of Pediatric Pulmonology, Marmara University School of Medicine, Istanbul, Turkey.
Department of Emergency Medicine, King's College Hospital, London, UK.
Pediatr Pulmonol. 2023 May;58(5):1463-1470. doi: 10.1002/ppul.26344. Epub 2023 Mar 21.
A collaboration between the University of Michigan (UM) Cystic Fibrosis Center (CFC) and Marmara University (MU) CFC was initiated in MU through conducting Quality Improvement projects (QIP). The global aim was to improve nutritional status of children with CF (cwCF), with a specific aim to increase the mean BMI percentile (BMIp) for cwCF by 10 percentile points in 12 months.
Body mass index (BMI) percentiles of cwCF were categorized as: nutritionally adequate (BMIp ≥ 50%); at risk (BMIp 25%-49%); urgently at risk (BMIp 10%-25%); critically at risk (BMIp < 10%). Appropriate interventions were made according to BMIp category every three months. Forced expiratory volume in one-second percent predicted (FEV1pp), and health-related quality of life (HRQoL) were evaluated.
One hundred and eight-two cwCF with a mean age of 9.1 ± 4.3 years were included in the project. Baseline BMIp increased from 25.6 to 37.2 at the 12th month (p < 0.001). In the critically at-risk group BMIp increased from 3.6 to 20.5 (p < 0.001), in the urgently at risk group from 15.9 to 30.8 (p < 0.001), in the at risk group from 37.0 to 44.2 (p < 0.079) and in the nutritionally adequate group the increase was from 66.8 to 69.5 (p < 0.301). FEV1pp also improved significantly, from 81.3 ± 20.6 to 85.9 ± 20.8 (p < 0.001). Physical functioning, eating problems, and respiratory symptoms domains of the HRQoL evaluation improved (p < 0.05).
This project has led to significant improvements in BMIp, FEV1pp and HRQoL of cwCF; similar projects could easily be implemented by centers in other developing countries.
密歇根大学（UM）囊性纤维化中心（CFC）与马尔马拉大学（MU）CFC通过开展质量改进项目（QIP）在MU发起了一项合作。总体目标是改善囊性纤维化患儿（cwCF）的营养状况，具体目标是在12个月内将cwCF的平均体重指数百分位数（BMIp）提高10个百分点。
将cwCF的体重指数（BMI）百分位数分为：营养充足（BMIp≥50%）；有风险（BMIp 25%-49%）；急需关注（BMIp 10%-25%）；极度危险（BMIp＜10%）。每三个月根据BMIp类别进行适当干预。评估一秒用力呼气量占预计值百分比（FEV1pp）和健康相关生活质量（HRQoL）。
该项目纳入了182例平均年龄为9.1±4.3岁的cwCF患儿。第12个月时，基线BMIp从25.6升至37.2（p＜0.001）。极度危险组的BMIp从3.6升至20.5（p＜0.001），急需关注组从15.9升至30.8（p＜0.001），有风险组从37.0升至44.2（p＜0.079），营养充足组从66.8升至69.5（p＜0.301）。FEV1pp也显著改善，从81.3±20.6升至85.9±20.8（p＜0.001）。HRQoL评估中的身体功能、饮食问题和呼吸症状领域有所改善（p＜0.05）。
该项目使cwCF的BMIp、FEV1pp和HRQoL得到显著改善；其他发展中国家的中心可以轻松实施类似项目。
