Longitudinal, prospective analysis of dietary intake in children with cystic fibrosis,☆☆,,★★,

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Abstract

OBJECTIVES: Prospective, 3-year longitudinal dietary intakes of 25 prepubertal, pancreatic-insufficient children with cystic fibrosis (CF) and mild lung disease, and the intakes of 26 control children were compared, and relationships among energy intake, nutritional status, and pulmonary function were determined. STUDY DESIGN: Intakes from 3-day weighed food records were compared with CF recommendations, recommended dietary allowances (RDA), and the recommendations of the Third National Health and Nutrition Examination Survey (NHANES III). Energy and nutrient intakes were analyzed by repeated-measures analysis of variance. RESULTS: Children with CF consumed more energy than control children (p = 0.025) in terms of calories per day, percentage of RDA by age and by age and weight, energy adjusted for fat malabsorption, and percentage of NHANES III recommendations. Energy intake was similar between boys and girls with CF. The percentage of energy from fat was greater (p = 0.0004) in the CF group (3-year mean, 33%) than in the control group. Height and weight z scores declined in the CF group (p <0.05) with time. Vitamin and mineral intakes were generally adequate in the CF group. CONCLUSIONS: The children in this sample did not consume the CF recommended intakes of 120% RDA for energy or a high-fat (40% of energy) diet. Energy intakes may be insufficient in this group to meet requirements for optimal growth. (J PEDIATR 1996;129:119-29)

Section snippets

METHODS

Subjects with CF were recruited from the CF center at Children's Hospital of Philadelphia. All subjects were adequately grown (height and weight at greater than the 3rd percentile) and had pancreatic insufficiency with mild pulmonary disease at enrollment. CF was diagnosed on the basis of clinical signs and duplicate quantitative pilocarpine iontophoresis sweat tests with sodium and chloride values greater than 60 mEq/L. Pancreatic insufficiency was based on fecal fat analysis of a 72-hour

RESULTS

Twenty-five children with CF (12 boys, 13 girls) and a healthy group of 26 children (14 boys, 12 girls) participated in the study. One child in each group had incomplete dietary data in year 0. Of 183 study evaluations completed, two diet records were returned incomplete and five were not returned. Therefore a total of 176 diet records on 51 children (81 CF, 95 control) were available for analysis. Both before and during the dietary assessment periods, a high-fat, high-calorie diet was

DISCUSSION

This 3-year study prospectively evaluated the pattern of dietary intake in pancreatic-insufficient children with CF, mild lung disease, and relatively good health in comparison with the dietary pattern in healthy control children. Although others have documented cross-sectional dietary intake in children with CF, only one group of investigators5 reported 4 years of energy intake, and this was during an intervention study rather than routine intake. In the current study, the CF group had lower

Acknowledgements

We appreciate the dedication and enthusiasm of the children and their families who participated in this study. Special thanks to the staffs of the CF center of the General Clinical Research Center and the Nutrition and Growth Laboratory; to Babette Zemel, PhD, and Deidre McLeod for their assistance in carrying out this research; and to Gil Diamond, PhD, for genotype analysis.

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    From the Division of Gastroenterology and Nutrition, the Division of Biostatistics and Epidemiology, and the Cystic Fibrosis Center, Children's Hospital of Philadelphia, Department of Pediatrics, University of Pennsylvania School of Medicine, Philadelphia

    ☆☆

    Supported by the Cystic Fibrosis Foundation, and the Heinz Nutrition Center and General Clinical Research Center (RR-00240), Children's Hospital of Philadelphia.

    aCurrently with the Pulmonary Section, St. Christopher's Hospital for Children, Philadelphia, Pa.

    ★★

    Reprint requests: Deborah Kawchak, MS, RD, Division of Gastroenterology and Nutrition, Children's Hospital of Philadelphia, 34th Street and Civic Center Boulevard, Philadelphia, PA 19104-4399.

    0022-3476/96/$5.00 + 0 9/21/73640

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