June 12, 2007

Using Nutrition to Stay Healthy with CF: Presentation

This Web cast is supported by an unrestricted educational grant from Genentech, Inc.

Using Nutrition to Stay Healthy with CF

Drucy Borowitz, M.D.Joseph Cronin, M.D.

Christine Coburn-Miller, M.S.R.D.

Our goal is healthy, full lives

From childhood…

Taylor S.

Throughadulthood!

Nancy M. and her daughter

For children under 2 years of age weight-for-length is used

Body Mass Index (BMI) Percentile is

used for people ages 2-20 years

BMI = weight(height)2

BMI Calculator at www.cdc.gov

BMI is used for people over age 20 years

BMI = weight(height)2

BMI Calculator at www.cdc.gov

BMI PercentileMales Females

FEV 1

% P

redi

cted

50556065707580859095

100

<5 5 10 15 20 25 30 35 40 45 50 55 60 65 70 75 80 85 90 95

FEV1 % Predicted vs. BMI PercentileAges 6 to 20 years

BMI PercentileMales Females

FEV 1

% P

redi

cted

50556065707580859095

100

<5 5 10 15 20 25 30 35 40 45 50 55 60 65 70 75 80 85 90 95

FEV1 % Predicted vs. BMI PercentileAges 6 to 20 years

BMI PercentileMales Females

FEV 1

% P

redi

cted

50556065707580859095

100

<5 5 10 15 20 25 30 35 40 45 50 55 60 65 70 75 80 85 90 95

FEV1 % Predicted vs. BMI PercentileAges 6 to 20 years

BMI PercentileMales Females

FEV 1

% P

redi

cted

50556065707580859095

100

<5 5 10 15 20 25 30 35 40 45 50 55 60 65 70 75 80 85 90 95

FEV1 % Predicted vs. BMI PercentileAges 6 to 20 years

90

FEV1 % Predicted vs. BMI Ages 21 to 40 years

FEV 1

% P

redi

cted

BMIMales Females

25303540455055606570758085

15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30

Females ≥ 22 BMIMales ≥ 23 BMI

90

FEV1 % Predicted vs. BMI Ages 21 to 40 years

FEV 1

% P

redi

cted

BMIMales Females

25303540455055606570758085

15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30

Females ≥ 22 BMIMales ≥ 23 BMI

2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21Age in years

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<10Weight Percentiles

>50

The more you weigh early in life, the taller you’ll be as an adult

2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21Age in years

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The more you weigh early in life, the taller you’ll be as an adult

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The more you weigh early in life, the taller you’ll be as an adult

2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21Age in years

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Hei

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The more you weigh early in life, the taller you’ll be as an adult

2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21Age in years

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The more you weigh early in life, the taller you’ll be as an adult

Slide courtesy of Judy Marciel, C.P.N.P.

Slide courtesy of Judy Marciel, C.P.N.P.

Slide courtesy of Judy Marciel, C.P.N.P.

Slide courtesy of Judy Marciel, C.P.N.P.

Lipase digests fats

Slide courtesy of Judy Marciel, C.P.N.P.

Proteasedigests proteins

Slide courtesy of Judy Marciel, C.P.N.P.

Amylase digests starches

Basics of Preventive Nutrition• Eat high-calorie, high-fat

meals and snacks every day• Establish good meal-time

behaviors• Take enzymes with every

meal and snack if your pancreas isn’t working

• Take CF vitamins every day

June 12, 2007

Using Nutrition to Stay Healthy with CF: Presentation

Number of Adults with CF in U.S.A.

19750

2000400060008000

1000012000

1970 1980 1990 2000 20061970 1975 1980 1985 1990 1995 2000 2005 2006Year

2000

4000

6000

8000

10000

12000

0

Education - Adults with CF

Some College

34%

9%

27%

30%

Less than High School

High School diploma

College graduate

2005 CF Foundation’s Patient Registry

Employment - Adults with CF Homemaker

Student

Retired

36%

27%

14%

10%

8%4%

1%

Full-time

Part-time

Unemployed

Disabled

2005 CF Foundation’s Patient Registry

Marital Status - Adults with CF

SingleMarried/Living

Together

WidowedSeparated/Divorced 0.2%4.9%

36%58.9%

2005 CF Foundation’s Patient Registry

June 12, 2007

Using Nutrition to Stay Healthy with CF: Presentation

What if Eating Becomes a Challenge?

• Try simple behavioral changes

• Seek an expert’s advice• Think about using tube

feedings (e.g., gastrostomy,G-tube, GT, button, NG)

ChildBehavior

Typical Parent Response

BehavioralChange

Taking bites • Not noticing Compliment child on eating

Excess talking

• Instructing child to eat

• Feeding child

Ignore child until they take a bite, then answer questions or engage in conversation

ChildBehavior

Typical Parent Response

BehavioralChange

Complaints:• Not liking

food• Negotiating

• Coaxing• Prompting• Making other

meals

Ignore complaints & compliment child for eating foods

Leaving the table

• Coax child to return

• Instruct child to return

Set rules about staying at table during meals

Guide back to table with minimal discussion

ChildBehavior

Typical Parent Response

BehavioralChange

Complaints of being full

• Coax• Prompt• Feeding• Negotiating

amount of food during the meal

Set appropriate food intake expectations and meal length and set rewards

Nutrition: How to Encourage Health Eating www.cff.org

• A tube is inserted directly into the stomach through the skin

• A high-calorie liquid goes into the stomach at night

• The tube is disconnected during the day and closed

Gastrostomy Feedings

June 12, 2007

Using Nutrition to Stay Healthy with CF: Presentation

Gastrostomy button as a

fashion statement!

BMI Calculator at www.cdc.gov

• Originally broadcast in 2007• Now in 2 parts

– Presentation – Part 1– Questions and Answers – Part 2

• Please contact your CF Care Center or the CF Foundation to get your questions answered– CF Foundation - info@cff.org or 1-800 FIGHT CF

June 12, 2007Using Nutrition to Stay Healthy with CF

June 12, 2007

Using Nutrition to Stay Healthy with CF: Presentation