High-fat, high-calorie foods may be harmful with pancreatic sufficiency

Cystic fibrosis diet could risk obesity-related ills for children in this group

Patricia Inácio, PhD avatar

by Patricia Inácio, PhD |

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An illustration of a child's digestive system.

Children with cystic fibrosis (CF) who have normal pancreas function — called pancreatic sufficiency (PS) — are at higher risk of being overweight and obese than those with pancreatic insufficiency (PI), according to a single-center study in Greece.

According to its researchers, findings support a reevaluation of “the recommendation for a [high-fat, high-calorie] diet … in patients with PS, in order to avoid potential consequences of obesity.”

The study, “Dietary intake, weight status, pulmonary function and metabolic profile in children with cystic fibrosis with or without pancreatic sufficiency,” was published in the journal Nutrition.

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CF diet guidelines do not differ by status of digestive enzyme production

Lung function and overall health with CF are known to benefit from good nutritional status and growth. Current guidelines advise that children and adolescents with this disease consume a high-fat and high-calorie diet, one that provides 110% to 200% of energy requirements for healthy individuals of similar age, sex, and size, including 35%-40% of energy from fat to meet daily energy requirements.

Such a diet is part of treating CF patients with PI, a condition that arises due to the accumulation of thick mucus that affects the release of pancreatic enzymes needed to properly digest food, particularly fats.

While most people with CF develop pancreatic insufficiency, around 15% retain sufficient production of digestive enzymes and typically have less severe disease. However, no dietary guidelines currently exist for PS patients, and most studies assessing nutritional status do not distinguish between patients with and without PI.

Researchers in Greece compared weight, clinical characteristics, and dietary intake of children with CF and pancreatic sufficiency to those of children with pancreatic insufficiency.

Their analysis included 134 CF children (median age of 10; 82% girls) — 30 with PS and 104 with PI — followed at the “Agia Sofia” Children’s Hospital in Athens from 2017 to 2020.

Children with pancreatic sufficiency had a significantly higher body mass index (BMI), a measure of body fat, as well as a higher percentage of excessive weight or obesity when compared to those with pancreatic insufficiency (46.7% vs. 22.1%).

Energy intake was significantly lower in children with PS compared with the group with PI (median 2,222 kcal vs. 2,951 kcal).

Cholesterol levels significantly higher in children with pancreatic sufficiency

Regarding diet, and after adjusting for potential confounding factors like a child’s sex, age and total energy intake, consumption of eggs was significantly lower among children with PS. But consumption of other foods, including cereals, meat and dairy products, as well as legumes, and water showed no differences between the two groups.

The median time spent in physical activities, watching television, or sleeping during the day also didn’t differ between the groups.

Profiling of metabolites, products and intermediates of cellular metabolism, showed that total cholesterol, as well as low-density lipoprotein (LDL) and high-density lipoprotein (HDL) cholesterol — dubbed “bad” and “good” cholesterol — were significantly higher in children with pancreatic sufficiency. No differences were observed regarding triglycerides, another type of fat, and blood glucose (sugar) levels.

Systolic blood pressure, the pressure in the arteries when the heart beats, was higher in children with PS.

“A potential concern about patients with PS would be that overweight and obesity may be associated with other adverse health effects, such as common cardiometabolic risk factors,” from diabetes and hypertension to obstructive sleep apnea, the researchers wrote, adding that cases of adult and pediatric CF patients with such comorbidities are being reported.

Lung function, assessed by forced vital capacity (FVC) and forced expiratory volume in one second (FEV1), was significantly better — as seen in higher scores — in children with PS compared to those with pancreatic insufficiency. FVC is the amount of air a person can exhale after a deep breath, and FEV1 represents that volume in one second.

PS linked with better lung function (assessed by FEV1), even after adjusting for age, sex, BMI, total energy intake, and physical activity, in statistical analyses.

Having pancreatic sufficiency also associated with a higher likelihood of being either obese or overweight.

“In summary, the present study indicates that children with CF and PS have better weight status and pulmonary function than children with PI, despite their lower energy intake,” the scientists wrote.

“Considering that pancreatic status might influence the nutritional management of patients with CF, future studies need to focus in this direction,” they concluded.