The effect of starting enteral tube feeding in patients with end-stage cystic fibrosis before lung transplantation
F.M Hollander, B.C. Broersen, G. Belle-van Meerkerk, N.M. de Roos, E.A. van de Graaf
Chair(s): dr. D.E. Braat & dr. N.C. van der Weerd
Thursday 9 march 2017
9:00 - 9:12h
at Johan de Meesterzaal
Categories: Parallel - Klinisch
Parallel session: Parallelsessie XII – Klinisch 4 - Pretransplantatie en donatie
Background & aims:
Lung transplantation (LTx) is an established treatment option for end-stage lung disease in patients with cystic fibrosis (CF). A body mass index (BMI) below 18.5 kg/m2 is often used as a preclusion for LTx. Pre-transplant nutrition management is aimed to maintain or improve nutritional status, in order to meet the criteria for LTx. Enteral tube feeding (ETF) is widely used to improve nutritional status in CF patients. Previous studies suggest a gender difference; CF women have a higher risk for malnutrition and detoriation of pulmonary function than men. The aim of this retrospective study was to investigate whether ETF improves body weight, BMI and pulmonary function and induces cystic fibrosis related diabetes (CFRD) equally in men and women with CF before lung transplantation.
Methods:
End-stage CF patients using ETF for at least 6 months between 2000 to 2014 were included. Outcomes were collected at the usual outpatient clinic visits and data on body weight and BMI are necessary according to Lung Allocation Score (LAS) implemented in April 2014. Data were extracted from patient files from six months before to 6 months after starting ETF and were analyzed for men and women separately.
Results:
Twenty-six adult patients with end-stage CF (19 women; 73%) were included. Six months before the start of ETF, 9 of the 19 women had a BMI less than 18.5 kg/m2. In women, mean BMI significantly decreased before the start of ETF (p<0.05) and increased significantly 1.4 kg/m2 after the start of ETF (p<0.05). Mean body weight increased by 3.3 kg (95%CI, 1.7 to 4.9 kg). In men, the increase in mean BMI of 0.3 kg/m2 over time was not significant. Body weight increased by 4 kg after the start of ETF but this was also not significant (95% CI, -1.2 to 9.1 kg). In women, pulmonary function (FEV1%pred) decreased significantly from 34% 6 months before starting ETF to 29.5% 6 months after (p<0.05). In men, FEV1%pred declined from 22.5% in the 6 months before to 21.5% 6 months after the start of ETF. At the start of ETF, 10 women and 3 men suffered from CFRD. Of the 13 patients with CFRD, only 1 woman developed CFRD after the start of ETF.
Conclusion:
ETF can help to improve body weight and BMI and may contribute to a stabilization of pulmonary function in patients with end-stage CF. This is an important outcome for patients waiting for lung transplantation. We found no indication that the effect was different for men and women.
