Nutritional status of individuals under 18 years old with cystic fibrosis: usual anthropometric index versus body composition
DOI:
https://doi.org/10.52521/nutrivisa.v12i1.15042Keywords:
cystic fibrosis; nutritional status; electric impedance; body mass index; body composition.Abstract
Nutritional status in cystic fibrosis (CF) is associated with prognosis and survival of patients, with body mass index (BMI) being the widely used parameter in clinical practice and assessment of body composition as a recommended complementary method. Aiming to assess nutritional status by comparing body mass index with body composition of individuals under 18 years of age with cystic fibrosis, a cross-sectional study was conducted with individuals under 18 years of age with cystic fibrosis (CF). Body mass index (BMI) and body weights of fat mass (FM) and fat-free mass (FFM) were evaluated by sex and age (medical record data), comparing body composition between sexes and BMI categories. Data from 57 individuals with CF, aged between 4.1 and 17.7 years, were included. The mean BMI was 16 kg/m2 (12.5–26.3 kg/m2). There was a higher frequency of adequate BMI (77.2%), and a lower frequency (10.5%) of BMI below the recommended level. Regarding body composition, 21.1% had FM above and 33.3% had FFM below the recommended level for their age. Furthermore, of the individuals with FFM below the recommended level, 26.3% had high FM. There was a difference between the BMI categories for both FM (p = 0.003) and FFM (p = 0.016). It was concluded that BMI, although widely used, is insufficient to adequately assess the nutritional status of children and adolescents with CF, as it does not allow the identification of hidden nutritional deficits. Therefore, it is recommended to integrate detailed analysis of body composition into the assessment of nutritional status in CF.
References
AIDOO, E., ALEXANDER, S., ALSHAFI, K., AL-YAGHCHI, C., ANDERSON, A.-K., BALFOUR-LYNN, I., BENTLEY, S., BUCHDAHL, R., BERESFORD, F., BILTON, D., BOSSLEY, C., BRIDGES, N., BROWN, S., BUSH, A., CARR, S., CARTWRIGHT, E., COLLINS, N., COURTNEY, C., COWLARD, J., CRAIG, F., CRAM, H., DAVIES, J., DEVON, C., DICK, K., DIXON, E., DOCKER, J., ELKIN, S., EQUI, A., FRANCIS, J., GARDNER, L., GOODHART, F., GRANT, W., GREGORY, J., GRIGORE, G., GRIME, C., HADJISYMEOU-ANDREOU, S., HANDFORD, A., HARCOURT, J., HARMAN-COLLINS, C., HARRINGTON, A., HARRIS, A., HENNEY, K., HILL, L., HILLIARD, T., HIRSCH, N., HUGHES, D., IRVING, S., JONES, D., JURD, M., KENNY, S., KHAN, K., KING, J., KOZLOWSKA, W., LEAR, E., MACLEOD, K., MADGE, S., MAKHECHA, S., MARTINDALE, K., MCCULLOGH, A., MCKEE, A., MCNAMARA, P., MCSHANE, D., MINASIAN, C., MOLEDINA, S., MONTGOMERY, A., MURRAY, N., NIGHTINGALE, M., NORTH, A., OFFICE, D., OVENS, M., PABARY, R., PAO, C., PIKE, S., PUCKEY, M., REED, L., ROSENTHAL, M., SCHELENZ, S., SCHEMBRI, L., SEDDON, L., SIMMONDS, N., SMITH, W., SPENCER, H., STONE, V., STRINGER, P., STUHLER, R., TURNER, J., TURNBULL, A., VASEY, K., WALLACE, H., WARRAICH, S., WINGETT, C. Clinical guidelines: Care of children with cystic fibrosis, 2023 | Royal Brompton & Harefield hospitals. 9. ed. London, UK: Ian Balfour-Lynn, 2023. Disponível em: https://www.rbht.nhs.uk/childrencf.
ATHANAZIO, R.A., FILHO, VERGARA, A.A., RIBEIRO, A.F., RIEDI, C.A., PROCIANOY, E. DA F.A., ADDE, F.V., REIS, F.J.C., RIBEIRO, J.D., TORRES, L.A., FUCCIO, M.B. DE, EPIFANIO, M., FIRMIDA, M. DE C., DAMACENO, N., LUDWIG-NETO, MARÓSTICA, RACHED, S.Z., MELO, S.F. DE O., GRUPO DE TRABALHO DAS DIRETRIZES BRASILEIRAS DE DIAGNÓSTICO E TRATAMENTO DA FIBROSE CÍSTICA. Diretrizes brasileiras de diagnóstico e tratamento da fibrose cística. Jornal Brasileiro de Pneumologia, v. 43, n. 3, p. 219–245, 2017. https://doi.org/10.1590/S1806-37562017000000065
BAILEY, J., ROZGA, M., MCDONALD, C.M., BOWSER, E.K., FARNHAM, K., MANGUS, M., PADULA, L., PORCO, K., ALVAREZ, J.A. Effect of CFTR Modulators on Anthropometric Parameters in Individuals with Cystic Fibrosis: An Evidence Analysis Center Systematic Review. Journal of the Academy of Nutrition and Dietetics, v. 121, n. 7, p. 1364-1378.e2, 2021. https://doi.org/10.1016/j.jand.2020.03.014
BOMFIM, J.C., DE MELO FILHO, V.M., DE JESUS, A.S., COQUEIRO, F.G., SOUZA, E.L. Avaliação antropométrica e sua associação com variáveis clínicas em pacientes pediátricos com fibrose cística de um centro no Nordeste brasileiro. Revista de Ciências Médicas e Biológicas, v. 19, n. 2, p. 298, 24 set. 2020. https://doi.org/10.9771/cmbio.v19i2.36560
BONHOURE, A., BOUDREAU, V., LITVIN, M., COLOMBA, J., BERGERON, C., MAILHOT, M., TREMBLAY, F., LAVOIE, A., RABASA-LHORET, R. Overweight, obesity and significant weight gain in adult patients with cystic fibrosis association with lung function and cardiometabolic risk factors. Clinical Nutrition, v. 39, n. 9, p. 2910–2916, 2020. https://doi.org/10.1016/j.clnu.2019.12.029
ESCALDELAI, F.M.D., DA SILVA, L.V.R.F., NERI, L. DE C.L., BERGAMASCHI, D.P. Quality of anthropometric data measured in children and adolescents with cystic fibrosis: a scoping review. Revista Paulista de Pediatria, [S. l.], v. 41, p. e2021333, 2023. https://doi.org/10.1590/1984-0462/2023/41/2021333
GOMES, A.; HUTCHEON, D.; ZIEGLER, J. Association Between Fat-Free Mass and Pulmonary Function in Patients With Cystic Fibrosis: A Narrative Review. Nutrition in Clinical Practice, v. 34, n. 5, p. 715–727, 2019. https://doi.org/10.1002/ncp.10251
IMREI, M., KÉRI, A.F., GÁCS, É., GÖNCZI, I., MELÁTH, M., KOSARAS, É., DEMETER, B., PÉTERFIA, C., VASS, K., SZÉKELY, G., OCSKAY, K., PÁRNICZKY, A. Body composition changes and clinical outcomes in pediatric cystic fibrosis during 24 months of lumacaftor ivacaftor therapy based on real-world data. Scientific Reports, [S. l.], v. 15, n. 1, p. 2247, 17 jan. 2025. https://doi.org/10.1038/s41598-025-86010-1
MADDE, A., OKONIEWSKI, W., SANDERS, D.B., REN, C.L., WEINER, D.J., FORNO, E. Nutritional status and lung function in children with pancreatic-sufficient cystic fibrosis. Journal of Cystic Fibrosis, v. 21, n. 5, p. 769–776, 2022. https://doi.org/10.1016/j.jcf.2021.12.014
MCDONALD, C.M., BOWSER, E.K., FARNHAM, K., ALVAREZ, J.A., PADULA, L., ROZGA, M. Dietary Macronutrient Distribution and Nutrition Outcomes in Persons with Cystic Fibrosis: An Evidence Analysis Center Systematic Review. Journal of the Academy of Nutrition and Dietetics, v. 121, n. 8, p. 1574-1590.e3, 1 ago. 2021. https://doi.org/10.1016/j.jand.2020.03.016
MINISTÉRIO DA SAÚDE BRASIL. Protocolo Clínico e Diretrizes Terapêuticas da Fibrose Cística. PORTARIA CONJUNTA SAES/SECTICS No 5, DE 30 DE ABRIL DE 2024. p. 47, 2024. Disponível em: https://www.gov.br/saude/pt-br/assuntos/pcdt/arquivos/2022/portal-portaria-conjunta-no-25_pcdt_fibrose-cistica.pdf/view.
NERI, L. DE C.L., SIMON, M.I.S. DOS S., AMBRÓSIO, V.L.S., BARBOSA, E., GARCIA, M.F., MAURI, J.F., GUIRAU, R.R., NEVES, M.A., CUNHA, C. DE A.P., NOGUEIRA, M.C., ALVES, A.C.D.C., GURMINI, J., SERVIDONI, M. DE F., EPIFANIO, M., ATHANAZIO, R. Brazilian Guidelines for Nutrition in Cystic Fibrosis. Einstein (Sao Paulo), v. 20, p., 2022. https://doi.org/10.31744/einstein_journal/2022RW5686
RITCHIE, H., NAHIKIAN-NELMS, M., ROBERTS, K., GEMMA, S., SHAIKHKHALIL, A. The prevalence of aberrations in body composition in pediatric cystic fibrosis patients and relationships with pulmonary function, bone mineral density, and hospitalizations. Journal of Cystic Fibrosis, v. 20, n. 5, p. 837–842, 1 set. 2021. https://doi.org/10.1016/j.jcf.2021.04.004
SAVANT, A., LYMAN, B., BOJANOWSKI, C., UPADIA, J. Cystic Fibrosis. In: ADAM, M.P., FELDMAN, J., MIRZAA, G.M., PAGON, R.A., WALLACE, S.E., AMEMIYA, A. (ed.). Cystic Fibrosis. 2023. ed. Seattle (WA): University of Washington, Seattle, 2023. v. 1993–2023 . Disponível em: https://www.ncbi.nlm.nih.gov/books/NBK1250/. Acesso em: 7 abr. 2023.
SCULLY, K.J., JAY, L.T., FREEDMAN, S., SAWICKI, G.S., ULUER, A., FINKELSTEIN, J.S., PUTMAN, M.S. The Relationship between Body Composition, Dietary Intake, Physical Activity, and Pulmonary Status in Adolescents and Adults with Cystic Fibrosis. Nutrients, v. 14, n. 2, p. 310, jan. 2022. https://doi.org/10.3390/nu14020310
SILVA, L.A. DA, LIMA, A.C.P., WITTMER, V.L., LIBERATO, F.M.G., ARPINI, L. DA S.B., PARO, F.M. Qualidade de vida de crianças e adolescentes com fibrose cística: importância da imagem corporal e impacto do estado nutricional, idade e raça/cor na percepção dos pacientes e responsáveis. DEMETRA: Alimentação, Nutrição & Saúde, v. 13, n. 3, p. 675–693, 2018. https://doi.org/10.12957/demetra.2018.32295
WILSCHANSKI, M., MUNCK, A., CARRION, E., CIPOLLI, M., COLLINS, S., COLOMBO, C., DECLERCQ, D., HATZIAGOROU, E., HULST, J., KALNINS, D., KATSAGONI, C.N., MAINZ, J.G., RIBES-KONINCKX, C., SMITH, C., SMITH, T., BIERVLIET, S.V., CHOURDAKIS, M. ESPEN-ESPGHAN-ECFS guideline on nutrition care for cystic fibrosis. Clinical Nutrition, v. 43, n. 2, p. 413–445, 1 fev. 2024. https://doi.org/10.1016/j.clnu.2023.12.017
Downloads
Published
How to Cite
Issue
Section
License
Copyright (c) 2025 Luana da Silva Baptista Arpini, Fernanda Mayrink Gonçalves Liberato, Sabrina da Silva Santos, Gina Torres Rego Monteiro

This work is licensed under a Creative Commons Attribution 4.0 International License.








