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Sinderholm Sposato N, Bjerså K, Gilljam M, Lannefors L, Fagevik Olsén M. Musculoskeletal aspects of respiratory function in cystic fibrosis: a cross-sectional comparative study. Eur Clin Respir J 2024; 11:2350206. [PMID: 38726022 PMCID: PMC11080665 DOI: 10.1080/20018525.2024.2350206] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2024] [Accepted: 04/29/2024] [Indexed: 05/12/2024] Open
Abstract
Background Respiration is an intricate interaction between visceral and musculoskeletal structures. In cystic fibrosis (CF), the airways and lungs are subject to progressive obstruction and destruction. However, knowledge about the musculoskeletal aspects of respiratory function and symptoms is still limited in this patient group. Methods In a cross-sectional comparative study, 21 adults with CF enrolled at the Gothenburg CF Centre were matched with 42 healthy controls. The two groups were examined and compared in terms of thoracic mobility, respiratory muscle strength, lung function, and musculoskeletal pain in accordance with a predefined protocol. Results Significant differences were observed between the groups in the number of tender points, thoracic excursion, forced vital capacity (FVC), and forced expiratory volume (FEV). The CF group also demonstrated a tendency toward reduced function in other measurements, although these were not statistically significant. Conclusion This cross-sectional study revealed that people with CF have reduced thoracic mobility and an increased prevalence of muscular tender points, alongside decreased lung function, compared to healthy controls. These findings stress the need for greater emphasis on the often-overlooked musculoskeletal aspects of CF care, especially as people with CF are living longer and may require more musculoskeletal health support.
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Affiliation(s)
- Niklas Sinderholm Sposato
- Department of Health and Rehabilitation, Institute of Neuroscience and Physiology, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Kristofer Bjerså
- Department of Surgery, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
- Family Medicine, School of Public Health and Community Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
- Region Västra Götaland, Primary Care, Närhälsan Majorna, Gothenburg, Sweden
| | - Marita Gilljam
- Department of Respiratory Medicine, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Louise Lannefors
- Department of Health and Rehabilitation, Institute of Neuroscience and Physiology, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
- Department of Physiotherapy, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Monika Fagevik Olsén
- Department of Health and Rehabilitation, Institute of Neuroscience and Physiology, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
- Department of Physiotherapy, Sahlgrenska University Hospital, Gothenburg, Sweden
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Jennerich AL, Downey L, Goss CH, Kapnadak SG, Pryor JB, Ramos KJ. Computed tomography body composition and clinical outcomes following lung transplantation in cystic fibrosis. BMC Pulm Med 2023; 23:105. [PMID: 36997883 PMCID: PMC10062009 DOI: 10.1186/s12890-023-02398-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2023] [Accepted: 03/24/2023] [Indexed: 04/01/2023] Open
Abstract
BACKGROUND Low muscle mass is common in patients approaching lung transplantation and may be linked to worse post-transplant outcomes. Existing studies assessing muscle mass and post-transplant outcomes include few patients with cystic fibrosis (CF). METHODS Between May 1993 and December 2018, 152 adults with CF received lung transplants at our institution. Of these, 83 met inclusion criteria and had usable computed tomography (CT) scans. Using Cox proportional hazards regression, we evaluated the association between pre-transplant thoracic skeletal muscle index (SMI) and our primary outcome of death after lung transplantation. Secondary outcomes, including days to post-transplant extubation and post-transplant hospital and intensive care unit (ICU) length of stay, were assessed using linear regression. We also examined associations between thoracic SMI and pre-transplant pulmonary function and 6-min walk distance. RESULTS Median thoracic SMI was 26.95 cm2/m2 (IQR 23.97, 31.32) for men and 22.83 cm2/m2 (IQR 21.27, 26.92) for women. There was no association between pre-transplant thoracic SMI and death after transplant (HR 1.03; 95% CI 0.95, 1.11), days to post-transplant extubation, or post-transplant hospital or ICU length of stay. There was an association between pre-transplant thoracic SMI and pre-transplant FEV1% predicted (b = 0.39; 95% CI 0.14, 0.63), with higher SMI associated with higher FEV1% predicted. CONCLUSIONS Skeletal muscle index was low for men and women. We did not identify a significant relationship between pre-transplant thoracic SMI and post-transplant outcomes. There was an association between thoracic SMI and pre-transplant pulmonary function, confirming the potential value of sarcopenia as a marker of disease severity.
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Affiliation(s)
- Ann L Jennerich
- Department of Medicine, Division of Pulmonary, Critical Care and Sleep Medicine, University of Washington, Seattle, WA, USA.
| | - Lois Downey
- Department of Medicine, Division of Pulmonary, Critical Care and Sleep Medicine, University of Washington, Seattle, WA, USA
| | - Christopher H Goss
- Department of Medicine, Division of Pulmonary, Critical Care and Sleep Medicine, University of Washington, Seattle, WA, USA
- Department of Pediatrics, Division of Pulmonary and Sleep Medicine, University of Washington, Seattle, WA, USA
| | - Siddhartha G Kapnadak
- Department of Medicine, Division of Pulmonary, Critical Care and Sleep Medicine, University of Washington, Seattle, WA, USA
| | - Joseph B Pryor
- Department of General Internal Medicine, University of Washington, Seattle, WA, USA
| | - Kathleen J Ramos
- Department of Medicine, Division of Pulmonary, Critical Care and Sleep Medicine, University of Washington, Seattle, WA, USA
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3
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Gusev E, Liang F, Bhattarai S, Broering FE, Leduc-Gaudet JP, Hussain SNA, Radzioch D, Petrof B. Characterization of skeletal muscle wasting pathways in diaphragm and limb muscles of cystic fibrosis mice. Am J Physiol Regul Integr Comp Physiol 2022; 322:R551-R561. [PMID: 35411814 DOI: 10.1152/ajpregu.00225.2021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
BACKGROUND Cystic fibrosis (CF) patients often suffer from skeletal muscle atrophy, most often attributed to physical inactivity and nutritional factors. CF is also characterized by abnormally elevated systemic inflammation. However, it is unknown whether the lack of a functional CF transmembrane conductance regulator (CFTR) gene predisposes to exaggerated inflammation-induced muscle proteolysis. METHODS CF mice (CFTR-/-) and their wild-type (WT=CFTR+/+) littermate controls were systemically injected with Pseudomonas-derived lipopolysaccharide (LPS). After 24 hours, the diaphragm and limb muscles (fast-twitch tibialis anterior, slow-twitch soleus) were assessed for induction of inflammatory cytokines (TNFa, IL1b, IL6), oxidative stress, canonical muscle proteolysis pathways (Calpain, Ubiquitin-Proteasome, Autophagy), muscle fiber histology, and diaphragm contractile function. RESULTS At baseline, CF and WT muscles did not differ with respect to indices of inflammation, proteolysis, or contractile function. After LPS exposure, there was significantly greater induction of all proteolysis pathways (Calpain activity; Ubiquitin-Proteasome: MuRF1 and Atrogin1; Autophagy: LC3B, Gabarapl-1, BNIP3) in CF mice for the diaphragm and tibialis anterior, but not the soleus. Proteolysis pathway upregulation and correlations with inflammatory cytokine induction were most prominent in the tibialis anterior. Diaphragm force normalized to muscle cross-sectional area was reduced by LPS to an equivalent degree in CF and WT mice. CONCLUSIONS CF skeletal muscles containing a high proportion of fast-twitch fibers (diaphragm, tibialis anterior) exhibit abnormally exaggerated upregulation of multiple muscle wasting pathways after exposure to an acute inflammatory stimulus, but not under basal conditions.
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Affiliation(s)
- Ekaterina Gusev
- Meakins-Christie Laboratories, Department of Medicine, McGill University, Montreal, Quebec, Canada.,Translational Research in Respiratory Diseases Program, McGill University Health Center and Research Institute, Montreal, Quebec, Canada
| | - Feng Liang
- Meakins-Christie Laboratories, Department of Medicine, McGill University, Montreal, Quebec, Canada.,Translational Research in Respiratory Diseases Program, McGill University Health Center and Research Institute, Montreal, Quebec, Canada
| | - Salyan Bhattarai
- Meakins-Christie Laboratories, Department of Medicine, McGill University, Montreal, Quebec, Canada.,Translational Research in Respiratory Diseases Program, McGill University Health Center and Research Institute, Montreal, Quebec, Canada
| | - Felipe E Broering
- Meakins-Christie Laboratories, Department of Medicine, McGill University, Montreal, Quebec, Canada.,Translational Research in Respiratory Diseases Program, McGill University Health Center and Research Institute, Montreal, Quebec, Canada
| | - Jean-Phillipe Leduc-Gaudet
- Meakins-Christie Laboratories, Department of Medicine, McGill University, Montreal, Quebec, Canada.,Translational Research in Respiratory Diseases Program, McGill University Health Center and Research Institute, Montreal, Quebec, Canada
| | - Sabah N A Hussain
- Meakins-Christie Laboratories, Department of Medicine, McGill University, Montreal, Quebec, Canada.,Translational Research in Respiratory Diseases Program, McGill University Health Center and Research Institute, Montreal, Quebec, Canada
| | - Danuta Radzioch
- Department of Human Genetics, McGill University, Montreal, Quebec, Canada.,Infectious Diseases and Immunity in Global Health Program, McGill University Health Center and Research Institute, Montreal, Quebec, Canada
| | - Basil Petrof
- Meakins-Christie Laboratories, Department of Medicine, McGill University, Montreal, Quebec, Canada.,Translational Research in Respiratory Diseases Program, McGill University Health Center and Research Institute, Montreal, Quebec, Canada
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Soltman S, Hicks RA, Naz Khan F, Kelly A. Body composition in individuals with cystic fibrosis. J Clin Transl Endocrinol 2021; 26:100272. [PMID: 34804808 PMCID: PMC8586800 DOI: 10.1016/j.jcte.2021.100272] [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: 07/23/2021] [Revised: 10/08/2021] [Accepted: 10/26/2021] [Indexed: 11/17/2022] Open
Abstract
BMI is used to characterize nutritional status but may not accurately depict body composition in CF. DXA and bioelectrical impedance are the most commonly used methods for assessing BC. Lower fat-free mass associates with worse pulmonary function and greater CF disease severity. Fat-free mass associates with greater bone mineral density in individuals with CF.
Because nutritional status is intimately linked with pulmonary function and survival, nutrition has been at the mainstay of cystic fibrosis (CF) care. Body Mass Index (BMI) is traditionally used to define nutritional status because of the ease with which it can be calculated, but it has a number of limitations including its inability to differentiate fat mass (FM) from lean body mass (LBM), the latter thought to confer health advantage. A number of tools are available to quantify body composition including dual-energy x-ray absorptiometry (DXA), bioelectrical impedance, MRI, CT, air displacement plethysmography, and stable isotopes, and these have been used to varying degrees in studies of CF. In CF, LBM tends to be lower for a given BMI, particularly at lower BMI. In adults, lower fat-free mass (FFM) correlates with greater CF disease severity, lower pulmonary function and higher inflammatory markers. FFM is also positively associated with greater bone mineral density, while greater FM is associated with greater loss of lumbar spine bone mineral density over 2 years. In youth, LBM is positively associated with pulmonary function. The predictive value of body composition for functional and clinical outcomes and the role of improving LBM on these outcomes remain undefined. With improvements in BMI accompanying highly-effective modulator therapy, closer evaluations of body composition may inform risk for more traditional, non-CF adult outcomes in CF.
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Mgbemena N, Jones A, Leicht AS. Relationship between handgrip strength and lung function in adults: a systematic review. Physiother Theory Pract 2021; 38:1908-1927. [PMID: 33870831 DOI: 10.1080/09593985.2021.1901323] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
Handgrip strength (HGS) is a functional test that has been directly associated with lung function in some healthy populations; however, inconsistent findings have been reported for populations with chronic diseases. The aim of this study was to identify the relationship between HGS and lung function in both healthy and unhealthy adults. A systematic search was conducted using six databases from their earliest inception to February 29, 2020. Two authors reviewed and assessed methodological quality of eligible studies using the Crowe Critical Appraisal Tool (CCAT). Twenty-five studies met the inclusion criteria with 8 and 17 studies examining healthy and unhealthy populations, respectively. Reported average methodological quality of all included studies using the CCAT was 38-85% with most rated as Good to Excellent. Despite the use of heterogeneous equipment and protocols during HGS and lung function assessments, significant positive and moderate correlations and/or regression coefficients were reported for healthy populations consistently. Conversely, the reported relationships between HGS and lung function for unhealthy counterparts were variable. Handgrip strength was significantly associated with lung function in most healthy adults. Future robust studies are needed to confirm the suitability of HGS to assess lung function for healthy and unhealthy adults.
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Affiliation(s)
- Nnamdi Mgbemena
- Department of Physiotherapy, James Cook University, Townsville, Queensland, Australia.,Australian Institute of Tropical Health and Medicine, James Cook University, Townsville, Queensland, Australia
| | - Anne Jones
- Department of Physiotherapy, James Cook University, Townsville, Queensland, Australia.,Australian Institute of Tropical Health and Medicine, James Cook University, Townsville, Queensland, Australia
| | - Anthony S Leicht
- Australian Institute of Tropical Health and Medicine, James Cook University, Townsville, Queensland, Australia.,Department of Sport and Exercise Science, James Cook University, Townsville, Queensland, Australia
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Interval versus constant-load exercise training in adults with Cystic Fibrosis. Respir Physiol Neurobiol 2021; 288:103643. [PMID: 33618051 DOI: 10.1016/j.resp.2021.103643] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2021] [Revised: 02/11/2021] [Accepted: 02/13/2021] [Indexed: 02/07/2023]
Abstract
BACKGROUND The efficacy of interval exercise (IE) compared to constant-load exercise (CLE) training remains unsettled in adults with Cystic Fibrosis (CF). METHODS Twenty-four adults with CF were randomised to 30-min IE (100 % peak work capacity (WRpeak) for 30-s alternated with 40 % WRpeak for 30-s; n = 12) or 30-min CLE (70 % WRpeak; n = 12) training, 3 times weekly, for 12 weeks. Isometric quadriceps muscle strength was assessed using a strain gauge Myometer. RESULTS The magnitude of improvement in quadriceps muscle strength was greater (p = 0.037) in the IE (by 32 ± 13 Nm) compared to the CLE (by 23 ± 12 Nm) groups. Maximum inspiratory and expiratory mouth pressures were significantly improved only in the IE group (by 30 ± 10 cmH2O; p = 0.009 and 13 ± 4 cmH2O; p = 0.007, respectively). Arterial oxygen saturation during training was higher (p = 0.002) for IE (94 ± 1%) compared to CLE (91 ± 1%), whereas dyspnoea scores were lower (p = 0.001) for IE (3.8 ± 0.7) compared to CLE (5.9 ± 0.8) CONCLUSIONS: IE is superior to CLE in improving peripheral and respiratory muscle strength and preferable to CLE because it is associated with lower exercise-induced arterial oxygen desaturation and breathlessness.
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King SJ, Keating D, Williams E, Paul E, Borg BM, Finlayson F, Button BM, Wilson JW, Kotsimbos T. Lumacaftor/ivacaftor-associated health stabilisation in adults with severe cystic fibrosis. ERJ Open Res 2021; 7:00203-2020. [PMID: 33569502 PMCID: PMC7861032 DOI: 10.1183/23120541.00203-2020] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2020] [Accepted: 10/27/2020] [Indexed: 11/05/2022] Open
Abstract
Introduction Lumacaftor/ivacaftor (LUM/IVA) has been shown to improve clinical outcomes in cystic fibrosis (CF) patients homozygous for Phe508del with forced expiratory volume in 1 s (FEV1) % pred >40%. We assessed the clinical utility of LUM/IVA in all eligible adult CF patients with FEV1 % pred <40% treated for at least 1 year under a single-centre managed access programme. Methods Following clinical optimisation, eligible patients (n=40) with FEV1 % pred <40% were commenced on LUM/IVA and monitored for tolerance and clinical outcomes, including health service utilisation, pulmonary function, weight and body composition. 24 patients reached 1 year of treatment by the time of evaluation. Six patients discontinued due to adverse events (five for increased airways reactivity) and three underwent lung transplantation. Results In comparison with the year prior to LUM/IVA commencement, significant reductions (median per year) were observed in the treatment year in the number of pulmonary exacerbations requiring hospitalisation (from 3 to 1.5; p=0.0002), hospitalisation days (from 27 to 17; p=0.0002) and intravenous antibiotic (IVAB) usage days (from 45 to 27; p=0.0007). Mean±sd change in FEV1 % pred was −2.10±1.18% per year in the year prior, with the decline reversed in the year following (+1.45±1.13% per year; p=0.035), although there was significant heterogeneity in individual responses. Mean±sd weight gain at 1 year was 2.5±4.1 kg (p=0.0007), comprising mainly fat mass (mean 2.2 kg). The proportion of patients severely underweight (body mass index <18.5 kg·m−2) decreased from 33% at baseline to 13% at 1 year (p=0.003). Conclusion This real-world evaluation study demonstrated benefits over several clinical domains (infective exacerbations requiring hospitalisation, IVABs, pulmonary function decline and nutritional parameters) in CF patients with severe lung disease. In adults with severe cystic fibrosis lung disease, 1 year of treatment with lumacaftor/ivacaftor was associated with reduced infective exacerbations, days of intravenous antibiotics and rate of pulmonary function decline, and improved nutritional statushttps://bit.ly/2I07suR
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Affiliation(s)
- Susannah J King
- Nutrition Dept, Alfred Hospital, Melbourne, Australia.,Cystic Fibrosis Service, Dept of Respiratory Medicine, Alfred Hospital, Melbourne, Australia.,Dept of Dietetics, Nutrition and Sport, LaTrobe University, Bundoora, Australia
| | - Dominic Keating
- Cystic Fibrosis Service, Dept of Respiratory Medicine, Alfred Hospital, Melbourne, Australia.,Dept of Medicine, Monash University, Melbourne, Australia
| | - Elyssa Williams
- Cystic Fibrosis Service, Dept of Respiratory Medicine, Alfred Hospital, Melbourne, Australia
| | - Eldho Paul
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
| | - Brigitte M Borg
- Physiology Service, Dept of Respiratory Medicine, Alfred Hospital, Melbourne, Australia
| | - Felicity Finlayson
- Cystic Fibrosis Service, Dept of Respiratory Medicine, Alfred Hospital, Melbourne, Australia
| | - Brenda M Button
- Cystic Fibrosis Service, Dept of Respiratory Medicine, Alfred Hospital, Melbourne, Australia.,Dept of Medicine, Monash University, Melbourne, Australia.,Physiotherapy Dept, Alfred Hospital, Melbourne, Australia
| | - John W Wilson
- Cystic Fibrosis Service, Dept of Respiratory Medicine, Alfred Hospital, Melbourne, Australia.,Dept of Medicine, Monash University, Melbourne, Australia
| | - Tom Kotsimbos
- Cystic Fibrosis Service, Dept of Respiratory Medicine, Alfred Hospital, Melbourne, Australia.,Dept of Medicine, Monash University, Melbourne, Australia
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8
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King SJ, Tierney AC, Edgeworth D, Keating D, Williams E, Kotsimbos T, Button BM, Wilson JW. Body composition and weight changes after ivacaftor treatment in adults with cystic fibrosis carrying the G551 D cystic fibrosis transmembrane conductance regulator mutation: A double-blind, placebo-controlled, randomized, crossover study with open-label extension. Nutrition 2021; 85:111124. [PMID: 33571868 DOI: 10.1016/j.nut.2020.111124] [Citation(s) in RCA: 25] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2020] [Revised: 11/15/2020] [Accepted: 12/09/2020] [Indexed: 11/30/2022]
Abstract
OBJECTIVES In patients with cystic fibrosis (CF) who carry the G551D mutation, treatment with ivacaftor improves lung function and weight; however, short- and long-term impacts on body composition have not been well studied. METHODS Twenty adults with CF carrying the G551D mutation (mean ± standard deviation body mass index [BMI] 23.3 ± 4.3 kg/m2) were recruited for a single-center, double-blind, placebo-controlled, 28-d, crossover study of ivacaftor, followed by an open-label extension (OLE) for 5 mo. Eleven patients underwent measurements 2 y later. The study variables included weight, BMI, and body composition (including fat-free mass [FFM] and fat mass). RESULTS After 28 d of treatment with ivacaftor, weight increased by 1.1 ± 1.3 kg, BMI by 0.4 ± 0.5 kg/m2, and FFM by 1.1 ± 1.2 kg (all P < .005) with no change in fat mass. Differences between 28-d changes on ivacaftor and placebo were not statistically significant. In the following 5 mo of the OLE, there were significant increases in weight (1.2 ± 1.9 kg; P < .05) and fat mass (1.5 ± 1.9 kg; P < .01), but not in FFM. Between baseline and the end of the OLE, the total weight gain was 2.5 ± 2.4 kg (P < .005), comprised of 0.9 ± 1.5 kg FFM (P < .05) and 1.6 ± 1.8 kg fat mass (P < .005). For the 11 participants who were followed for a further 2 y, no further changes in mean weight, BMI, or body composition parameters between 6 mo and 2 y later were observed. CONCLUSIONS Small gains were seen in FFM in the first month of ivacaftor treatment. Weight, BMI, and fat-mass gains in the first 6 mo on ivacaftor plateaued by 2.5 y. The metabolic and clinical consequences of weight and fat-mass gains remain to be determined.
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Affiliation(s)
- Susannah J King
- Nutrition Department, Alfred Hospital, Melbourne, Victoria, Australia; Cystic Fibrosis Service, Department of Respiratory Medicine, Alfred Hospital, Melbourne, Victoria, Australia; Department of Dietetics, Nutrition and Sport, LaTrobe University, Victoria, Australia.
| | - Audrey C Tierney
- Nutrition Department, Alfred Hospital, Melbourne, Victoria, Australia; Cystic Fibrosis Service, Department of Respiratory Medicine, Alfred Hospital, Melbourne, Victoria, Australia; Department of Dietetics, Nutrition and Sport, LaTrobe University, Victoria, Australia; School of Allied Health, University of Limerick, Limerick, Ireland
| | - Deirdre Edgeworth
- Cystic Fibrosis Service, Department of Respiratory Medicine, Alfred Hospital, Melbourne, Victoria, Australia; Department of Anesthesia and Intensive Care Medicine, St James' Hospital, Dublin, Ireland
| | - Dominic Keating
- Cystic Fibrosis Service, Department of Respiratory Medicine, Alfred Hospital, Melbourne, Victoria, Australia; Department of Medicine, Monash University, Melbourne, Victoria, Australia
| | - Elyssa Williams
- Cystic Fibrosis Service, Department of Respiratory Medicine, Alfred Hospital, Melbourne, Victoria, Australia
| | - Tom Kotsimbos
- Cystic Fibrosis Service, Department of Respiratory Medicine, Alfred Hospital, Melbourne, Victoria, Australia; Department of Medicine, Monash University, Melbourne, Victoria, Australia
| | - Brenda M Button
- Cystic Fibrosis Service, Department of Respiratory Medicine, Alfred Hospital, Melbourne, Victoria, Australia; Department of Medicine, Monash University, Melbourne, Victoria, Australia; Physiotherapy Department, Alfred Hospital, Melbourne, Victoria, Australia
| | - John W Wilson
- Cystic Fibrosis Service, Department of Respiratory Medicine, Alfred Hospital, Melbourne, Victoria, Australia; Department of Medicine, Monash University, Melbourne, Victoria, Australia
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10
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Calella P, Valerio G, Brodlie M, Taylor J, Donini LM, Siervo M. Tools and Methods Used for the Assessment of Body Composition in Patients With Cystic Fibrosis: A Systematic Review. Nutr Clin Pract 2019; 34:701-714. [DOI: 10.1002/ncp.10247] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Affiliation(s)
- Patrizia Calella
- Department of Movement Sciences and Wellbeing; Parthenope University; Naples Italy
- Human Nutrition Research Centre; Institute of Cellular Medicine; Newcastle University; Newcastle on Tyne UK
| | - Giuliana Valerio
- Department of Movement Sciences and Wellbeing; Parthenope University; Naples Italy
| | - Malcolm Brodlie
- Institute of Cellular Medicine; Newcastle University and Great North Children's Hospital; Newcastle upon Tyne UK
| | - Jake Taylor
- Institute of Cellular Medicine; Newcastle University and Great North Children's Hospital; Newcastle upon Tyne UK
| | - Lorenzo Maria Donini
- Department of Experimental Medicine-Medical Pathophysiology; Food Science and Endocrinology Section; Food Science and Human Research Unit; Sapienza University of Rome; Rome Italy
| | - Mario Siervo
- Human Nutrition Research Centre; Institute of Cellular Medicine; Newcastle University; Newcastle on Tyne UK
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11
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Peripheral muscle abnormalities in cystic fibrosis: Etiology, clinical implications and response to therapeutic interventions. J Cyst Fibros 2017; 16:538-552. [DOI: 10.1016/j.jcf.2017.02.007] [Citation(s) in RCA: 68] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2016] [Revised: 02/10/2017] [Accepted: 02/12/2017] [Indexed: 12/14/2022]
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12
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Hloch O, Charvat J, Fila L, Jan H. Immunonutrition in patients with cyctic fibrosis leads to drop of serum amyloid A and increase of oxidative stress. J Clin Biochem Nutr 2017; 60:176-179. [PMID: 28584399 PMCID: PMC5453022 DOI: 10.3164/jcbn.16-83] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2016] [Accepted: 11/01/2016] [Indexed: 11/22/2022] Open
Abstract
The aim of the present study is to evaluate of the impact of immunonutrition on parameters of oxidative stress and inflammation in patients with cystic fibrosis and malnutrition. In the 30 patients with cystic fibrosis and long-term enteral nutrition support for malnutrition the effect of standard and immunonutrion sipping on oxidative stress and inflammatory activity parameters was compared. Malonyldialdehyde (MDA) as parameter of oxidative stress and serum amyloid A (SAA), interleukin 1 and 6, hsCRP, IgM, IgA, IgG as parameters of inflammatory activity were examined. Immunonutrition decreased SAA to 17.6 mg/L comparing to 25.6 mg/L when standard nutrition was given (p = 0.014). MDA was 0.66 µM on standard and 0.96 µM on immunonutrition support (p<0.01). The significant negative correlation was recorded between MDA and SAA, hs-CRP, interleukin 6, IgA and IgG. In conclusion, the application of immunonutrition in patients with cystic fibrosis and malnutrition is associated with drop of SAA but with the rise of MDA.
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Affiliation(s)
- Ondrej Hloch
- Department of Internal Medicine, 2nd Faculty Medicine of Charles University and Faculty Hospital Prague Motol, Prague, V Úvalu 84, 150 06 Prague 5, Czech Republic
| | - Jiri Charvat
- Department of Internal Medicine, 2nd Faculty Medicine of Charles University and Faculty Hospital Prague Motol, Prague, V Úvalu 84, 150 06 Prague 5, Czech Republic
| | - Libor Fila
- Department of Pneumology, 2nd Faculty Medicine of Charles University and Faculty Hospital Prague Motol, Prague, V Úvalu 84, 150 06 Prague 5, Czech Republic
| | - Havlin Jan
- 3rd Department of Surgery, 1st Faculty Medicine of Charles University and Faculty Hospital Prague Motol, Czech Republic
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13
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Brandt C, Thronicke A, Roehmel JF, Krannich A, Staab D, Schwarz C. Impact of Long-Term Tiotropium Bromide Therapy on Annual Lung Function Decline in Adult Patients with Cystic Fibrosis. PLoS One 2016; 11:e0158193. [PMID: 27351829 PMCID: PMC4924629 DOI: 10.1371/journal.pone.0158193] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2016] [Accepted: 06/13/2016] [Indexed: 01/01/2023] Open
Abstract
Background Chronic lung disease is the leading cause of death in patients with Cystic Fibrosis (CF) and is often treated with bronchodilators. It is not known whether long-term tiotropium bromide treatment may have a positive impact on lung function. Methods This retrospective cohort study estimated annual lung function decline utilizing longitudinal data for forced expiratory volume in 1 s (FEV1). Results A total of 160 adult patients with CF were analyzed. The subjects treated for 24 months with tiotropium bromide had a significantly slower decline of mean annual change of FEV1 (treated: -0.3±4.0%; control: -2.3±5.0%; p = 0.0130). In patients with FEV1 ≥70% predicted, long-term tiotropium bromide treatment was associated with greater improvements in annual lung function decline (FEV1 ≥70% predicted: treated: +0.5±4.7%; control: -4.0±6.3%; p = 0.0132; FEV1 50–69% predicted: treated: -0.5±4.4%; control: -0.8±3.8%; p = 0.7142; FEV1 ≤49% predicted: treated: -0.6±3.4%; control: -2.4±4.8%; p = 0.0898). Conclusion This study suggests that long-term tiotropium bromide treatment may be associated with reduced annual decline of FEV1 in patients with CF, particularly in adults with a mild degree of severity.
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Affiliation(s)
- Claudia Brandt
- Department of Pediatric Pneumology and Immunology, Cystic Fibrosis Center / Charité – Universitätsmedizin Berlin, Augustenburger Platz 1, 13353 Berlin, Germany
| | - Anja Thronicke
- Department of Pediatric Pneumology and Immunology, Cystic Fibrosis Center / Charité – Universitätsmedizin Berlin, Augustenburger Platz 1, 13353 Berlin, Germany
| | - Jobst F. Roehmel
- Department of Pediatric Pneumology and Immunology, Cystic Fibrosis Center / Charité – Universitätsmedizin Berlin, Augustenburger Platz 1, 13353 Berlin, Germany
| | - Alexander Krannich
- Biostatistics Unit, Berlin Institute of Health, Charité – Universitätsmedizin Berlin, Augustenburger Platz 1, 13353 Berlin, Germany
| | - Doris Staab
- Department of Pediatric Pneumology and Immunology, Cystic Fibrosis Center / Charité – Universitätsmedizin Berlin, Augustenburger Platz 1, 13353 Berlin, Germany
| | - Carsten Schwarz
- Department of Pediatric Pneumology and Immunology, Cystic Fibrosis Center / Charité – Universitätsmedizin Berlin, Augustenburger Platz 1, 13353 Berlin, Germany
- * E-mail:
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14
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Alvarez JA, Ziegler TR, Millson EC, Stecenko AA. Body composition and lung function in cystic fibrosis and their association with adiposity and normal-weight obesity. Nutrition 2016; 32:447-52. [PMID: 26740256 PMCID: PMC4769897 DOI: 10.1016/j.nut.2015.10.012] [Citation(s) in RCA: 63] [Impact Index Per Article: 7.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2015] [Revised: 09/28/2015] [Accepted: 10/15/2015] [Indexed: 10/22/2022]
Abstract
OBJECTIVES This study aimed to evaluate the relationship between lung function and body composition in cystic fibrosis (CF) and examine the presence of normal-weight obesity (NWO), a high body fat percentage with a normal body mass index (BMI), in this population. METHODS In a pilot, cross-sectional study, 32 subjects with CF and a reference group of 20 adults without CF underwent body composition analysis with air displacement plethysmography. NWO was defined as a BMI <25 kg/m(2) and body fat >30% (for women) or >23% (for men). Lung function in subjects with CF was determined by the percentage of predicted forced expiratory volume in 1 s (FEV1% predicted). RESULTS Despite lower BMI and fat-free mass index (P < 0.01), fat mass index and percent body fat did not differ between subjects with CF and the reference group. Among subjects with CF, FEV1% predicted was positively associated with fat-free mass index (β = 6.31 ± 2.93, P = 0.04) and inversely associated with fat mass index (β = -6.44 ± 2.93, P = 0.04), after adjusting for age, sex, and BMI. Ten subjects with CF (31%) had NWO, which corresponded with lower fat-free mass index and FEV1% predicted compared with overweight subjects (P = 0.006 and 0.004, respectively). CONCLUSIONS Excess adiposity, particularly in the form of NWO, was inversely associated with lung function in CF. Larger prospective studies should be undertaken to confirm these findings and determine the long-term metabolic and clinical consequences of excess adiposity in CF. As the lifespan of individuals with CF increases, nutrition screening protocols, which primarily rely on BMI, may require reassessment.
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Affiliation(s)
- Jessica A Alvarez
- Division of Endocrinology, Metabolism and Lipids, Department of Medicine, Emory University School of Medicine, Atlanta, Georgia, USA; Center for Clinical and Molecular Nutrition, Emory University School of Medicine, Atlanta, Georgia, USA; Center for Cystic Fibrosis and Airways Disease Research, Children's Healthcare of Atlanta, Atlanta, Georgia, USA.
| | - Thomas R Ziegler
- Division of Endocrinology, Metabolism and Lipids, Department of Medicine, Emory University School of Medicine, Atlanta, Georgia, USA; Center for Clinical and Molecular Nutrition, Emory University School of Medicine, Atlanta, Georgia, USA; Center for Cystic Fibrosis and Airways Disease Research, Children's Healthcare of Atlanta, Atlanta, Georgia, USA
| | - Erin C Millson
- Center for Clinical and Molecular Nutrition, Emory University School of Medicine, Atlanta, Georgia, USA; Clinical Research Network, Atlanta Clinical and Translational Science Institute, Atlanta, Georgia, USA
| | - Arlene A Stecenko
- Center for Cystic Fibrosis and Airways Disease Research, Children's Healthcare of Atlanta, Atlanta, Georgia, USA; Division of Pulmonology, Allergy/Immunology, Cystic Fibrosis and Sleep, Department of Pediatrics, Emory University School of Medicine, Atlanta, Georgia, USA
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15
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Alicandro G, Battezzati A, Bianchi ML, Loi S, Speziali C, Bisogno A, Colombo C. Estimating body composition from skinfold thicknesses and bioelectrical impedance analysis in cystic fibrosis patients. J Cyst Fibros 2015; 14:784-91. [DOI: 10.1016/j.jcf.2015.07.011] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2014] [Revised: 07/29/2015] [Accepted: 07/29/2015] [Indexed: 01/10/2023]
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16
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Santetti D, de Albuquerque Wilasco MI, Dornelles CTL, Werlang ICR, Fontella FU, Kieling CO, dos Santos JL, Vieira SMG, Goldani HAS. Serum proinflammatory cytokines and nutritional status in pediatric chronic liver disease. World J Gastroenterol 2015; 21:8927-8934. [PMID: 26269683 PMCID: PMC4528036 DOI: 10.3748/wjg.v21.i29.8927] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/20/2014] [Revised: 01/06/2015] [Accepted: 02/13/2015] [Indexed: 02/06/2023] Open
Abstract
AIM: To evaluate the nutritional status and its association with proinflammatory cytokines in children with chronic liver disease.
METHODS: We performed a cross-sectional study with 43 children and adolescents, aged 0 to 17 years, diagnosed with chronic liver disease. All patients regularly attended the Pediatric Hepatology Unit and were under nutritional follow up. The exclusion criteria were fever from any etiology at the time of enrollment, inborn errors of the metabolism and any chronic illness. The severity of liver disease was assessed by Child-Pugh, Model for End-stage Liver Disease (MELD) and Pediatric End Stage Liver Disease (PELD) scores. Anthropometric parameters were height/age, body mass index/age and triceps skinfold/age according to World Health Organization standards. The cutoff points for nutritional status were risk of malnutrition (Z-score < -1.00) and malnutrition (Z-score < -2.00). Interleukin-1β (IL-1β), IL-6 and tumor necrosis factor-α levels were assessed by commercial ELISA kits. For multivariate analysis, linear regression was applied to assess the association between cytokine levels, disease severity and nutritional status.
RESULTS: The median (25th-75th centile) age of the study population was 60 (17-116)-mo-old, and 53.5% were female. Biliary atresia was the main cause of chronic liver disease (72%). With respect to Child-Pugh score, cirrhotic patients were distributed as follows: 57.1% Child-Pugh A, a mild presentation of the disease, 34.3% Child-Pugh B, a moderate stage of cirrhosis and 8.6% Child-Pugh C, were considered severe cases. PELD and MELD scores were only above the cutoff point in 5 cases. IL-6 values were increased in patients at nutritional risk (34.9%) compared with those who were well-nourished [7.12 (0.58-34.23) pg/mL vs 1.63 (0.53-3.43) pg/mL; P = 0.02], correlating inversely with triceps skinfold-for-age z-score (rs = -0.61; P < 0.001). IL-6 levels were associated with liver disease severity assessed by Child-Pugh score (P = 0.001). This association remained significant after adjusting for nutritional status in a linear regression model.
CONCLUSION: High IL-6 levels were found in children with chronic liver disease at nutritional risk. Inflammatory activity may be related to nutritional status deterioration in these patients.
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Hardy CL, King SJ, Mifsud NA, Hedger MP, Phillips DJ, Mackay F, de Kretser DM, Wilson JW, Rolland JM, O'Hehir RE. The activin A antagonist follistatin inhibits cystic fibrosis-like lung inflammation and pathology. Immunol Cell Biol 2015; 93:567-74. [PMID: 25753271 PMCID: PMC4495664 DOI: 10.1038/icb.2015.7] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2014] [Revised: 12/17/2014] [Accepted: 12/17/2014] [Indexed: 01/16/2023]
Abstract
Cystic fibrosis (CF) is the most common life-limiting genetically acquired respiratory disorder. Patients with CF have thick mucus obstructing the airways leading to recurrent infections, bronchiectasis and neutrophilic airway inflammation culminating in deteriorating lung function. Current management targets airway infection and mucus clearance, but despite recent advances in care, life expectancy is still only 40 years. We investigated whether activin A is elevated in CF lung disease and whether inhibiting activin A with its natural antagonist follistatin retards lung disease progression. We measured serum activin A levels, lung function and nutritional status in CF patients. We studied the effect of activin A on CF lung pathogenesis by treating newborn CF transgenic mice (β-ENaC) intranasally with the natural activin A antagonist follistatin. Activin A levels were elevated in the serum of adult CF patients, and correlated inversely with lung function and body mass index. Follistatin treatment of newborn β-ENaC mice, noted for respiratory pathology mimicking human CF, decreased the airway activin A levels and key features of CF lung disease including mucus hypersecretion, airway neutrophilia and levels of mediators that regulate inflammation and chemotaxis. Follistatin treatment also increased body weight and survival of β-ENaC mice, with no evidence of local or systemic toxicity. Our findings demonstrate that activin A levels are elevated in CF and provide proof-of-concept for the use of the activin A antagonist, follistatin, as a therapeutic in the long-term management of lung disease in CF patients.
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Affiliation(s)
- Charles L Hardy
- 1] Department of Allergy, Immunology & Respiratory Medicine, Central Clinical School, Monash University, Melbourne, Victoria, Australia [2] Department of Immunology, Central Clinical School, Monash University, Melbourne, Victoria, Australia
| | - Susannah J King
- Department of Allergy, Immunology & Respiratory Medicine, The Alfred Hospital, Melbourne, Victoria, Australia
| | - Nicole A Mifsud
- 1] Department of Allergy, Immunology & Respiratory Medicine, Central Clinical School, Monash University, Melbourne, Victoria, Australia [2] Department of Allergy, Immunology & Respiratory Medicine, The Alfred Hospital, Melbourne, Victoria, Australia
| | - Mark P Hedger
- MIMR-PHI Institute of Medical Research, Clayton, Victoria, Australia
| | - David J Phillips
- MIMR-PHI Institute of Medical Research, Clayton, Victoria, Australia
| | - Fabienne Mackay
- Department of Immunology, Central Clinical School, Monash University, Melbourne, Victoria, Australia
| | - David M de Kretser
- 1] MIMR-PHI Institute of Medical Research, Clayton, Victoria, Australia [2] Department of Anatomy and Developmental Biology, Monash University, Clayton, Victoria, Australia
| | - John W Wilson
- 1] Department of Allergy, Immunology & Respiratory Medicine, Central Clinical School, Monash University, Melbourne, Victoria, Australia [2] Department of Allergy, Immunology & Respiratory Medicine, The Alfred Hospital, Melbourne, Victoria, Australia
| | - Jennifer M Rolland
- 1] Department of Allergy, Immunology & Respiratory Medicine, Central Clinical School, Monash University, Melbourne, Victoria, Australia [2] Department of Immunology, Central Clinical School, Monash University, Melbourne, Victoria, Australia
| | - Robyn E O'Hehir
- 1] Department of Allergy, Immunology & Respiratory Medicine, Central Clinical School, Monash University, Melbourne, Victoria, Australia [2] Department of Immunology, Central Clinical School, Monash University, Melbourne, Victoria, Australia [3] Department of Allergy, Immunology & Respiratory Medicine, The Alfred Hospital, Melbourne, Victoria, Australia
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18
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Engelen MP, Com G, Deutz NE. Protein is an important but undervalued macronutrient in the nutritional care of patients with cystic fibrosis. Curr Opin Clin Nutr Metab Care 2014; 17:515-20. [PMID: 25295631 PMCID: PMC5241003 DOI: 10.1097/mco.0000000000000100] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
PURPOSE OF REVIEW Achieving an optimal nutritional status in patients with cystic fibrosis (CF) is important to maintain better pulmonary function, physical performance, and to prolong survival. So far, nutrition care in CF has mainly focused on fat intake and achieving energy balance, but there is increasing information on the clinical importance of muscle maintenance and protein intake in CF. RECENT FINDINGS Low muscle mass is consistently associated with pulmonary decline, bone mineral loss, and poor survival in CF. High energy and fat intake contributes to an increased prevalence of overweight and obesity in CF. Obesity per se is not related to better lung function in CF and has negative metabolic and clinical consequences, particularly when muscle wasting is present. Protein digestion capacity is severely impaired in CF, but high protein intake is needed and essential amino acid mixtures appear highly anabolic even in those with severe muscle loss. SUMMARY Body composition assessment and achieving protein balance in the routine care in CF is important to prevent muscle loss and further improve the clinical and overall outcome of these patients. New approaches are needed to optimize the interaction between high essential amino-acid-rich protein intake and pancreatic enzyme regimen in CF. The optimal level of protein intake needs to be assessed in clinically stable CF patients as well as in those recovering from an acute exacerbation.
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Affiliation(s)
- Mariëlle P.K.J. Engelen
- Center for Translational Research in Aging and Longevity, Dept. Health and Kinesiology, Texas A&M University, TX, USA
| | - Gulnur Com
- Dept. Pediatric Pulmonology, University of Arkansas for Medical Sciences and Arkansas Children’s Hospital, Little Rock, AR, USA
| | - Nicolaas E.P. Deutz
- Center for Translational Research in Aging and Longevity, Dept. Health and Kinesiology, Texas A&M University, TX, USA
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Pohl CH, Kock JLF. Oxidized fatty acids as inter-kingdom signaling molecules. Molecules 2014; 19:1273-85. [PMID: 24448067 PMCID: PMC6270766 DOI: 10.3390/molecules19011273] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2013] [Revised: 01/16/2014] [Accepted: 01/16/2014] [Indexed: 12/27/2022] Open
Abstract
Oxylipins or oxidized fatty acids are a group of molecules found to play a role in signaling in many different cell types. These fatty acid derivatives have ancient evolutionary origins as signaling molecules and are ideal candidates for inter-kingdom communication. This review discusses examples of the ability of organisms from different kingdoms to “listen” and respond to oxylipin signals during interactions. The interactions that will be looked at are signaling between animals and plants; between animals and fungi; between animals and bacteria and between plants and fungi. This will aid in understanding these interactions, which often have implications in ecology, agriculture as well as human and animal health.
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Affiliation(s)
- Carolina H Pohl
- Department of Microbial, Biochemical and Food Biotechnology, University of the Free State, PO Box 339, Bloemfontein 9300, South Africa.
| | - Johan L F Kock
- Department of Microbial, Biochemical and Food Biotechnology, University of the Free State, PO Box 339, Bloemfontein 9300, South Africa.
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