Predictors of Malnutrition in Children with Cystic Fibrosis

Objective: To determine occurrence of malnutrition in children with cystic fibrosis and identify predictors of malnutrition at time of enrolment and after 2 years of follow up. Design: Retrospective chart review. Setting: Pediatric chest clinic at a tertiary-care center in northern India. Patients: Cystic fibrosis patients enrolled between 2009-2015 with at least 3 years follow-up. Procedure: Weight and height were noted at enrolment, and after 1 year and 2 years of follow-up. Clinical details, medications, and pulmonary exacerbations during second year were recorded. Main outcome measure: Occurrence of malnutrition i.e. weight for age Z-score < -2. Results: 61 medical records were reviewed. Occurrence of malnutrition at baseline, and 1- and 2-year follow-up was 65.5%, 54.1% and 57.3%, respectively. Weight for age Z-score at enrolment significantly correlated with time to diagnosis from onset r=0.015, P=0.029). Weight for age Z-score at 2-year follow-up was significantly associated with steatorrhea (P=0.03), increased frequency of stools (P<0.01) and pulmonary exacerbation (P=0.03) during second year. Linear regression showed significant association between weight for age Z-score at 2 years with steatorrhea and pulmonary exacerbations [r=-10.795 (-1.527, -0.062)] and [r=-0.261 (-0.493, -0.028)]. Pulmonary exacerbations during second and third year had significant correlation with weight for age Z-score at the beginning of respective years (r = -0.219, P=0.015). Conclusion: Occurrence of malnutrition is high in children with cystic fibrosis in this region, with uncontrolled fat malabsorption and recurrent respiratory infections being significant risk factors.