Effect of Protein Intake on Weight Gain and Growth in Cystic Fibrosis Patients
Main Article Content
Abstract
Background and aim: despite the knowledge about the importance of adequate nutritional status in the health of patients with cystic fibrosis (CF), achieving protein intake recommendation remains a challenge. The influence of protein on anthropometric parameters in these patients needs to be better studied. The aim of the study was evaluated anthropometric changes after nutritional counselling to increase protein content in CF children and adolescents with low protein intake.
Methods: a prospective longitudinal study in 20 children and adolescents with CF. Food record of 3 consecutive days and anthropometric assessment were applied with an interval of 3 months. Patients with a protein intake <20% of the total daily caloric intake received nutritional counselling to increase protein content and patients with protein intake of ≥20% maintained their routine diet. Data were analyzed using the Generalized Estimating Equations (GEE) model.
Results: 15 patients (75%) had a daily protein intake of less than 20% of total daily calories at the first dietary assessment and received nutritional counselling. After 3 months, the protein content of the diet underwent a statistically significant increase, despite the other macronutrients and total daily calories. There was a significant improvement in z scores for weight (p<0.001), height (p<0.001) and body mass index (BMI) (p=0.001) compared to patients with adequate protein intake.
Conclusion: most CF patients did not meet the daily recommendation for protein intake. The reach of the proper protein intake allowed an increase in weight, height, and BMI.
Article Details
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References
2. Turck D, Braegger CP, Colombo C, et al. ESPEN-ESPGHAN-ECFS guidelines on nutrition care for infants, children, and adults with cystic fibrosis. Clin Nutr. 2016;35(3):557–577. Doi: dx.doi.org/10.1016/j.clnu.2016.03.004
3. Athanazio RA, Silva Filho LVRF da, Vergara AA, et al. Brazilian guidelines for the diagnosis and treatment of cystic fibrosis. J Bras Pneumol. 2017;43(3):219–245. Doi: 10.1590/S1806-37562017000000065
4. Dodge JA, Turck D. Cystic fibrosis: Nutritional consequences and management. Best Pract Res Clin Gastroenterol. 2006;20(3):531–546. Doi: 10.1016/j.bpg.2005.11.006
5. Solomon M, Bozic M, Mascarenhas MR. Nutritional issues in cystic fibrosis. Clin Chest Med. 2016;37(1):97–107. Doi: 10.1016/j.ccm.2015.11.009
6. Colombo C, Nobili RM, Alicandro G. Challenges with optimizing nutrition in cystic fibrosis. Expert Rev Respir Med. 2019;13(6):533–544. Doi: doi.org/10.1080/17476348.2019.1614917
7. White H, Wolfe SP, Foy J, Morton A, Conway SP, Brownlee KB. Nutritional intake and status in children with cystic fibrosis: Does age matter? J Pediatr Gastroenterol Nutr. 2007;44(1):116–123. Doi: 10.1097/01.mpg.0000237929.45846.78
8. Woestenenk JW, Schulkes DA, Schipper HS, van der Ent CK, Houwen RHJ. Dietary intake and lipid profile in children and adolescents with cystic fibrosis. J Cyst Fibros. 2017;16(3):410–417. Doi: dx.doi.org/10.1016/j.jcf.2017.02.010
9. Woestenenk JW, Castelijns SJAM, van der Ent CK, Houwen RHJ. Dietary intake in children and adolescents with cystic fibrosis. Clin Nutr. 2014;33(3):528–532. Doi: 10.1016/j.clnu.2013.07.011
10. Engelen MPKJ, Com G, Deutz NEP. Protein is an important but undervalued macronutrient in the nutritional care of patients with cystic fibrosis. Curr Opin Clin Nutr Metab Care. 2014;17(6):515–520. Doi: 10.1097/MCO.0000000000000100
11. WHO. World Health Organization. Child growth standards, https://www.who.int/tools/child-growth-standards; [acessed 16 September 2021].
12. WHO. World Health Organization. Growth reference data for 5-19 years, https://www.who.int/tools/growth-reference-data-for-5to19-years; [accessed 16 September 2021].
13. Dietbox. Software de nutrição, https://dietbox.me/pt-BR/#; [acessed 08 July 2021].
14. Altman K, McDonald CM, Michel SH, Maguiness K. Nutrition in cystic fibrosis: From the past to the present and into the future. Pediatr Pulmonol. 2019;54(S3):S56–73. Doi: 10.1002/ppul.24521
15. Lahiri T, Hempstead SE, Brady C, et al. Clinical practice guidelines from the Cystic Fibrosis Foundation for preschoolers with cystic fibrosis. Pediatrics. 2016;137(4):e20151784. Doi: 10.1542/peds.2015-1784
16. Declercq D, van Meerhaeghe S, Marchand S, et al. The nutritional status in CF: Being certain about the uncertainties. Clin Nutr ESPEN. 2019;29:15–21. Doi: doi.org/10.1016/j.clnesp.2018.10.009
17. Calvo-Lerma J, Hulst JM, Asseiceira I, et al. Nutritional status, nutrient intake and use of enzyme supplements in paediatric patients with cystic fibrosis; a European multicentre study with reference to current guidelines. J Cyst Fibros. 2017;16(4):510–518. Doi: dx.doi.org/10.1016/j.jcf.2017.03.005
18. Calvo-Lerma J, Boon M, Hulst J, et al. Change in nutrient and dietary intake in European children with cystic fibrosis after a 6-month intervention with a self-management mHealth Tool. Nutrients. 2021;13(6):1801. Doi: doi.org/10.3390/nu13061801
19. Mehta NM, Corkins MR, Lyman B, et al. Defining pediatric malnutrition: A paradigma shift toward etiology-related definitions. J Parenter Enteral Nutr. 2013;37(4):460–481. Doi: 10.1177/0148607113479972
20. Inzaghi E, Pampanini V, Deodati A, Cianfarani S. The effects of nutrition on linear growth. Nutrients. 2022;14(9):1752. Doi: 10.3390/nu14091752
21. Adhikari S, Schop M, de Boer IJM, Huppertz T. Protein quality in perspective: A review of protein quality metrics and their applications. Nutrients. 2022;14(5):947. Doi: 10.3390/nu14050947
22. Becker P, Carney LN, Corkins MR, et al. Consensus statement of the Academy of Nutrition and Dietetics/American Society for Parenteral and Enteral Nutrition: Indicators recommended for the identification and documentation of pediatric malnutrition (undernutrition). Nutr Clin Pract. 2015;30(1):147–161. Doi: 10.1177/0884533614557642
23. Engelen MPKJ, Com G, Wolfe RR, Deutz NEP. Dietary essential amino acids are highly anabolic in pediatric patients with cystic fibrosis. J Cyst Fibros. 2013;12(5):445–453. Doi: 10.1016/j.jcf.2012.12.011
24. Filigno SS, Robson SM, Szczesniak RD, et al. Macronutrient intake in preschoolers with cystic fibrosis and the relationship between macronutrients and growth. J Cyst Fibros. 2017;16(4):519–524. Doi: dx.doi.org/10.1016/j.jcf.2017.01.010
25. Collins S. Nutritional management of cystic fibrosis – an update for the 21st century. Paediatr Respirator Rev. 2018;26:4–6. Doi: 10.1016/j.prrv.2017.03.006
26. Hollander FM, van Pierre DD, de Roos NM, van de Graaf EA, Iestra JA. Effects of nutritional status and dietetic interventions on survival in cystic fibrosis patients before and after lung transplantation. J Cyst Fibros. 2014;13(2):212–218. Doi: dx.doi.org/10.1016/j.jcf.2013.08.009