Long term nutritional rehabilitation by gastrostomy in Israeli patients with cystic fibrosis: Clinical outcome in advanced pulmonary disease

Ori Efrati, Meir Mei-Zahav, Joseph Rivlin, Eitan Kerem, Hannah Blau, Asher Barak, Yoram Bujanover, Arie Augarten, Brijit Cochavi, Yaacov Yahav, Dalit Modan-Moses

Research output: Contribution to journalArticlepeer-review

Abstract

Objectives: Several studies have shown a linear correlation between nutritional status and pulmonary function in patients with cystic fibrosis. Our study aims were: 1) To evaluate the effect of nutritional supplementation via gastrostomy on nutritional, clinical, and pulmonary parameters, and 2) To identify predicting factors for success of long-term nutritional rehabilitation. Methods: Twenty-one Israeli patients, aged 8 months to 20 years, underwent gastrostomy insertion from 1992 to 2001. All patients were pancreatic insufficient, and all carried severe mutations (W1282X in 62% of the patients). Anthropometric and clinical data were obtained for each patient: 0-12 months before and 6-12 months and 18-24 months after gastrostomy placement. Standard deviation scores (SDS) for height, weight, and body mass index as well as percent of height-appropriate body weight were calculated. Results: The mean percent-of-predicted forced expiratory volume in 1 second (FEV1) decreased significantly during the first year of gastrostomy feeding (n = 16), from 44.2% ± 13.9 to 41% ± 13.3 (P = 0.05). However, during the second year of therapy (n = 10), a trend toward improvement was observed (from 39.4 ± 12.1 to 41.4 ± 16.1). Weight, and BMI z-scores as well as weight percent-of ideal body weight increased significantly. Height z-score for age decreased during the first year (from -1.9 ± 1.3 to -2.1 ± 1.4), However, a trend toward improvement was observed during the second year. A significant correlation was found between the change in weight z-score and height z-score during the first (r = 0.488, P = 0.016) and the second (r = 0.825, P < 0.001) years. There was no difference between compliers and noncompliers regarding height, weight, and BMI either before or after gastrostomy placement. A significant correlation between age at insertion of gastrostomy and improvement in height z-score (r = 0.52, P = 0.016) was observed. Cystic fibrosis related diabetes (n = 8) did not affect the response to supplemental feeding. Conclusions: We observed a trend toward improvement of pulmonary disease during the second year, and a significant improvement in weight, height, and BMI z-scores. Compliance, diabetes, and young age prior to tube insertion did not predict success of nutritional rehabilitation.

Original languageEnglish
Pages (from-to)222-228
Number of pages7
JournalJournal of Pediatric Gastroenterology and Nutrition
Volume42
Issue number2
DOIs
StatePublished - Feb 2006

Keywords

  • Cystic fibrosis
  • Cystic fibrosis related diabetes (CFRD)
  • Growth retardation
  • Percutaneous endoscopic gastrostomy feeding (PEG)
  • Pulmonary function tests

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