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220 Nutritional outcomes of enteral nutrition in children with cystic fibrosis
10. Gastroenterology/Nutrition
Posters
220 Nutritional outcomes of enteral nutrition in children with cystic fibrosis K. Fisher1 , C. Patchell1 , S. Jones1 , L. Hull1 , S. Cooper1 , M. Desai1 . 1 NHS, SCWM CF Network, Birmingham, United Kingdom Introduction: The importance of good nutrition in CF is well recognised. CF European Consensus guidelines recommend that children achieve good nutrition, aiming for a Body Mass Index (BMI) of the 50th centile [1]. Enteral nutrition (EN) via NG or gastrostomy should be used if nutritional goals are not met by other means. Objectives: To assess if European Consensus nutritional aims are met and maintained after EN is started, the time scale, and identify reasons these may not be achieved. Method: Data on BMI and energy intake from feeds was collected retrospectively from 16 patients (10 male), median age 8.5 yrs (2.5−16 yrs) at start of EN and then at 1/12, 3/12, 6/12, 1, 2 and 3 years after starting. Results: See the table. Problems associated with EN included vomiting and diabetes. Time (yrs) after Median BMI percentile starting EN
% Patients % Patients % Patients % EAR Energy ↑BMI →BMI ↓BMI from feed
0
9th (0.4th−2nd to 25th−50th)
1/12
25th (2nd−75th)
100
50 (30−82)
3/12
25th−50th (2nd−91st)
46
46
8
6/12
25th−50th (9th−91st)
50
8
42
1
25th−50th (9th−75th)
17
17
66
2
25th−50th (9th−75th)
46
27
27
3
9th−25th (2nd−75th)
37
0
63
42 (25−75) 45 (26−80)
Conclusions: BMI improves within 3/12 of starting EN, is maintained for 2 yrs and then declines, despite no change in prescribed EAR energy from feed. Reasons for this decline which may include adherence, tolerance or declining clinical status will be described. Reference(s)
S115
222 Prevalence of overweight & obesity in the Scottish paediatric CF population J. Crocker1 , G. Smith2 . 1 Royal Hospital for Sick Children, Nutrition & Dietetics, Glasgow, United Kingdom; 2 Wishaw General Hospital, Nutrition & Dietetics, Wishaw, United Kingdom Objectives: Children with CF should have a BMI 50th percentile [1]. Scotland has a rate of 28.8% childhood overweight/obesity [2]. We compared rates of overweight/obesity in the Scottish paediatric CF population. Methods: A questionnaire was sent to 10 Scottish paediatric CF Units. 8 responded providing data on 293 children with CF. BMI was plotted on the UK 1990 BMI chart. Results: 12% (34) of the Scottish paediatric CF population were overweight or obese; 8% above the 91st centile and 4% above the 98th centile. The majority (65%) were between 5 and 11 years old, 15% were <5 years old, 10% were 12 years and above. 70% were pancreatic insufficient. The genotype varied, with the majority DF508/DF508 (38%), DF508/G551D (12%) and DF508/R117H (12%). 80% had an FEV1 %predicted score above 90%. Only 3 children had significant CF bacteriology, 1 with mycobacterium abscesses and 2 with Pseudomonas aeruginosa. Glucose tolerance, as assessed by OGTT, was normal in 50% of those old enough for OGTT. 6 children (17%) had impaired glucose tolerance. 10 children were too young for OGTT. Conclusion: Prevalence of overweight/obesity in the Scottish paediatric CF population is lower compared to the general Scottish paediatric population. Long term health consequences of being overweight/obese with CF are unknown. However, it is likely to be an increasing issue as treatments and life expectancy improve. Primary school age children may be at greatest risk of becoming overweight/obese. Genotype may not be an indication of future fatness/thinness, as a large proportion of this group were homozygote for DF508.
[1] Sinaasappel et al. Nutrition in patients with Cystic Fibrosis: A European Consensus. J Cystic Fibros, 2002; 51−75.
Reference(s) [1] CFF, 2008. [2] Scottish Health Survey, 2013.
221 Influence of nutritional status of children with cystic fibrosis on disease outcome
223 Prevalence of overweight and obesity in Scottish adults with cystic fibrosis
I. Yankov1 , N. Genkova1 , M. Bosheva1 . 1 St. George University Hospital, Pediatrics and Medical Genetics, Plovdiv, Bulgaria
L. Robb1 , M. Richardson1 , A. Peters1 , H.C. Rodgers1 . 1 Scottish Adult Cystic Fibrosis Service, Western General Hospital, Edinburgh, United Kingdom
Objectives: To establish the influence of nutritional status of children with CF, who are in critical condition, on disease outcome. Methods: This is a retrospective study of children with CF admitted to the pediatric ICU of St. George University Hospital, Plovdiv, from January 2004 to June 2013. Children were admitted because of respiratory failure, heart failure or dehydration. We analyzed patients’ weight, height, BMI, severity of the disease based on the Shwachman-Kulczycki score, colonization with P. aeruginosa, length of hospital stay and disease outcome. Results: 23 children are included in the study − 12 boys and 11 girls. The mean age of the patients is 63.7 months (1–214 months). The main reason for admission to ICU was respiratory infection (78.3%). Two of the children had severe dehydration and one had arrhythmia. Five of the patients died in ICU (21.7%). There is a positive correlation between the nutrition deficit on one side, low ShwachmanKulczycki score, longer hospital stay and unfavourable disease outcome on the other. Children without nutritional deficit had a significantly shorter hospital stay and higher Shwachman-Kulczycki score on admission. We did not establish a statistically significant correlation between the degree of nutritional deficit and colonization with P. aeruginosa. Conclusion: Children with nutritional deficit and low Shwachman-Kulczycki score have a longer hospital stay and are at a higher risk of unfavorable disease outcome. If the nutritional deficit is diagnosed early and actively corrected, this could lead to shorter hospital stay and reduced disease severity while on ICU.
Background: Incidence of overweight (defined as BMI 25−30 kg/m2 in adults) and obesity (BMI >30 kg/m2 ) is increasing. Scottish Government statistics indicate that over 60% of adults are overweight or obese increasing risk of cardiovascular (CV) disease. Prevalence of overweight and obesity among individuals with Cystic Fibrosis (CF) is also increasing. Rates of 6−13% have been reported throughout Europe and nearly half of Australian adult men with CF are overweight or obese. There does not appear to be the same correlation between overweight/obesity and CV risk in CF but it may place an additional burden on the endocrine pancreas. Being overweight/obese may actually exert a positive effect on lung function contrary to its role in non-CF individuals. This positive association between nutritional status and lung function may be limited when BMI >23 kg/m2 . Objectives: Audit prevalence of overweight/obesity in Scottish Adult CF patients. Methods: Scottish Adult CF Centres were invited to take part in the study (n = 4) and asked to complete a short survey. Results were collated and analysed by the Scottish Adult CF Dietitians Results: Data was obtained for 531 Scottish Adult CF patients (Aberdeen n = 63, Dundee n = 46, Edinburgh n = 177, Glasgow n = 245). 20.7% were overweight/obese (15.6% & 5.1% respectively). In the obese group, mean FEV1 was 87.4% predicted. 11% were post transplant. 84% were non-Pseudomonas aeruginosa (PA). 59.3% were pancreatic sufficient. 26.9% had abnormal glucose tolerance. Conclusion: One fifth of the Scottish Adult CF population are overweight indicating higher prevalence than the rest of Europe.
Posters
220 Nutritional outcomes of enteral nutrition in children with cystic fibrosis K. Fisher1 , C. Patchell1 , S. Jones1 , L. Hull1 , S. Cooper1 , M. Desai1 . 1 NHS, SCWM CF Network, Birmingham, United Kingdom Introduction: The importance of good nutrition in CF is well recognised. CF European Consensus guidelines recommend that children achieve good nutrition, aiming for a Body Mass Index (BMI) of the 50th centile [1]. Enteral nutrition (EN) via NG or gastrostomy should be used if nutritional goals are not met by other means. Objectives: To assess if European Consensus nutritional aims are met and maintained after EN is started, the time scale, and identify reasons these may not be achieved. Method: Data on BMI and energy intake from feeds was collected retrospectively from 16 patients (10 male), median age 8.5 yrs (2.5−16 yrs) at start of EN and then at 1/12, 3/12, 6/12, 1, 2 and 3 years after starting. Results: See the table. Problems associated with EN included vomiting and diabetes. Time (yrs) after Median BMI percentile starting EN
% Patients % Patients % Patients % EAR Energy ↑BMI →BMI ↓BMI from feed
0
9th (0.4th−2nd to 25th−50th)
1/12
25th (2nd−75th)
100
50 (30−82)
3/12
25th−50th (2nd−91st)
46
46
8
6/12
25th−50th (9th−91st)
50
8
42
1
25th−50th (9th−75th)
17
17
66
2
25th−50th (9th−75th)
46
27
27
3
9th−25th (2nd−75th)
37
0
63
42 (25−75) 45 (26−80)
Conclusions: BMI improves within 3/12 of starting EN, is maintained for 2 yrs and then declines, despite no change in prescribed EAR energy from feed. Reasons for this decline which may include adherence, tolerance or declining clinical status will be described. Reference(s)
S115
222 Prevalence of overweight & obesity in the Scottish paediatric CF population J. Crocker1 , G. Smith2 . 1 Royal Hospital for Sick Children, Nutrition & Dietetics, Glasgow, United Kingdom; 2 Wishaw General Hospital, Nutrition & Dietetics, Wishaw, United Kingdom Objectives: Children with CF should have a BMI 50th percentile [1]. Scotland has a rate of 28.8% childhood overweight/obesity [2]. We compared rates of overweight/obesity in the Scottish paediatric CF population. Methods: A questionnaire was sent to 10 Scottish paediatric CF Units. 8 responded providing data on 293 children with CF. BMI was plotted on the UK 1990 BMI chart. Results: 12% (34) of the Scottish paediatric CF population were overweight or obese; 8% above the 91st centile and 4% above the 98th centile. The majority (65%) were between 5 and 11 years old, 15% were <5 years old, 10% were 12 years and above. 70% were pancreatic insufficient. The genotype varied, with the majority DF508/DF508 (38%), DF508/G551D (12%) and DF508/R117H (12%). 80% had an FEV1 %predicted score above 90%. Only 3 children had significant CF bacteriology, 1 with mycobacterium abscesses and 2 with Pseudomonas aeruginosa. Glucose tolerance, as assessed by OGTT, was normal in 50% of those old enough for OGTT. 6 children (17%) had impaired glucose tolerance. 10 children were too young for OGTT. Conclusion: Prevalence of overweight/obesity in the Scottish paediatric CF population is lower compared to the general Scottish paediatric population. Long term health consequences of being overweight/obese with CF are unknown. However, it is likely to be an increasing issue as treatments and life expectancy improve. Primary school age children may be at greatest risk of becoming overweight/obese. Genotype may not be an indication of future fatness/thinness, as a large proportion of this group were homozygote for DF508.
[1] Sinaasappel et al. Nutrition in patients with Cystic Fibrosis: A European Consensus. J Cystic Fibros, 2002; 51−75.
Reference(s) [1] CFF, 2008. [2] Scottish Health Survey, 2013.
221 Influence of nutritional status of children with cystic fibrosis on disease outcome
223 Prevalence of overweight and obesity in Scottish adults with cystic fibrosis
I. Yankov1 , N. Genkova1 , M. Bosheva1 . 1 St. George University Hospital, Pediatrics and Medical Genetics, Plovdiv, Bulgaria
L. Robb1 , M. Richardson1 , A. Peters1 , H.C. Rodgers1 . 1 Scottish Adult Cystic Fibrosis Service, Western General Hospital, Edinburgh, United Kingdom
Objectives: To establish the influence of nutritional status of children with CF, who are in critical condition, on disease outcome. Methods: This is a retrospective study of children with CF admitted to the pediatric ICU of St. George University Hospital, Plovdiv, from January 2004 to June 2013. Children were admitted because of respiratory failure, heart failure or dehydration. We analyzed patients’ weight, height, BMI, severity of the disease based on the Shwachman-Kulczycki score, colonization with P. aeruginosa, length of hospital stay and disease outcome. Results: 23 children are included in the study − 12 boys and 11 girls. The mean age of the patients is 63.7 months (1–214 months). The main reason for admission to ICU was respiratory infection (78.3%). Two of the children had severe dehydration and one had arrhythmia. Five of the patients died in ICU (21.7%). There is a positive correlation between the nutrition deficit on one side, low ShwachmanKulczycki score, longer hospital stay and unfavourable disease outcome on the other. Children without nutritional deficit had a significantly shorter hospital stay and higher Shwachman-Kulczycki score on admission. We did not establish a statistically significant correlation between the degree of nutritional deficit and colonization with P. aeruginosa. Conclusion: Children with nutritional deficit and low Shwachman-Kulczycki score have a longer hospital stay and are at a higher risk of unfavorable disease outcome. If the nutritional deficit is diagnosed early and actively corrected, this could lead to shorter hospital stay and reduced disease severity while on ICU.
Background: Incidence of overweight (defined as BMI 25−30 kg/m2 in adults) and obesity (BMI >30 kg/m2 ) is increasing. Scottish Government statistics indicate that over 60% of adults are overweight or obese increasing risk of cardiovascular (CV) disease. Prevalence of overweight and obesity among individuals with Cystic Fibrosis (CF) is also increasing. Rates of 6−13% have been reported throughout Europe and nearly half of Australian adult men with CF are overweight or obese. There does not appear to be the same correlation between overweight/obesity and CV risk in CF but it may place an additional burden on the endocrine pancreas. Being overweight/obese may actually exert a positive effect on lung function contrary to its role in non-CF individuals. This positive association between nutritional status and lung function may be limited when BMI >23 kg/m2 . Objectives: Audit prevalence of overweight/obesity in Scottish Adult CF patients. Methods: Scottish Adult CF Centres were invited to take part in the study (n = 4) and asked to complete a short survey. Results were collated and analysed by the Scottish Adult CF Dietitians Results: Data was obtained for 531 Scottish Adult CF patients (Aberdeen n = 63, Dundee n = 46, Edinburgh n = 177, Glasgow n = 245). 20.7% were overweight/obese (15.6% & 5.1% respectively). In the obese group, mean FEV1 was 87.4% predicted. 11% were post transplant. 84% were non-Pseudomonas aeruginosa (PA). 59.3% were pancreatic sufficient. 26.9% had abnormal glucose tolerance. Conclusion: One fifth of the Scottish Adult CF population are overweight indicating higher prevalence than the rest of Europe.