Study Identifies Risk Factors of Malnutrition in Children With CF

Children with cystic fibrosis (CF) who are older, thinner, or have worse lung function may be at increased risk of malnutrition, a study indicates.

These findings highlight the importance of screening for malnutrition among children with CF.

The study, “Triage for Malnutrition Risk among Pediatric and Adolescent Outpatients with Cystic Fibrosis, Using a Disease-Specific Tool,” was published in the journal Children.

Because the function of the pancreas is affected in CF, people with the condition may be at increased risk of malnutrition — in which a person’s diet fails to provide enough energy and nutrients for their body to function properly.

Children are particularly vulnerable to the effects of malnutrition because their bodies are still developing. For this reason, it is important to monitor the nutritional status of children with CF.

Researchers in Greece assessed malnutrition risk in 76 children (32 boys and 44 girls), between the ages of 6 and 18, with CF. Their data was collected as part of an observational study called GreeCF.

For their purposes, they used a screening tool specifically designed to evaluate nutritional status people with CF. The tool calculates malnutrition risk based on 10 factors, including body mass index (BMI, a ratio of weight to height), forced expiratory volume (FEV, a lung function measure), dietary intake, pancreas function, reduced height or weight, infection with specific disease-causing organisms, and enteral feeding, in which complete nutrition is delivered directly to the stomach or small intestine.

According to this tool, patients with scores of 0–3 are classified as having a low risk of malnutrition; scores of 4–7 indicate an average risk; and scores higher than 8 are considered high risk.

Of the 76 children assessed, 60 (78.9%) had a low risk of being malnourished. The rest were at average risk; none of the children were at high risk of malnutrition.

“In the present study, participants with CF were predominantly well-nourished and exhibited adequate physiological lung function, with a moderate risk for malnutrition prevailing only in small proportions (1/5) of the sample,” the researchers wrote.

Statistical analyses also found a significant positive association between malnutrition risk and age. In other words, older children were at a higher risk of becoming malnourished than younger children. These analyses also indicated the risk of malnutrition was higher among children who were shorter, had worse lung function, and lower BMI.

Although worse lung function was correlated with a higher risk of malnutrition, the researchers also noted that 37.5% of the children at a moderate risk of becoming malnourished had adequate lung function.

“The present study is one of the few that have assessed malnutrition risk in the pediatric CF population, further highlighting risk factors for malnutrition that may be masked under optimal clinical outcomes (such as physiological lung function),” the researchers wrote.

But they acknowledged the study had several limitations, including its small sample size, cross-sectional design, and the fact that some relevant parameters (e.g., nutrient levels in the children’s blood) were not measured. They also noted a need for more research into how CF treatments affect nutritional status.

“Screening for malnutrition risk in pediatric patients with CF is important, although often neglected. Even in populations with a low prevalence of malnutrition, the risk for malnutrition might be elevated, highlighting the need for more frequent assessments and nutrition interventions,” they concluded.