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Escobedo-Monge MF, Marcos-Temprano M, Parodi-Román J, Escobedo-Monge MA, Alonso-Vicente C, Torres-Hinojal MC, Marugán-Miguelsanz JM. Calcium, Phosphorus, and Vitamin D Levels in a Series of Cystic Fibrosis Patients: A Cross-Sectional Study. Int J Mol Sci 2024; 25:1900. [PMID: 38339178 PMCID: PMC10856093 DOI: 10.3390/ijms25031900] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2023] [Revised: 01/03/2024] [Accepted: 01/27/2024] [Indexed: 02/12/2024] Open
Abstract
Cystic fibrosis (CF) is a monogenic disease with different types of mutations that mainly affect the respiratory-digestive system. Calcium (Ca), phosphorus (P), and vitamin D (Vit-D) are essential nutrients for maintaining adequate growth and development, as well as key components in crucial metabolic pathways. Proper diagnosis, treatment, and response are decisive components of precision medicine. Therefore, we conducted a cross-sectional study to evaluate Ca, P, and Vit-D levels along with health and nutritional indicators, regarding their non-skeletal functions, in a series of CF patients. Anthropometric and clinical evaluation, biochemical analysis, dietary survey, and respiratory and pancreatic status were performed. Even though the results showed that all patients had normal dietary and serum Ca levels, 47% of patients had deficient Vit-D intake, 53% of patients had hypovitaminosis D, 35% had insufficient Vit-D levels, 18% had hypophosphatemia, 76% had elevated alkaline phosphate levels, 29% had hypercalciuria, and 65% had hyperphosphaturia. There were no significant differences between homozygous and compound heterozygous patients. Ca, P, and Vit-D levels were associated with body mass index; body composition; physical activity; diet; growth hormones; and the immune, liver, and kidney systems. We suggest a periodically evaluation of Ca and P losses.
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Affiliation(s)
| | - Marianela Marcos-Temprano
- Castilla y León Cystic Fibrosis Unit, University Clinical Hospital of Valladolid, Avenida Ramón y Cajal, 3, 47005 Valladolid, Spain;
| | - Joaquín Parodi-Román
- Science Faculty, University of Cadiz, Paseo de Carlos III, 28, 11003 Cádiz, Spain;
| | | | - Carmen Alonso-Vicente
- Department of Pediatrics of the Faculty of Medicine, University of Valladolid; Section of Gastroenterology and Pediatric Nutrition, University Clinical Hospital of Valladolid, Avenida Ramón y Cajal, 7, 47005 Valladolid, Spain; (C.A.-V.); (J.M.M.-M.)
| | | | - José Manuel Marugán-Miguelsanz
- Department of Pediatrics of the Faculty of Medicine, University of Valladolid; Section of Gastroenterology and Pediatric Nutrition, University Clinical Hospital of Valladolid, Avenida Ramón y Cajal, 7, 47005 Valladolid, Spain; (C.A.-V.); (J.M.M.-M.)
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Wilschanski M, Munck A, Carrion E, Cipolli M, Collins S, Colombo C, Declercq D, Hatziagorou E, Hulst J, Kalnins D, Katsagoni CN, Mainz JG, Ribes-Koninckx C, Smith C, Smith T, Van Biervliet S, Chourdakis M. ESPEN-ESPGHAN-ECFS guideline on nutrition care for cystic fibrosis. Clin Nutr 2024; 43:413-445. [PMID: 38169175 DOI: 10.1016/j.clnu.2023.12.017] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2023] [Revised: 12/13/2023] [Accepted: 12/18/2023] [Indexed: 01/05/2024]
Abstract
BACKGROUND Nutritional status is paramount in Cystic Fibrosis (CF) and is directly correlated with morbidity and mortality. The first ESPEN-ESPGHAN-ECFS guidelines on nutrition care for infants, children, and adults with CF were published in 2016. An update to these guidelines is presented. METHODS The study was developed by an international multidisciplinary working group in accordance with officially accepted standards. Literature since 2016 was reviewed, PICO questions were discussed and the GRADE system was utilized. Statements were discussed and submitted for on-line voting by the Working Group and by all ESPEN members. RESULTS The Working Group updated the nutritional guidelines including assessment and management at all ages. Supplementation of vitamins and pancreatic enzymes remains largely the same. There are expanded chapters on pregnancy, CF-related liver disease, and CF-related diabetes, bone disease, nutritional and mineral supplements, and probiotics. There are new chapters on nutrition with highly effective modulator therapies and nutrition after organ transplantation.
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Affiliation(s)
- Michael Wilschanski
- Pediatric Gastroenterology, Hadassah Hebrew University Medical Center, Jerusalem, Israel.
| | - Anne Munck
- Cystic Fibrosis Centre, Hopital Necker-Enfants Malades, AP-HP, Paris, France
| | - Estefania Carrion
- Division of Gastroenterology, Hepatology and Nutrition, The Hospital for Sick Children, Toronto, Canada
| | - Marco Cipolli
- Cystic Fibrosis Center, Azienda Ospedaliera Universitaria Integrata, Verona, Italy
| | - Sarah Collins
- CF Therapies Team, Royal Brompton & Harefield Hospital, London, UK
| | - Carla Colombo
- University of Milan, Fondazione IRCCS Ca' Granda, Ospedale Maggiore Policlinico, Milan, Italy
| | - Dimitri Declercq
- Cystic Fibrosis Reference Centre, Ghent University Hospital and Department of Internal Medicine and Paediatrics, Faculty of Medicine and Health Sciences, Ghent University, Ghent, Belgium
| | - Elpis Hatziagorou
- Cystic Fibrosis Unit, 3rd Pediatric Dept, Hippokration Hospital, Aristotle University of Thessaloniki, Greece
| | - Jessie Hulst
- Division of Gastroenterology, Hepatology and Nutrition, The Hospital for Sick Children, Toronto, Canada; Department of Pediatrics and Department of Nutritional Sciences, The University of Toronto, Toronto, Canada
| | - Daina Kalnins
- Department of Clinical Dietetics, The Hospital for Sick Children, Toronto, Canada
| | - Christina N Katsagoni
- Department of Clinical Nutrition, Agia Sofia Children's Hospital, Athens, Greece; EFAD, European Specialist Dietetic Networks (ESDN) for Gastroenterology, Denmark
| | - Jochen G Mainz
- Brandenburg Medical School, University Hospital. Klinikum Westbrandenburg, Brandenburg an der Havel, Germany
| | - Carmen Ribes-Koninckx
- Pediatric Gastroenterology and Paediatric Cystic Fibrosis Unit. La Fe Hospital & La Fe Research Institute, Valencia, Spain
| | - Chris Smith
- Department of Dietetics, Royal Alexandra Children's Hospital, Brighton, UK
| | - Thomas Smith
- Independent Patient Consultant Working at Above-disease Level, UK
| | | | - Michael Chourdakis
- School of Medicine, Faculty of Health Sciences, Aristotle University of Thessaloniki, Greece
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Chadwick C, Arcinas R, Ham M, Huang R, Hunter S, Mehta M, Sharma P, Varghese PA, Williams K, Troendle DM, Sathe M. The use of DXA for early detection of pediatric cystic fibrosis-related bone disease. Pediatr Pulmonol 2023; 58:1136-1144. [PMID: 36593123 DOI: 10.1002/ppul.26304] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/28/2022] [Revised: 11/30/2022] [Accepted: 12/27/2022] [Indexed: 01/04/2023]
Abstract
BACKGROUND Cystic fibrosis (CF)-related bone disease (CFBD) is seen in adults and can be associated with respiratory illness and malnutrition. There is limited and conflicting data regarding CFBD in pediatric CF. With longer life expectancy and promotion of disease prevention, pediatric CFBD demands further investigation. METHODS Our center initiated a quality improvement (QI) project from April 2016 to December 2018 to improve CFBD screening in patients 8 years or older, per current CF Foundation (CFF) guidelines. Our team formulated a dual-energy X-ray absorptiometry (DXA) scan algorithm based upon degree of bone mineral density (BMD); shared CFBD guideline recommendations in our quarterly newsletter; and ordered scans for eligible patients at weekly review meetings. We reviewed DXA results from 141 patients after institutional review board approval and gathered data including comorbidities, genetics, anthropometric measures, medication exposure, and relevant serum studies. RESULTS Fifty-three percent of our patients had normal BMD (n = 75). Seventeen patients (12%) had a Z score ≤ -2. Patients with lower BMD also had lower mean forced expiratory volume (FEV1 ) percent predicted (FEV1 %) (p < 0.001) as well as lower body mass index % (p = 0.001). Patients with lower BMD were overall older at time of DXA (p = 0.016). During study duration, 13 patients who had abnormal DXA results underwent repeat DXAs after physical therapy; 11 of the 13 showed improvement in DXA results. CONCLUSIONS A DXA scan is a useful screening tool and can be used to identify pediatric patients who could benefit from further therapy and interventions to preserve adequate bone health and avoid further loss. QI initiatives can lead to improved screening and diagnosis and earlier intervention such as physical therapy. Further studies are needed to better understand the utility of physical therapy in children with CF.
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Affiliation(s)
- Christina Chadwick
- Division of Pediatric Gastroenterology, University of Florida, Gainesville, Florida, USA
| | - Renallie Arcinas
- Children's Health Rehabilitation and Therapy Services, Physical Rehabilitation, Children's Health, Dallas, Texas, USA
| | - Melissa Ham
- Division of Pediatric Endocrinology, UT Southwestern Medical Center, Dallas, Texas, USA
| | - Rong Huang
- Department of Clinical Research, Research Administration, Children's Health, Dallas, Texas, USA
| | - Stacie Hunter
- Department of Pediatric Clinical Nutrition, Clinical Nutrition, Children's Health, Dallas, Texas, USA
| | - Megha Mehta
- Division of Pediatric Gastroenterology, University of Florida, Gainesville, Florida, USA
| | - Preeti Sharma
- Division of Pediatric Pulmonology, UT Southwestern Medical Center, Dallas, Texas, USA
| | - Prigi Anu Varghese
- Division of Pediatric Pulmonology, UT Southwestern Medical Center, Dallas, Texas, USA
| | - Kelli Williams
- Division of Pulmonology, Children's Health, Dallas, Texas, USA
| | - David M Troendle
- Division of Pediatric Gastroenterology, University of Florida, Gainesville, Florida, USA
| | - Meghana Sathe
- Division of Pediatric Gastroenterology, University of Florida, Gainesville, Florida, USA
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Mariotti Zani E, Grandinetti R, Cunico D, Torelli L, Fainardi V, Pisi G, Esposito S. Nutritional Care in Children with Cystic Fibrosis. Nutrients 2023; 15:nu15030479. [PMID: 36771186 PMCID: PMC9921127 DOI: 10.3390/nu15030479] [Citation(s) in RCA: 10] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2022] [Revised: 01/05/2023] [Accepted: 01/16/2023] [Indexed: 01/18/2023] Open
Abstract
Patients with cystic fibrosis (CF) are prone to malnutrition and growth failure, mostly due to malabsorption caused by the derangement in the chloride transport across epithelial surfaces. Thus, optimal nutritional care and support should be an integral part of the management of the disease, with the aim of ameliorating clinical outcomes and life expectancy. In this report, we analyzed the nutrition support across the different ages, in patients with CF, with a focus on the relationships with growth, nutritional status, disease outcomes and the use of the CF transmembrane conductance regulator (CFTR) modulators. The nutrition support goal in CF care should begin as early as possible after diagnosis and include the achievement of an optimal nutritional status to support the growth stages and puberty development in children, that will further support the maintenance of an optimal nutritional status in adult life. The cornerstone of nutrition in patients with CF is a high calorie, high-fat diet, in conjunction with a better control of malabsorption due to pancreatic enzyme replacement therapy, and attention to the adequate supplementation of fat-soluble vitamins. When the oral caloric intake is not enough for reaching the anthropometric nutritional goals, supplemental enteral feeding should be initiated to improve growth and the nutritional status. In the last decade, the therapeutic possibilities towards CF have grown in a consistent way. The positive effects of CFTR modulators on nutritional status mainly consist in the improvement in weight gain and BMI, both in children and adults, and in an amelioration in terms of the pulmonary function and reduction of exacerbations. Several challenges need to be overcome with the development of new drugs, to transform CF from a fatal disease to a treatable chronic disease with specialized multidisciplinary care.
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Affiliation(s)
- Elena Mariotti Zani
- Pediatric Clinic, Department of Medicine and Surgery, University of Parma, 43126 Parma, Italy
| | - Roberto Grandinetti
- Pediatric Clinic, Department of Medicine and Surgery, University of Parma, 43126 Parma, Italy
| | - Daniela Cunico
- Pediatric Clinic, Department of Medicine and Surgery, University of Parma, 43126 Parma, Italy
| | - Lisa Torelli
- Pediatric Clinic, Department of Medicine and Surgery, University of Parma, 43126 Parma, Italy
| | - Valentina Fainardi
- Pediatric Clinic, Department of Medicine and Surgery, University of Parma, 43126 Parma, Italy
| | - Giovanna Pisi
- Pediatric Clinic, Department of Medicine and Surgery, University of Parma, 43126 Parma, Italy
| | - Susanna Esposito
- Pediatric Clinic, Department of Medicine and Surgery, University of Parma, 43126 Parma, Italy
- Correspondence: ; Tel.: +39-0521-903524
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Wysocka-Wojakiewicz P, Woś H, Wielkoszyński T, Pyziak-Skupień A, Grzybowska-Chlebowczyk U. Vitamin Status in Children with Cystic Fibrosis Transmembrane Conductance Regulator Gene Mutation. Nutrients 2022; 14:nu14214661. [PMID: 36364923 PMCID: PMC9654413 DOI: 10.3390/nu14214661] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2022] [Revised: 10/21/2022] [Accepted: 11/01/2022] [Indexed: 11/06/2022] Open
Abstract
Background: The issue of vitamin metabolism in children with cystic fibrosis screen positive, inconclusive diagnosis (CFSPID) is not well known. The aim of this study was to determine the status of vitamins A, D, E, and C in the blood of a group of children with CFSPID. Material and Methods: A total of 89 children were enrolled in the study (Me: 3.6 years, 52.8% boys), as follows: 28 with CFSPID, 31 with CF (cystic fibrosis), and 30 HC (healthy children). Their blood concentrations of vitamins A, D, E, and C, and their dietary intake of these vitamins were analysed in the study groups on the basis of a three-day food diary. Results: The patients with CFSPID had significantly higher serum vitamin D (p = 0.01) and E (p = 0.04) concentrations, compared to the children with CF. None of the children with CFSPID revealed vitamin A or E deficiencies. Patients with CF had been consuming significantly higher vitamin D and E amounts (p = 0.01). The vitamin concentrations did not depend either on the pancreatic/liver function or on anthropometric parameters. In total, 32.14% of patients with CF did not cover the baseline recommended calorie intake, and 53.6% and 36% did not take the recommended vitamin E and vitamin A intake, respectively. Conclusion: Children with CF and CFSPID did not fully cover the dietary recommendations for vitamin supply, but vitamin deficiency was found only in CF.
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Affiliation(s)
- Paulina Wysocka-Wojakiewicz
- Department of Pediatrics, Faculty of Medical Sciences, Medical University of Silesia, 40-752 Katowice, Poland
- Correspondence:
| | - Halina Woś
- Faculty of Health Sciences, University of Bielsko-Biala, 43-309 Bielsko-Biała, Poland
| | - Tomasz Wielkoszyński
- Higher School of Strategic Planning and Laboratory Medicine Centre, 41-303 Dąbrowa Górnicza, Poland
| | - Aleksandra Pyziak-Skupień
- Department of Children’s Diabetology, Silesian Medical University in Katowice, 40-752 Katowice, Poland
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Lima AA, Mridha MF, Das SC, Kabir MM, Islam MR, Watanobe Y. A Comprehensive Survey on the Detection, Classification, and Challenges of Neurological Disorders. BIOLOGY 2022; 11:469. [PMID: 35336842 PMCID: PMC8945195 DOI: 10.3390/biology11030469] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/13/2022] [Revised: 03/12/2022] [Accepted: 03/14/2022] [Indexed: 01/19/2023]
Abstract
Neurological disorders (NDs) are becoming more common, posing a concern to pregnant women, parents, healthy infants, and children. Neurological disorders arise in a wide variety of forms, each with its own set of origins, complications, and results. In recent years, the intricacy of brain functionalities has received a better understanding due to neuroimaging modalities, such as magnetic resonance imaging (MRI), magnetoencephalography (MEG), and positron emission tomography (PET), etc. With high-performance computational tools and various machine learning (ML) and deep learning (DL) methods, these modalities have discovered exciting possibilities for identifying and diagnosing neurological disorders. This study follows a computer-aided diagnosis methodology, leading to an overview of pre-processing and feature extraction techniques. The performance of existing ML and DL approaches for detecting NDs is critically reviewed and compared in this article. A comprehensive portion of this study also shows various modalities and disease-specified datasets that detect and records images, signals, and speeches, etc. Limited related works are also summarized on NDs, as this domain has significantly fewer works focused on disease and detection criteria. Some of the standard evaluation metrics are also presented in this study for better result analysis and comparison. This research has also been outlined in a consistent workflow. At the conclusion, a mandatory discussion section has been included to elaborate on open research challenges and directions for future work in this emerging field.
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Affiliation(s)
- Aklima Akter Lima
- Department of Computer Science and Engineering, Bangladesh University of Business and Technology, Dhaka 1216, Bangladesh; (A.A.L.); (M.F.M.); (S.C.D.); (M.M.K.)
| | - M. Firoz Mridha
- Department of Computer Science and Engineering, Bangladesh University of Business and Technology, Dhaka 1216, Bangladesh; (A.A.L.); (M.F.M.); (S.C.D.); (M.M.K.)
| | - Sujoy Chandra Das
- Department of Computer Science and Engineering, Bangladesh University of Business and Technology, Dhaka 1216, Bangladesh; (A.A.L.); (M.F.M.); (S.C.D.); (M.M.K.)
| | - Muhammad Mohsin Kabir
- Department of Computer Science and Engineering, Bangladesh University of Business and Technology, Dhaka 1216, Bangladesh; (A.A.L.); (M.F.M.); (S.C.D.); (M.M.K.)
| | - Md. Rashedul Islam
- Department of Computer Science and Engineering, University of Asia Pacific, Dhaka 1216, Bangladesh
| | - Yutaka Watanobe
- Department of Computer Science and Engineering, University of Aizu, Aizu-Wakamatsu 965-8580, Japan;
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Ullal J, Kutney K, Williams KM, Weber DR. Treatment of cystic fibrosis related bone disease. J Clin Transl Endocrinol 2022; 27:100291. [PMID: 35059303 PMCID: PMC8760456 DOI: 10.1016/j.jcte.2021.100291] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2021] [Revised: 12/03/2021] [Accepted: 12/04/2021] [Indexed: 11/29/2022] Open
Abstract
The advent of highly effective CFTR modulator therapies has slowed the progression of pulmonary complications in people with cystic fibrosis. There is increased interest in cystic fibrosis bone disease (CFBD) due to the increasing longevity of people with cystic fibrosis. CFBD is a complex and multifactorial disease. CFBD is a result of hypomineralized bone leading to poor strength, structure and quality leading to susceptibility to fractures. The development of CFBD spans different age groups. The management must be tailored to each group with nuance and based on available guidelines while balancing therapeutic benefits to risks of long-term use of bone-active medication. For now, the mainstay of treatment includes bisphosphonates. However, the long-term effects of bisphosphonate treatment in people with CF are not fully understood. We describe newer agents available for osteoporosis treatment. Still, the lack of data behooves trials of monoclonal antibodies treatments such as Denosumab and Romozosumab and anabolic bone therapy such as teriparatide and Abaloparatide. In this review, we also summarize screening and non-pharmacologic treatment of CFBD and describe the various options available for the pharmacotherapy of CFBD. We address the prospect of CFTR modulators on bone health while awaiting long-term trials to describe the effects of these medications on bone health.
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Affiliation(s)
- Jagdeesh Ullal
- UPMC Center for Diabetes and Endocrinology, University of Pittsburgh Medical Center, 3601 Fifth Ave, Suite 3B, Falk Medical Building, Pittsburgh, PA 15213, USA
- Corresponding author at: UPMC Center for Diabetes and Endocrinology, Falk Medical Building, 3601 Fifth Ave Suite 3B, Pittsburgh, PA 15213, USA. Tel.: 412-586-9700; Fax: 412-586-9724.
| | - Katherine Kutney
- Pediatric Endocrinology, Rainbow Babies and Children's Hospital, 11100 Euclid Ave, Suite 737, Cleveland, OH 44106, USA
| | - Kristen M. Williams
- Naomi Berrie Diabetes Center, Columbia University Irving Medical Center Division of Pediatric Endocrinology, Diabetes, and Metabolism, Columbia University Irving Medical Center, 1150 St Nicholas Avenue, New York, NY 10032, USA
| | - David R. Weber
- Division of Pediatric Endocrinology & Diabetes & Center for Bone Health, The Children’s Hospital of Philadelphia and Perelman School of Medicine at the University of Pennsylvania Roberts Clinical Research Bldg., Room 14361 415 Curie Boulevard, Philadelphia, PA 19104, USA
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8
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Atlas G, Yap M, Lim A, Vidmar S, Smith N, King L, Jones A, Hong J, Ranganathan S, Simm PJ. The clinical features that contribute to poor bone health in young Australians living with cystic fibrosis: A recommendation for BMD screening. Pediatr Pulmonol 2021; 56:2014-2022. [PMID: 33724711 DOI: 10.1002/ppul.25375] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/27/2020] [Revised: 02/27/2021] [Accepted: 02/27/2021] [Indexed: 01/04/2023]
Abstract
BACKGROUND For Australians living with cystic fibrosis (CF), increased longevity means greater consideration needs to be given to long-term endocrine sequelae such as CF-related bone disease. Deficits in bone mass accrual are most likely to occur during childhood and adolescence. Current guidelines in Australia suggest repeat dual-energy X-ray absorptiometry (DXA) scans every 2 years. This study aims to stratify clinical factors that determine future bone health in the Australian CF population and use this to guide a more streamlined approach to bone health screening. METHODS This study was a retrospective audit of all patients diagnosed with CF who were treated at the Royal Children's Hospital Melbourne, Australia from 2000 to 2016 (n = 453). Two hundred and two patients had a DXA scan in the study period (191 with height-adjusted data) and 111 patients had more than one scan (108 with height-adjusted data). An investigation into the associations between bone mineral density (BMD) Z score and potential risk factors was conducted using DXA and historical data. RESULTS The main predictor of future BMD was the previous BMD Z score (p < .001). Other factors found to be determinants of BMD included nutritional status, lung function (FEV1 ), age, history of previous fracture, oral corticosteroid use, and the number of hospital admissions. However, after adjusting for previous BMD, evidence of an association remained only with nutritional status, FEV1 , and number of hospital admissions. CONCLUSION Second yearly scans may be unnecessary in children with an adequate DXA score on the initial scan who remain clinically stable. However, clinical deterioration in those whose BMD was previously normal, may require closer monitoring of bone health. We propose a guideline for the frequency of DXA monitoring in relation to clinical risk factors.
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Affiliation(s)
- Gabby Atlas
- Royal Children's Hospital Melbourne, Parkville, Victoria, Australia.,Murdoch Children's Research Institute, Royal Children's Hospital, Parkville, Victoria, Australia
| | - Matthew Yap
- Murdoch Children's Research Institute, Royal Children's Hospital, Parkville, Victoria, Australia
| | - Angelina Lim
- Murdoch Children's Research Institute, Royal Children's Hospital, Parkville, Victoria, Australia.,Centre for Medicine Use and Safety, Monash University Parkville, Parkville, Victoria, Australia
| | - Suzanna Vidmar
- Murdoch Children's Research Institute, Royal Children's Hospital, Parkville, Victoria, Australia.,Department of Paediatrics, University of Melbourne, Melbourne, Australia
| | - Nathan Smith
- Murdoch Children's Research Institute, Royal Children's Hospital, Parkville, Victoria, Australia
| | - Louise King
- Murdoch Children's Research Institute, Royal Children's Hospital, Parkville, Victoria, Australia
| | - Alicia Jones
- Monash Medical Centre, Clayton, Victoria, Australia.,Monash Centre for Health Research and Implementation, Monash University, Melbourne, Victoria, Australia
| | - Jason Hong
- Murdoch Children's Research Institute, Royal Children's Hospital, Parkville, Victoria, Australia
| | - Sarath Ranganathan
- Royal Children's Hospital Melbourne, Parkville, Victoria, Australia.,Murdoch Children's Research Institute, Royal Children's Hospital, Parkville, Victoria, Australia.,Department of Paediatrics, University of Melbourne, Melbourne, Australia
| | - Peter J Simm
- Royal Children's Hospital Melbourne, Parkville, Victoria, Australia.,Murdoch Children's Research Institute, Royal Children's Hospital, Parkville, Victoria, Australia.,Department of Paediatrics, University of Melbourne, Melbourne, Australia
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9
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Tomaszek L, Cepuch G, Pawlik L. Evaluation of selected insomnia predictors in adolescents and young adults with cystic fibrosis. Biomed Pap Med Fac Univ Palacky Olomouc Czech Repub 2018; 162:212-218. [DOI: 10.5507/bp.2018.009] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2017] [Accepted: 03/14/2018] [Indexed: 12/27/2022] Open
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10
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Smith N, Lim A, Yap M, King L, James S, Jones A, Ranganathan S, Simm P. Bone mineral density is related to lung function outcomes in young people with cystic fibrosis-A retrospective study. Pediatr Pulmonol 2017; 52:1558-1564. [PMID: 29082636 DOI: 10.1002/ppul.23894] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/03/2017] [Accepted: 09/21/2017] [Indexed: 11/06/2022]
Abstract
INTRODUCTION Improvements in the medical management of cystic fibrosis (CF) in recent years have resulted in increased prevalence of long-term sequelae of the condition, such as low bone mineral density (BMD) and hence an increased risk of fractures in later life. Aim To explore the interaction between BMD and lung function, nutrition, and genotype. METHODS This study was a retrospective audit of 202 children with CF from August 2000 to January 2016 to investigate associations between BMD Z-scores with clinical status, nutrition, and genetics using dual-energy absorptiometry X-ray data from the Royal Children's Hospital Melbourne, Australia. RESULTS Severity of both lung disease (P < 0.0001) and nutritional status (P < 0.05) was found to be strongly associated with BMD Z-scores. CONCLUSIONS This is the biggest study to date to provide further evidence that the severity of pulmonary disease is related to BMD in CF patients and therefore screening guidelines for bone health in children with CF should target individuals with the poorest clinical status.
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Affiliation(s)
- Nathan Smith
- Murdoch Childrens Research Institute, Royal Children's Hospital, Victoria, Australia
| | - Angelina Lim
- Murdoch Childrens Research Institute, Royal Children's Hospital, Victoria, Australia.,Monash University Parkville, Victoria, Australia
| | - Matthew Yap
- Murdoch Childrens Research Institute, Royal Children's Hospital, Victoria, Australia
| | - Louise King
- Murdoch Childrens Research Institute, Royal Children's Hospital, Victoria, Australia
| | - Simon James
- School of Information Technology, Deakin University, Victoria, Australia
| | | | - Sarath Ranganathan
- Murdoch Childrens Research Institute, Royal Children's Hospital, Victoria, Australia.,Royal Children's Hospital, Victoria, Australia.,Department of Paediatrics, University of Melbourne, Melbourne, Australia
| | - Peter Simm
- Murdoch Childrens Research Institute, Royal Children's Hospital, Victoria, Australia.,Royal Children's Hospital, Victoria, Australia.,Department of Paediatrics, University of Melbourne, Melbourne, Australia
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11
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Braun C, Bacchetta J, Braillon P, Chapurlat R, Drai J, Reix P. Children and adolescents with cystic fibrosis display moderate bone microarchitecture abnormalities: data from high-resolution peripheral quantitative computed tomography. Osteoporos Int 2017; 28:3179-3188. [PMID: 28795206 DOI: 10.1007/s00198-017-4179-9] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/16/2017] [Accepted: 07/25/2017] [Indexed: 12/15/2022]
Abstract
UNLABELLED We investigated whether bone microstructure assessed by high-resolution peripheral quantitative tomography (HR-pQCT) could be altered in children and teenagers with cystic fibrosis (CF). In comparison to their healthy counterparts, bone microstructure was mildly affected at the tibial level only. INTRODUCTION Cystic fibrosis-related bone disease (CFBD) may alter bone health, ultimately predisposing patients to bone fractures. Our aim was to assess bone microstructure using high-resolution peripheral quantitative tomography (HR-pQCT) in a cohort of children and teenagers with CF in comparison to age-, puberty-, and gender-matched healthy volunteers (HVs). METHODS In this single-center, prospective, cross-sectional study, we evaluated the HR-pQCT bone parameters of CF patients and compared them to those of the healthy volunteers. RESULTS At a median age of 15.4 [range, 10.5-17.9] years, 37 CF patients (21 boys) with 91% [range, 46-138%] median forced expiratory volume in 1 s were included. At the ultradistal tibia, CF patients had a smaller bone cross-sectional area (579 [range, 399-1087] mm2) than HVs (655 [range, 445-981] mm2) (p = 0.027), related to a decreased trabecular area, without any significant differences for height. No other differences were found (trabecular number, separation, thickness, or distribution) at the radial or tibial levels. Bone structure was different in patients receiving ursodeoxycholic acid and those bearing two F508del mutations. CONCLUSION In our cohort of children and teenagers with good nutritional and lung function status, bone microstructure evaluated with HR-pQCT was not severely affected. Minimal microstructure abnormalities observed at the tibial level may be related to the cystic fibrosis transmembrane conductance regulator defect alone; the long-term consequences of such impairment will require further evaluation.
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Affiliation(s)
- C Braun
- Pediatric Cystic Fibrosis Center, Hospices Civils de Lyon, Lyon, France.
- University Claude-Bernard Lyon 1, Lyon, France.
- Centre de Ressources et de Compétences de la Mucoviscidose, Hôpital Femme Mère Enfant, 69677, Bron, France.
| | - J Bacchetta
- University Claude-Bernard Lyon 1, Lyon, France
- INSERM UMR 1033, Lyon, France
- Rare Renal Diseases Reference Center Néphrogones, Hospices Civils de Lyon, Lyon, France
| | - P Braillon
- University Claude-Bernard Lyon 1, Lyon, France
- Pediatric Radiology Department, Hospices Civils de Lyon, Lyon, France
| | - R Chapurlat
- University Claude-Bernard Lyon 1, Lyon, France
- INSERM UMR 1033, Lyon, France
- Pediatric Radiology Department, Hospices Civils de Lyon, Lyon, France
| | - J Drai
- Rheumatology Department, Hospices Civils de Lyon, Lyon, France
| | - P Reix
- Pediatric Cystic Fibrosis Center, Hospices Civils de Lyon, Lyon, France
- University Claude-Bernard Lyon 1, Lyon, France
- Biochemistry Department, Hospices Civils de Lyon, Lyon, France
- UMR 5558 (EMET). CNRS, LBBE, Université de Lyon, Villeurbanne, France
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Abstract
Children and adolescents with chronic disease are predisposed to impaired bone health. Pediatric illness, including type 1 diabetes mellitus, celiac disease, and cystic fibrosis, have significant risk of low bone mineralization and fracture due to underlying inflammation, malabsorption, lack of physical activity, and delayed puberty. Dual-energy x-ray absorptiometry is the primary imaging method to assess bone health in this population. The purpose of this review is to update readers about the assessment and management of bone health in children with common pediatric chronic illnesses and review recent advances in the prevention and treatment of impaired bone health.
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Affiliation(s)
- Kristen M Williams
- Division of Pediatric Endocrinology and Diabetes, Department of Pediatrics, Icahn School of Medicine at Mount Sinai, One Gustave L. Levy Place, New York, NY 10029, USA.
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