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Leonard A, Bailey J, Bruce A, Jia S, Stein A, Fulton J, Helmick M, Litvin M, Patel A, Powers KE, Reid E, Sankararaman S, Clemm C, Reno K, Hempstead SE, DiMango E. Nutritional considerations for a new era: A CF foundation position paper. J Cyst Fibros 2023; 22:788-795. [PMID: 37230807 DOI: 10.1016/j.jcf.2023.05.010] [Citation(s) in RCA: 14] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2023] [Revised: 05/13/2023] [Accepted: 05/13/2023] [Indexed: 05/27/2023]
Abstract
OBJECTIVE To provide interim advice and considerations to the CF Community around CF nutrition in the current era. METHODS The Cystic Fibrosis (CF) Foundation organized a multidisciplinary committee to develop a Nutrition Position Paper based on the rapidly changing nutrition landscape in CF, due in part to widespread use of cystic fibrosis transmembrane regulator highly effective modulator therapy (HEMT). Four workgroups were formed: Weight Management, Eating Behavior/Food Insecurity, Salt Homeostasis and Pancreatic Enzyme use. Each workgroup conducted their own focused review of the literature. RESULTS The committee summarized current understanding of issues pertaining to the four workgroup topics and provided 6 key take-aways around CF Nutrition in the new era. CONCLUSION People with CF (pwCF) are living longer, particularly with the advent of HEMT. The traditional high fat, high calorie CF diet may have negative nutritional and cardiovascular consequences as pwCF age. Individuals with CF may have poor diet quality, food insecurity, distorted body image, and an higher incidence of eating disorders. An increase in overweight and obesity may lead to new considerations for nutritional management, given potential effects of overnutrition on pulmonary and cardiometabolic parameters.
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Affiliation(s)
- Amanda Leonard
- The Johns Hopkins Children's Center, Baltimore, MD, United States of America.
| | - Julianna Bailey
- The University of Alabama at Birmingham, Birmingham, Alabama, United States of America
| | - Amanda Bruce
- University of Kansas Medical Center, Kansas City, Kansas United States of America
| | - Shijing Jia
- University of Michigan Medical School, Ann Arbor, Michigan, United States of America
| | - Adam Stein
- Northwestern Medicine, Feinberg School of Medicine, Chicago, Illinois, United States of America
| | - Judith Fulton
- Children's Hospital Colorado, Aurora, Colorado, United States of America
| | - Meagan Helmick
- Community Advisor to the Cystic Fibrosis Foundation, Bethesda, Maryland, United States of America
| | - Marina Litvin
- Division of Endocrinology, Metabolism and Lipid Research. Washington University School of Medicine. St. Louis, MO, United States of America
| | - Alpa Patel
- Nationwide Children's Hospital, Columbus Ohio, United States of America
| | - Kate E Powers
- Albany Medical Center, Albany, New York, United States of America
| | - Elizabeth Reid
- Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, United States of America
| | | | - Cristen Clemm
- Cystic Fibrosis Foundation, Bethesda, Maryland United States of America
| | - Kim Reno
- Cystic Fibrosis Foundation, Bethesda, Maryland United States of America
| | - Sarah E Hempstead
- Cystic Fibrosis Foundation, Bethesda, Maryland United States of America
| | - Emily DiMango
- Columbia University Irving Medical Center, New York, New York, United States of America
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Mc Hugh R, Vaughan RS, Duarte C, McDevitt-Petrovic O, Kirby K. Psychometric properties of the Cystic Fibrosis Eating Attitudes and Behaviours scale (CFEAB) in an adult population. J Psychosom Res 2023; 165:111123. [PMID: 36549076 DOI: 10.1016/j.jpsychores.2022.111123] [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: 09/12/2022] [Revised: 12/13/2022] [Accepted: 12/13/2022] [Indexed: 12/23/2022]
Abstract
OBJECTIVES Individuals with Cystic Fibrosis (CF) may be at an increased risk of developing a range of eating difficulties. Scales designed to measure disordered eating in the general population do not cover CF-specific behaviours resulting in a knowledge gap. The CFEAB was developed as a CF-specific measure assessing eating behaviours and attitudes however little evidence exists regarding its psychometric quality. The aim of this cross-sectional study was to provide a robust assessment of its internal consistency, structural validity, and criterion validity. METHODS One-hundred and thirty-two people with CF completed self-report scales pertaining to mental health, eating disorders, and the Cystic Fibrosis Eating Attitudes and Behaviours (CFEAB). RESULTS Results of exploratory structural equation modelling indicated that a three-factor structure produced good fit with the 24-item CFEAB but a purified 12-item CFEAB displayed superior fit and internal consistency. Also, the 12-item scale predicted significant amounts of variance for anxiety, depression, and eating disorders showing enhanced relevance for clinical use. Conclusions These findings add emphasis to the importance of the validation and development of CF-specific measures and the possible inclusion at clinics to help improve CF patient care.
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Affiliation(s)
- Rachel Mc Hugh
- Ulster University, Cromore Road, Coleraine, Northern Ireland BT52 1SA, UK.
| | - Robert S Vaughan
- Ulster University, Cromore Road, Coleraine, Northern Ireland BT52 1SA, UK; York st john university, UK
| | - Cristiana Duarte
- Ulster University, Cromore Road, Coleraine, Northern Ireland BT52 1SA, UK; York st john university, UK
| | | | - Karen Kirby
- Ulster University, Cromore Road, Coleraine, Northern Ireland BT52 1SA, UK
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Kass AP, Kazmerski TM, Bern E, Sabharwal S, Leonard J, Harrison M, Barnico K, Richmond T, Sawicki GS. Clinician perspectives on assessing for disordered eating and body image disturbance in adolescents and young adults with cystic fibrosis. J Cyst Fibros 2022:S1569-1993(22)01416-3. [DOI: 10.1016/j.jcf.2022.11.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2022] [Revised: 11/21/2022] [Accepted: 11/27/2022] [Indexed: 12/05/2022]
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Kass AP, Berbert L, Dahlberg S, Bern E, Sabharwal S, Leonard J, Richmond T, Sawicki GS. Eating disorders in adolescents and young adults with cystic fibrosis. Pediatr Pulmonol 2022; 57:2791-2797. [PMID: 35931664 DOI: 10.1002/ppul.26102] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/04/2022] [Revised: 06/23/2022] [Accepted: 08/03/2022] [Indexed: 11/07/2022]
Abstract
INTRODUCTION There is evidence for increased risk of eating disorders in individuals with diet-treated chronic illnesses, however, data in patients with cystic fibrosis (CF) is less clear. No studies have evaluated avoidant/restrictive food intake disorder (ARFID) in the CF population. We investigated the prevalence of eating disorders, including ARFID, in adolescents and young adults with CF. METHODS Patients with CF aged 14-35 years were recruited to complete three validated surveys: (1) Eating Disorder Examination Questionnaire (EDE-Q), (2) Nine-Item Avoidant/Restrictive Food Intake Disorder Scale (NIAS), and (3) Cystic Fibrosis Questionnaire-Revised (CFQ-R). Univariate linear regression analysis identified baseline risk factors associated with these survey scores. Variables with univariate p < 0.20 were considered for inclusion in a multivariable linear regression model. Backwards stepwise linear regression was used to identify the final model. RESULTS A total of 52 patients enrolled. The prevalence of a positive screen on the EDE-Q was 9.6%, and on the NIAS was 13.5%. The CFQ-R eating and weight subscales were associated with scores on the EDE-Q, and CFQ-R eating subscale and being dF508 homozygous were correlated with the NIAS total score. DISCUSSION A clinically significant number of participants screened positive for eating disorders on the EDE-Q and NIAS. Scores on the eating and weight scales of the CFQ-R were associated with the scores on these surveys. Further work is needed to better understand the optimal way to use such tools to screen and treat for eating disorders in individuals with CF.
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Affiliation(s)
- Alexandra P Kass
- Division of Pediatric Pulmonology, Columbia University Irving Medical Center, New York City, New York, USA
| | - Laura Berbert
- Boston Children's Hospital, Boston, Massachusetts, USA
| | | | - Elana Bern
- Division of Gastroenterology, Hepatology, and Nutrition, Boston, Massachusetts, USA
| | - Sabina Sabharwal
- Division of Gastroenterology, Hepatology, and Nutrition, Boston, Massachusetts, USA
| | - Jessica Leonard
- Division of Gastroenterology, Hepatology, and Nutrition, Boston, Massachusetts, USA
| | - Tracy Richmond
- Division of Adolescent/Young Adult Medicine, Boston, Massachusetts, USA
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Petropoulou A, Bakounaki G, Grammatikopoulou MG, Bogdanos DP, Goulis DG, Vassilakou T. Eating Disorders and Disordered Eating Behaviors in Cystic Fibrosis: A Neglected Issue. CHILDREN (BASEL, SWITZERLAND) 2022; 9:children9060915. [PMID: 35740852 PMCID: PMC9221629 DOI: 10.3390/children9060915] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/16/2022] [Revised: 06/06/2022] [Accepted: 06/16/2022] [Indexed: 05/28/2023]
Abstract
As with the majority of chronic diseases having specific nutrition recommendations, in cystic fibrosis (CF), the emphasis placed on patients regarding their diet and ideal body weight status often increases the risk of developing disordered eating behaviors and by inference, eating disorders (EDs). Body weight appears to be an important concern for patients with CF, with many patients struggling to lose weight. Between sexes, women appear more preoccupied with dieting compared to men, but exhibit a better body image, mainly due to their preference for a lower weight. Several comorbidities appear to change these dynamics, and visibly apparent factors, including scars, ports, and tubes, and the need for supplementary oxygen supply, may also influence body image perception. Disordered eating is usually initiated during a bout of pulmonary infection, with the patient feeling unwell to eat. Regarding the prevalence of EDs, research appears conflicting on whether it is higher among individuals with a CF diagnosis or not. As for comorbidities, anxiety and depression consist of the most common psychiatric diagnoses in CF, also greatly prevalent in EDs. Despite the plethora of studies, non-specific CF tools, small samples, and lack of data regarding important outcomes, including lung health, indicate the need for more research.
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Affiliation(s)
- Anastasia Petropoulou
- Department of Nutritional Sciences & Dietetics, Faculty of Health Sciences, International Hellenic University, Alexander Campus, 57400 Thessaloniki, Greece; (A.P.); (G.B.)
| | - Georgia Bakounaki
- Department of Nutritional Sciences & Dietetics, Faculty of Health Sciences, International Hellenic University, Alexander Campus, 57400 Thessaloniki, Greece; (A.P.); (G.B.)
| | - Maria G. Grammatikopoulou
- Department of Nutritional Sciences & Dietetics, Faculty of Health Sciences, International Hellenic University, Alexander Campus, 57400 Thessaloniki, Greece; (A.P.); (G.B.)
- Department of Rheumatology and Clinical Immunology, University General Hospital of Larissa, Faculty of Medicine, School of Health Sciences, University of Thessaly, 40500 Larissa, Greece;
- Unit of Reproductive Endocrinology, 1st Department of Obstetrics and Gynecology, Papageorgiou General Hospital, Medical School, Aristotle University of Thessaloniki, Agiou Pavlou 76, 56429 Thessaloniki, Greece;
| | - Dimitrios P. Bogdanos
- Department of Rheumatology and Clinical Immunology, University General Hospital of Larissa, Faculty of Medicine, School of Health Sciences, University of Thessaly, 40500 Larissa, Greece;
| | - Dimitrios G. Goulis
- Unit of Reproductive Endocrinology, 1st Department of Obstetrics and Gynecology, Papageorgiou General Hospital, Medical School, Aristotle University of Thessaloniki, Agiou Pavlou 76, 56429 Thessaloniki, Greece;
| | - Tonia Vassilakou
- Department of Public Health Policy, School of Public Health, University of West Attica, Athens University Campus, 196 Alexandra’s Avenue, 11521 Athens, Greece
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Bailey J, Krick S, Fontaine KR. The Changing Landscape of Nutrition in Cystic Fibrosis: The Emergence of Overweight and Obesity. Nutrients 2022; 14:1216. [PMID: 35334873 PMCID: PMC8953232 DOI: 10.3390/nu14061216] [Citation(s) in RCA: 21] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2022] [Revised: 03/07/2022] [Accepted: 03/11/2022] [Indexed: 02/06/2023] Open
Abstract
Cystic fibrosis has historically been characterized by malnutrition, and nutrition strategies have placed emphasis on weight gain due to its association with better pulmonary outcomes. As treatment for this disease has significantly improved, longevity has increased and overweight and obesity have emerged issues in this population. The effect of excess weight and adiposity on CF clinical outcomes is unknown but may produce similar health consequences and obesity-related diseases as those observed in the general population. This review examines the prevalence of overweight and obesity in CF, the medical and psychological impact, as well as the existing evidence for treatment in the general population and how this may be applied to people with CF. Clinicians should partner with individuals with CF and their families to provide a personalized, interdisciplinary approach that includes dietary modification, physical activity, and behavioral intervention. Additional research is needed to identify the optimal strategies for preventing and addressing overweight and obesity in CF.
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Affiliation(s)
- Julianna Bailey
- Division of Pulmonary, Allergy and Critical Care Medicine, University of Alabama at Birmingham, Birmingham, AL 35294, USA;
| | - Stefanie Krick
- Division of Pulmonary, Allergy and Critical Care Medicine, University of Alabama at Birmingham, Birmingham, AL 35294, USA;
- Gregory Fleming James Cystic Fibrosis Research Center, University of Alabama at Birmingham, Birmingham, AL 35294, USA
| | - Kevin R. Fontaine
- Department of Health Behavior, School of Public Health, University of Alabama at Birmingham, Birmingham, AL 35294, USA;
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Darukhanavala A, Merjaneh L, Mason K, Le T. Eating disorders and body image in cystic fibrosis. J Clin Transl Endocrinol 2021; 26:100280. [PMID: 34917482 PMCID: PMC8646158 DOI: 10.1016/j.jcte.2021.100280] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2021] [Revised: 11/18/2021] [Accepted: 11/19/2021] [Indexed: 11/28/2022] Open
Abstract
Eating disorders and disturbed body image have been reported in individuals with cystic fibrosis (CF) and may contribute to poor weight gain, reduced lung function and increased mortality. CF individuals often look and feel different from their peers and bear the additional burden of body-altering side effects of treatment. As a result, the impact of disorders such as binge eating, anorexia nervosa, and bulimia nervosa may adversely affect the social, emotional, and physical development of those with CF. Multiple risk factors may contribute to the development of an eating disorder in CF. Growth failure is affected by the physical impairments of CF, including pancreatic insufficiency, high energy demands, respiratory infections, and delayed and stunted growth and puberty. Psychological factors, such as CF associated depression and anxiety, intense focus on BMI, lack of control in a chronic disease, and preoccupation with morbidity and mortality, likely further contribute. Exercise inefficiency, secondary to poor lung function, low BMI and pulmonary exacerbations, and the potential for medication manipulation are also additional risk factors. The intense scrutiny around BMI may lead to a poor relationship with food, including disordered eating habits, abnormal mealtime behaviors, and stressful caregiver-patient interactions regarding meals. This further contributes to a discrepancy between ideal CF nutritional standards and the reality of the challenges of appropriate daily energy intake for an individual with CF. It is imperative that CF providers are equipped to identify potential eating disorders and disturbed body image in their CF patients. Improved screening and monitoring practices should be developed and implemented, with multidisciplinary support from all CF care team members, including dietitians, mental health professionals, and social workers, to best support holistic care and optimize outcomes. Increased attention to these concerns may help reduce CF related morbidity and mortality.
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Affiliation(s)
- Amy Darukhanavala
- Division of Pediatric Endocrinology, University of Massachusetts Medical Center, 55 Lake Ave North, Worcester, MA, USA
- Corresponding author.
| | - Lina Merjaneh
- Division of Pediatric Endocrinology and Diabetes, Seattle Children’s Hospital, Seattle, WA, USA
| | - Kelly Mason
- Division of Pediatric Endocrinology and Diabetes, University of Virginia, Charlottesville, VA, USA
| | - Trang Le
- Department of Internal Medicine and Pediatrics, Division of Pediatric Endocrinology, Diabetes, and Metabolism, Virginia Commonwealth University, Richmond, VA, USA
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Chin M, Brennan AL, Bell SC. Emerging non-pulmonary complications for adults with cystic fibrosis. Chest 2021; 161:1211-1224. [PMID: 34774529 DOI: 10.1016/j.chest.2021.11.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2021] [Revised: 09/27/2021] [Accepted: 11/04/2021] [Indexed: 11/30/2022] Open
Abstract
Improved treatments of cystic fibrosis (CF) related lung disease have resulted in increased longevity, but also increasing prevalence and severity of extrapulmonary manifestations of CF, treatment related complications, age-related conditions and psychosocial effects of longstanding chronic disease. Likewise, the recognition of mild CF phenotypes has changed the landscape of CF disease. This review outlines our current understanding of the common extrapulmonary complications of CF, as well as the changing landscape and future directions of the extrapulmonary complications experienced by patients with CF.
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Affiliation(s)
- Melanie Chin
- Department of Medicine and the Ottawa Hospital Research Institute, University of Ottawa, Ottawa, ON, Canada
| | - Amanda L Brennan
- Manchester Adult Cystic Fibrosis Centre, Manchester University NHS Foundation Trust, Manchester, UK
| | - Scott C Bell
- Thoracic Medicine, The Prince Charles Hospital, Brisbane, Australia; Faculty of Medicine, The University of Queensland, Brisbane, Australia; Translational Research Institute, Brisbane, Australia.
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Abstract
Women with cystic fibrosis (CF) face several unaddressed concerns related to their health. These areas of concern include explanations and guidance on a sex disparity in outcomes, timing of puberty, effects of contraception, prevalence of infertility and impact of pregnancy, and prevention of urinary incontinence and osteoporosis. These understudied topics leave women with numerous unanswered questions about how to manage sexual and reproductive health in the setting of CF. Because people with CF are living longer and healthier lives, there is an increasing awareness of these important aspects of care and multiple ongoing studies to address these understudied topics.
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Behrhorst KL, Everhart RS, Schechter MS. Mental Health in Cystic Fibrosis. Respir Med 2020. [DOI: 10.1007/978-3-030-42382-7_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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Colombo C, Nobili RM, Alicandro G. Challenges with optimizing nutrition in cystic fibrosis. Expert Rev Respir Med 2019; 13:533-544. [PMID: 31094240 DOI: 10.1080/17476348.2019.1614917] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Introduction. Optimizing nutrition remains the cornerstone of therapy for patients with cystic fibrosis (CF) since it is associated with better pulmonary function and survival. However, a significant proportion of patients still fail to achieve normal growth and nutritional status. Areas covered. This review describes the current challenges in providing effective nutritional therapy in CF with a focus on the current issues related to energy imbalance, dietary composition, adherence to nutritional recommendations, pancreatic enzyme replacement therapy, and the effects of modulators of the CF transmembrane conductance regulator. Expert opinion. CF is a multisystemic disease that requires a personalized nutritional approach with accurate evaluation of energy balance. There is an urgent need for evidence-based recommendations on the dietary composition, in consideration of the increasing prevalence of overweight, diabetes and the potential effects of fatty acids on inflammation and immune response. More research into new pancreatic enzyme formulations is also required.
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Affiliation(s)
- Carla Colombo
- a Department of Pathophysiology and Transplantation , Università degli Studi di Milano , Milan , Italy.,b Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Cystic Fibrosis Centre , Milan , Italy
| | - Rita Maria Nobili
- b Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Cystic Fibrosis Centre , Milan , Italy
| | - Gianfranco Alicandro
- c Department of Clinical Sciences and Community Health , Università degli Studi di Milano , Milano , Italy
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Abstract
Background Cystic fibrosis (CF) is a disease in which nutritional barriers are diverse and common, with malnutrition greatly influencing pulmonary trajectory and overall outcomes. Despite this, the most effective methods to optimize CF nutrition are unknown, and literature describing patients’ perspectives on their specific nutritional needs is lacking, particularly in the modern era of CF care. This study aimed to identify the most important nutritional needs and desired health-improvement resources in a contemporary adult CF cohort. Methods A 14-question investigator-designed survey addressing nutrition concerns, preferred health-improvement resources, and dietary/exercise routines was administered to CF adults. Clinical characteristics and survey responses are presented with descriptive statistics, and responses compared by body mass index (BMI) category (< 18.5 kg/m2; 18.5–24.99 kg/m2; 25–29.99 kg/m2; ≥30 kg/m2), gender, and socioeconomic status using Chi square or Fisher’s Exact testing. Results Of 66 total patients, nine (13.6%) were underweight (BMI < 18.5 kg/m2), while 19 (28.8%) were overweight or obese (BMI ≥ 25 kg/m2). In the overall cohort, the most common primary concern was preventing weight loss [in 20/66 patients (30.3%)], but there were significant differences by BMI (p < 0.001), with the most common concern in the overweight subgroup being preventing weight gain. Fifteen (46.9%) men (BMI mean 20.7, range 16.4–29.2 kg/m2) listed preventing weight loss as the primary concern, compared to only 5 (14.7%) women (BMI mean 18.4, range 16.2–19.9 kg/m2), representing a trend toward a difference in primary concerns by gender (p = 0.066). The most commonly desired health-improvement resource was online CF nutrition and fitness information, found in 26 patients (39.4%) in the overall cohort, without significant differences by BMI (p = 0.814) or gender (p = 0.199). Financial assistance was the preferred resource in 17 (26.2%), without differences by socioeconomic status (p = 0.367). Conclusions We identified a wide variety of nutritional needs in CF adults, including a high prevalence of overweight status, many patients desiring weight loss, and many seeking financial resources. Our findings support the individualization of modern-day CF nutrition programs and development of online resources, in an effort to address the heterogeneous barriers that exist in the contemporary CF population and improve outcomes in patients with the disease. Electronic supplementary material The online version of this article (10.1186/s40795-018-0266-3) contains supplementary material, which is available to authorized users.
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Helms SW, Christon LM, Dellon EP, Prinstein MJ. Patient and Provider Perspectives on Communication About Body Image With Adolescents and Young Adults With Cystic Fibrosis. J Pediatr Psychol 2018; 42:1040-1050. [PMID: 28369522 DOI: 10.1093/jpepsy/jsx055] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2016] [Accepted: 02/05/2017] [Indexed: 11/13/2022] Open
Abstract
Objective This mixed-methods study examined perspectives of adolescents and young adults (AYAs) with cystic fibrosis (CF) and health care providers on body image communication. Methods Interviews and questionnaires were completed by 20 AYAs and 28 providers. Results Although 85% of patients reported they had never had a body image conversation with a health care provider, 74% of providers reported discussing this topic with patients. Patients and providers described body image as an important issue, which should be discussed comfortably and supportively. However, patients often preferred to discuss body image as a distinct topic, separate from physical health, whereas providers preferred integrating body image conversations within weight- and health-based discussions. Conclusions Body image is an important topic for AYAs with CF that often goes unaddressed or addressed in ways that are less preferred by patients. Providers should reduce barriers to effective communication about this important topic, particularly through increased awareness of AYA preferences.
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Affiliation(s)
- Sarah W Helms
- Department of Psychology, The University of North Carolina
| | | | - Elisabeth P Dellon
- Division of Pediatric Pulmonology, Department of Pediatrics, The University of North Carolina
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14
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The Impact of Weight Status on Health-Related Quality of Life and Body Image in Adults With Cystic Fibrosis. TOP CLIN NUTR 2018. [DOI: 10.1097/tin.0000000000000139] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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15
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A weekend/weekday comparison of adherence to daily treatment regimens in adults with cystic fibrosis. HEALTH PSYCHOLOGY REPORT 2018. [DOI: 10.5114/hpr.2018.72331] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
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Gawlik NR, Elias AJ, Bond MJ. Appearance Investment, Quality of Life, and Metabolic Control Among Women with Type 1 Diabetes. Int J Behav Med 2017; 23:348-354. [PMID: 26582422 DOI: 10.1007/s12529-015-9524-9] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Abstract
BACKGROUND Concomitants of Type 1 diabetes management include weight gain and dietary restraint. Body image concerns, particularly among women, are therefore common. PURPOSE The study evaluated associations between the appearance investment component of body image, age, quality of life and self-reported metabolic control were examined, along with the practice of insulin restriction as a weight control strategy. METHOD A questionnaire comprising demographic and diabetes-related information, the Appearance Schemas Inventory, and Diabetes Quality of Life Brief Clinical Inventory was completed by Australian women diagnosed with type 1 diabetes (N = 177). RESULTS Self-evaluative salience was higher among younger participants, those with a lower quality of life, and those with better metabolic control of their diabetes, with the relationships between metabolic control and all of age, quality of life, and self-evaluative salience noted to be non-linear. Among participants who reported restricting insulin for weight control, self-evaluative salience was particularly relevant. Motivational salience was not related to other study variables. CONCLUSION Clinically, the provision of information regarding appearance changes that might arise in order to mitigate later body image difficulties is a potentially beneficial adjunct to standard diabetes management protocols that may lead to more successful disease adjustment.
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Affiliation(s)
- Nicola R Gawlik
- School of Psychology, Flinders University, Adelaide, Australia
| | - Anna J Elias
- School of Medicine, Flinders University, Level 3, Health Sciences Building, GPO Box 2100, Adelaide, South Australia, 5001, Australia
| | - Malcolm J Bond
- School of Medicine, Flinders University, Level 3, Health Sciences Building, GPO Box 2100, Adelaide, South Australia, 5001, Australia.
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Bhatt-Poulose K, James K, Reid M, Harrison A, Asnani M. Increased rates of body dissatisfaction, depressive symptoms, and suicide attempts in Jamaican teens with sickle cell disease. Pediatr Blood Cancer 2016; 63:2159-2166. [PMID: 27393908 DOI: 10.1002/pbc.26091] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/20/2015] [Revised: 05/02/2016] [Accepted: 05/13/2016] [Indexed: 11/08/2022]
Abstract
BACKGROUND This study aims to examine the association of body image and weight perceptions with risk of depression and suicidal attempts in Jamaican adolescents with sickle cell disease (SCD). METHODS Adolescents with SCD and a national sample of Jamaican adolescents completed a questionnaire examining body image, weight perceptions, and risk for depression. RESULTS Perceived and desired body images were similar for both groups. Adolescents with SCD had higher levels of "negative body satisfaction" (43.9% vs. 33.9%; P = 0.03), risk for depression (28.7% vs. 19.3%; P = 0.01), and attempted suicide (12.4% vs. 6.6%; P = 0.02) than national sample. Risk of depression was higher in those who perceived themselves to be over or underweight, and lower in those with more friends and attending school. Females and those with body image dissatisfaction were more likely to have attempted suicide. Within the SCD adolescents, girls were at greater odds of having mental health issues. CONCLUSIONS Jamaican adolescents with SCD have significantly higher rates of negative body satisfaction and depressive symptoms, and nearly twice the rate of attempted suicide, compared with their healthy peers. This underscores the need for healthcare professionals to better explore and discuss healthy weight, body satisfaction, and coping with the demands and uncertainties of having a chronic illness with Jamaican adolescents with SCD, even while promoting body acceptance and good self-esteem. Screening for mood disorders is strongly recommended and gender-specific interventions should be developed. Healthcare professionals need to encourage positive social interactions that improve adolescents' mental health.
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Affiliation(s)
- Komal Bhatt-Poulose
- Sickle Cell Unit, Tropical Medicine Research Institute, The University of the West Indies, Mona, Jamaica
| | - Kenneth James
- Department of Community Health and Psychiatry, The University of the West Indies, Mona, Jamaica
| | - Marvin Reid
- Tropical Metabolism Research Unit, Tropical Medicine Research Institute, The University of the West Indies, Mona, Jamaica
| | - Abigail Harrison
- Department of Child and Adolescent Health, The University of the West Indies, Mona, Jamaica
| | - Monika Asnani
- Sickle Cell Unit, Tropical Medicine Research Institute, The University of the West Indies, Mona, Jamaica.
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Abstract
Close attention to nutrition and growth is essential in caring for children with cystic fibrosis (CF). Growth and nutritional status should be monitored as part of routine CF care. Children with CF should achieve growth and nutritional status comparable with that of well-nourished children without CF. Children with CF are at risk for nutritional deficiencies. Optimal nutritional and growth status may be difficult to attain in this population given risk of insufficient caloric intake and likelihood of increased caloric expenditure. Various methods to attain optimal nutritional status may be used, including oral supplementation, behavioral treatment, pharmacotherapy, and enteral nutrition.
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20
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What Is the Role of Nutrition Therapy in the Management of the Adult Cystic Fibrosis Patient? Curr Nutr Rep 2015. [DOI: 10.1007/s13668-015-0136-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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21
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McDermott E, Mullen G, Moloney J, Keegan D, Byrne K, Doherty GA, Cullen G, Malone K, Mulcahy HE. Body image dissatisfaction: clinical features, and psychosocial disability in inflammatory bowel disease. Inflamm Bowel Dis 2015; 21:353-60. [PMID: 25569732 DOI: 10.1097/mib.0000000000000287] [Citation(s) in RCA: 59] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
BACKGROUND Body image refers to a person's sense of their physical appearance and body function. A negative body image self-evaluation may result in psychosocial dysfunction. Crohn's disease and ulcerative colitis are associated with disabling features, and body image dissatisfaction is a concern for many patients with inflammatory bowel disease (IBD). However, no study has assessed body image and its comorbidities in patients with IBD using validated instruments. Our aim was to explore body image dissatisfaction in patients with IBD and assess its relationship with biological and psychosocial variables. METHODS We studied 330 patients (median age, 36 yr; range, 18-83; 169 men) using quantitative and qualitative methods. Patients completed a self-administered questionnaire that included a modified Hopwood Body Image Scale, the Cash Body Image Disturbance Questionnaire, and other validated instruments. Clinical and disease activity data were also collected. RESULTS Body image dissatisfaction was associated with disease activity (P < 0.001) and steroid treatment (P = 0.03) but not with immunotherapy (P = 0.57) or biological (P = 0.55) therapy. Body image dissatisfaction was also associated with low levels of general (P < 0.001) and IBD-specific (P < 0.001) quality of life, self-esteem (P < 0.001), and sexual satisfaction (P < 0.001), and with high levels of anxiety (P < 0.001) and depression (P < 0.001). Qualitative analysis indicated that patients were concerned about both physical and psychosocial consequences of body image dissatisfaction, including steroid side effects and impaired work and social activities. CONCLUSIONS Body image dissatisfaction is common in patients with IBD, relates to specific clinical variables and is associated with significant psychological dysfunction. Its measurement is warranted as part of a comprehensive patient-centered IBD assessment.
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Affiliation(s)
- Edel McDermott
- *Centre for Colorectal Disease, St Vincent's University Hospital, Dublin, Ireland; †School of Medicine and Medical Science, University College Dublin, Dublin, Ireland; ‡Department of Psychiatry, Psychotherapy and Mental Health Research, St Vincent's University Hospital, Dublin, Ireland; and §Department of Gastroenterology, St Luke's Hospital, Kilkenny, Ireland
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22
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Rost Geteilte Erstautorenschaft S, Sarrar Geteilte Erstautorenschaft L, Schneider N, Klenk V, Staab D, Pfeiffer E, Lehmkuhl U, Jaite C. [A pilot study on the specificity of body image disturbance in anorexia nervosa]. ZEITSCHRIFT FUR KINDER- UND JUGENDPSYCHIATRIE UND PSYCHOTHERAPIE 2015; 43:57-67. [PMID: 25536897 DOI: 10.1024/1422-4917/a000333] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
OBJECTIVE Body image disturbance (BID) is a central feature of anorexia nervosa (AN), but evidence for bodily-related disorders also exists for patients with cystic fibrosis (CF), who are frequently underweight. A comparison of BID in patients with AN, CF and controls serves to clarify the specificity of BID for AN. METHOD 22 patients with AN, 10 patients with CF, and 23 controls were tested with regard to perceptual and cognitive-affective components of BID. Further data concerning eating-disorder-related psychopathology were assessed. RESULTS BID occurred in all patients with AN. Patients with CF perceived themselves as thinner than the controls did, and three of them exhibited BID. Patients with AN and CF did not differ regarding body satisfaction, and only controls showed higher satisfaction than patients with CF. Patients with AN and CF differed on desire for thinness, dissatisfaction with their body, and interoceptive awareness, with higher scores occurring in patients with AN. CONCLUSIONS Our pilot study reveals no severe psychopathology concerning body image in patients with CF. However, we did observe a general body dissatisfaction among these patients, probably associated with their being underweight. BID still seems to be a central diagnostic criterion for AN and should be carefully considered during therapeutic interventions.
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Affiliation(s)
| | | | - Nora Schneider
- Klinik für Psychiatrie, Psychosomatik und Psychotherapie des Kindes- und Jugendalters, Charité - Universitätsmedizin Berlin
| | - Vera Klenk
- Klinik für Psychiatrie, Psychosomatik und Psychotherapie des Kindes- und Jugendalters, Charité - Universitätsmedizin Berlin
| | - Doris Staab
- Klinik für Pädiatrie mit Schwerpunkt Pneumologie/Immunologie, Charité - Universitätsmedizin Berlin
| | - Ernst Pfeiffer
- Klinik für Psychiatrie, Psychosomatik und Psychotherapie des Kindes- und Jugendalters, Charité - Universitätsmedizin Berlin
| | - Ulrike Lehmkuhl
- Klinik für Psychiatrie, Psychosomatik und Psychotherapie des Kindes- und Jugendalters, Charité - Universitätsmedizin Berlin
| | - Charlotte Jaite
- Klinik für Psychiatrie, Psychosomatik und Psychotherapie des Kindes- und Jugendalters, Charité - Universitätsmedizin Berlin
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Quick VM, Byrd-Bredbenner C, Neumark-Sztainer D. Chronic illness and disordered eating: a discussion of the literature. Adv Nutr 2013; 4:277-86. [PMID: 23674793 PMCID: PMC3650496 DOI: 10.3945/an.112.003608] [Citation(s) in RCA: 80] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
This paper describes the prevalence of eating disorders and disordered eating behaviors, the reasons why these practices are endorsed, and the potential consequences in youths and young adults with selected diet-related chronic health conditions (DRCHCs) and provides recommendations for eating disorder prevention interventions and research efforts. Although it remains unclear whether the prevalence of eating disorders is higher in those with DRCHCs compared with the general population, overall findings suggest that young people with DRCHCs may be at risk of endorsing disordered eating behaviors that may lead to diagnosis of an eating disorder and other health problems over the course of their treatment. Thus, health care providers should be aware that young people with DRCHCs may be at risk of eating disorders and carefully monitor psychological changes and the use of unhealthy weight control methods. It is also important to develop and evaluate theory-based interventions and disease-specific eating disorder risk screening tools that are effective in halting the progression of eating disorders and negative health outcomes in young people with chronic health conditions.
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Affiliation(s)
- Virginia M. Quick
- Eunice Kennedy Shriver National Institute of Child Health and Human Development, Division of Epidemiology, Statistics, and Prevention Research, NIH, DHHS, Bethesda, MD
| | | | - Dianne Neumark-Sztainer
- School of Public Health, Division of Epidemiology and Community Health, University of Minnesota, Minneapolis, MN
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