Growth & Nutrition in Cystic FibrosisAssessing differences between two Wisconsin cohorts

Claire Clemens, MS, RDPediatric Pulmonary Center TraineeJanuary 24, 2012

Background

2005 MSN Benchmarking visit 2006 Return to clinic algorithm

2005 CFF recommendations: BMI goal = 50%tile

2009 CFF Infant Care Guidelines

Assume Greater focus on NUTRITION

Research Question

Does increased focus on nutrition improve growth outcomes in children with CF from 0-2 years?

Methodology

Retrospective medical record analysis Growth Feeding

Madison and Milwaukee CF centers

Cohort comparison: Born 2000-2004 Born 2006-2010

Cohort Characteristics

Characteristic 2000-2004 (n=53) 2006-2010 (n=37)

Age: Dx (mo) Mean 0.98 --

Median 0.30 --

Age: First visit (mo) Mean 1.48 1.00

Median 0.69 0.63

Gender Male 26 (49%) 16 (43%)

Female 27 (51%) 21 (57%)

Phenotype MI 8 (15%) 5 (13%)

PS 6 (11%) 11 (30%)

PI 39 (74%) 21 (57%)

Birth Wt (g) 3303 3260

Growth Outcomes

p = 0.5458

p = 0.0408

p = 0.0072

Growth Outcomes: PIp = 0.0184

p = 0.8406

p = 0.0570

Feeding Practices: Breastfeeding

Feeding practice 2000-2004 2006-2010

Ever BF# 4.99 5.59

Ex BF 1.26 1.63

Phenotype 2000-2004 2006-2010

MI 3/8 0/5

PS 2/6 4/11

PI 20/39 4/21

Never breastfed:

Average breastfeeding duration (mos):

#Ever BF = Ex BF + Partial BF

*p = 0.0108

Feeding Practices: Supplementation

High calorie formula or shakes

No difference in age when supplementation began

Phenotype 2000-2004 2006-2010

MI 3/8 0/5

PS 5/6 6/11

PI 27/39 2/21

Phenotype of subjects not receiving high calorie supplementation:

*p < 0.0001

Clinic Visits

Cumulative clinic visits through 24 months

*P = 0.0014#P = 0.0002+P < 0.0001

**

#

#

+

+

Infection

Mean positive sputum cultures through age 2 yr

Limitations

Small population with high variability Feeding groups Phenotype groups

Retrospective

Dependent on data contained in chart

Conclusions

In more recent cohort:

More aggressive nutrition intervention may contribute to improved weight-for-length percentiles prior to age 2

More children were breastfed

More children received high calorie supplementation

Thank You!

Tami Miller

Dr. Lai’s lab: Zhumin Zhang Suzanne Shoff

Mary Marcus