Clinical nutrition

Long-term use of tube feeding in children with cystic fibrosis: results from two Belgian CF centers

Abstract

Background

Enteral tube feeding (ETF) is often used in an attempt to optimize the nutritional status. The aim of this study was to observe the long term effect of ETF and to compare the start of ETF with the current European guidelines on nutrition care in CF.

Method

From all patients who received ETF (ETFp) between February 2000 and September 2016 in the Ghent University Hospital (GUH) or Brussels University Hospital (BUH), z-scores for body weight (W), height (H), growth velocity (GV) and BMI, FEV1%, and FVC% were retrospectively collected from the patients’ medical record, 3 years before and 5 years after the year of ETF initiation. Gender, age, and pancreatic status matched controls were selected from the GUH database.

Results

All baseline (T0) measurements in ETFp were worse compared to controls. Only 11% of the controls had a Hz < −1.6 compared 58% of the ETFp. After the initiation of ETF a rapid weight gain was noted until the second year (T + 2:−1.9 (−2.8; −1.0) vs. T0:−2.7 (−3.2; −2.1) (p = 0.01) with a stabilization afterwards. A rapid GVz increase was noted at T + 1:1.0 (−0.8; 1.9) vs. T0:−1.5 (−2.0;−0.3). After the start of ETF until T + 3, a stabilization of FEV1% was noted. However, compared to controls, it remained significantly lower (p < 0.05).

Conclusion

ETF as a nutritional intervention has its effect on weight, height, GV, and BMI. To our knowledge this is the first study that describes the evolution of growth in ETFp. The effect on GV argues for a faster introduction of ETF in malnourished children with CF.

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Fig. 1: Evolution of median height z-score (Hz) and growth velocity z-score (GVz) over the 8 year study period for patients and controls.
Fig. 2: Evolution of forced expired volume in 1 s (FEV1) and forced vital capacity (FVC) in the control and the patient group over a study period of 8 years.

References

  1. 1.

    Turck D, Braegger CP, Colombo C, Declercq D, Morton A, Pancheva R, et al. ESPEN-ESPGHAN-ECFS guidelines on nutrition care for infants, children, and adults with cystic fibrosis. Clin Nutr. 2016;35:557–77.

    Article  Google Scholar 

  2. 2.

    Orenti A, Zolin A, Naehrlich L, van Rens J. ECFS Patient Registry annual data report. 2018:1–139.

  3. 3.

    Declercq D, Van Meerhaeghe S, Marchand S, Van Braeckel E, van Daele S, De Baets F, et al. The nutritional status in CF: Bein certain about the uncertainties. Clin Nutr. ESPEN. 2018;29:15–21.

    Article  Google Scholar 

  4. 4.

    Pencharz PB, Durie PR. Pathogenesis of malnutrition in cystic fibrosis, and its treatment. Clin Nutr. 2000;19:387–94.

    CAS  Article  Google Scholar 

  5. 5.

    Erskine JM, Lingard C, Sontag M. Update on enteral nutrition support for cystic fibrosis. Nutr Clin Pract. 2007;22:223–32.

    Article  Google Scholar 

  6. 6.

    Vieni G, Faraci S, Collura M, Lombardo M, Traverso G, Cristadoro S, et al. Stunting is an independent predictor of mortality in patients with cystic fibrosis. Clin Nutr. 2013;32:382–5.

    Article  Google Scholar 

  7. 7.

    Oliver MR, Heine RG, Ng CH, Volders E, Olinsky A. Factors affecting clinical outcome in gastrostomy-fed children with cystic fibrosis. Pediatr Pulmonol. 2004;37:324–9.

    Article  Google Scholar 

  8. 8.

    Steinkamp G, von der Hardt H. Improvement of nutritional status and lung function after long-term nocturnal gastrostomy feedings in cystic fibrosis. J Pediatr. 1994;124:244–9.

    CAS  Article  Google Scholar 

  9. 9.

    Bradley GM, Carson KA, Leonard AR, Mogayzel PJ Jr, Oliva-Hemker M. Nutritional outcomes following gastrostomy in children with cystic fibrosis. Pediatr Pulmonol. 2012;47:743–8.

    Article  Google Scholar 

  10. 10.

    Libeert D, Declercq D, Wanyama S, Thomas M, Van Daele S, De Baets F, et al. The effect of enteral tube feeding in cystic fibrosis: a registry based study. J Cyst Fibros. 2018;17:264–70.

    Article  Google Scholar 

  11. 11.

    White H, Morton AM, Conway SP, Peckham DG. Enteral tube feeding in adults with cystic fibrosis; patient choice and impact on long term outcomes. J Cyst Fibros. 2013;12:616–22.

    CAS  Article  Google Scholar 

  12. 12.

    Van Biervliet S, De Waele K, Van Winckel M, Robberecht E. Percutaneous endoscopic gastrostomy in cystic fibrosis: patient acceptance and effect of overnight tube feeding on nutritional status. Acta Gastro-enterol Belgica. 2004;67:241–4.

    Google Scholar 

  13. 13.

    Schwarzenberg SJ, Hempstead SE, McDonald CM, Powers SW, Wooldridge J, Blair S, et al. Enteral tube feeding for individuals with cystic fibrosis: cystic Fibrosis Foundation evidence-informed guidelines. J Cyst Fibros. 2016;15:724–35.

    Article  Google Scholar 

  14. 14.

    Khalaf RT, Green D, Amankwah EK, Peck J, Carr V, Goldenberg NA, et al. Percutaneous endoscopic gastrostomy tubes may be associated with preservation of lung function in patients with cystic fibrosis. Nutr Clin Pract. 2019;34:290–6.

    Article  Google Scholar 

  15. 15.

    De Boeck K, Zolin A, Cuppens H, Olesen HV, Viviani L. The relative frequency of CFTR mutation classes in European patients with cystic fibrosis. J Cyst Fibros. 2014;13:403–9.

    Article  Google Scholar 

  16. 16.

    Roelants M, Hauspie R, Hoppenbrouwers K. References for growth and pubertal development from birth to 21 years in Flanders, Belgium. Ann Hum Biol. 2009;36:680–94.

    CAS  Article  Google Scholar 

  17. 17.

    Gunnell S, Christensen NK, McDonald C, Jackson D. Attitudes toward percutaneous endoscopic gastrostomy placement in cystic fibrosis patients. J Pediatr Gastroenterol Nutr. 2005;40:334–8.

    Article  Google Scholar 

  18. 18.

    Truby H, Cowlishaw P, O’Neil C, Wainwright C. The long term efficacy of gastrostomy feeding in children with cystic fibrosis on anthropometric markers of nutritonal status and pulmonary function. Open Respir Med J. 2009;3:112–5.

    Article  Google Scholar 

  19. 19.

    Yen EH, Quinton H, Borowitz D. Better nutritional status in early childhood is associated with improved clinical outcomes and survival in patients with cystic fibrosis. J Pediatr. 2013;162:530–5 e1.

    Article  Google Scholar 

  20. 20.

    Bournez M, Bellis G, Huet F. Growth during puberty in cystic fibrosis: a retrospective evaluation of a French cohort. Arch Dis Child. 2012;97:714–20.

    Article  Google Scholar 

  21. 21.

    Woestenenk JW, Gulmans VA, van der Ent CK, Houwen RH. Height assessment in the Dutch-origin pediatric cystic fibrosis population. Nutr Clin Pract. 2017;32:130–2.

    Article  Google Scholar 

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Authors

Contributions

DD, KH, and SVB were responsible for the design of the study. DD, KH, and HB were responsible for collecting the data from the two different CF Centers. The statistics were performed by DD and KH. All authors interpreted the results and suggestions were made to report the results. All authors contributed to the draft and revised the manuscript. All authors approved the final version and agreed for submission.

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Correspondence to D. Declercq.

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The authors declare that they have no conflict of interest.

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Declercq, D., Huysentruyt, K., Hauser, B. et al. Long-term use of tube feeding in children with cystic fibrosis: results from two Belgian CF centers. Eur J Clin Nutr (2020). https://doi.org/10.1038/s41430-020-00782-5

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