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Duijsens D, Pälchen K, Guevara-Zambrano J, Verkempinck S, Infantes-Garcia M, Hendrickx M, Van Loey A, Grauwet T. Corrigendum to “Strategic choices for in vitro food digestion methodologies enabling food digestion design” [Trends in Food Science & Technology 126 (2022) 61–72]. Trends Food Sci Technol 2022. [DOI: 10.1016/j.tifs.2022.09.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/14/2022]
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Duijsens D, Pälchen K, Guevara-Zambrano J, Verkempinck S, Infantes-Garcia M, Hendrickx M, Van Loey A, Grauwet T. Strategic choices for in vitro food digestion methodologies enabling food digestion design. Trends Food Sci Technol 2022. [DOI: 10.1016/j.tifs.2022.06.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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Abstract
BACKGROUND Cystic fibrosis (CF) is an autosomal recessive, life-limiting, multisystem disease affecting over 70,000 individuals worldwide. Between 80% and 90% of people with CF suffer with pancreatic exocrine insufficiency, which if left untreated, leads to a poor nutritional status. Pancreatic enzyme replacement therapy (PERT) has been shown to be effective in improving nutritional status and subsequently associated with improved lung function. However, the timings of PERT administration in relation to a meal are subjective and not standardised, meaning that variations in the timing of PERT dosing persist. OBJECTIVES The primary objective of the review is to compare the efficacy (fat absorption) and effectiveness (nutritional status, lung function and quality of life) of different PERT dosing strategies in terms of timing of administration for treating dietary malabsorption in all individuals with CF. SEARCH METHODS We searched the Cochrane Cystic Fibrosis Trials Register, compiled from electronic database searches and handsearching of journals and conference abstract books. We also searched the reference lists of relevant articles and reviews. Date of last search: 24 June 2021. We also searched ongoing trials registers on 09 July 2021. SELECTION CRITERIA Randomised controlled trials (RCTs), including cross-over RCTs with a minimum washout period of two weeks, and quasi-RCTs of PERT dosing regimens in people (of any age) with CF. DATA COLLECTION AND ANALYSIS Two authors independently assessed and screened the studies identified from the searches. We planned to use GRADE to assess the certainty of evidence for our pre-specified critical outcomes, but we did not identify any eligible studies. MAIN RESULTS No studies met the eligibility criteria and therefore we did not include any in this review. The excluded studies were either cross-over in design (but lacking a sufficient washout period between treatments) or did not assess the timing of PERT. One study which was terminated early is awaiting assessment pending further information. AUTHORS' CONCLUSIONS We were unable to determine whether one dosing schedule for PERT is better than another since we identified no eligible RCTs. While the introduction of PERT to people with CF can improve their nutritional status, there are a limited number of studies which address this review question, and none met our eligibility criteria. Since malnutrition and adverse gastrointestinal symptoms remain a common feature in CF, the assessment of the relative performance of dosing schedules may provide evidence to improve outcomes in people with CF who are pancreatic insufficient. Further research is needed to fully evaluate the role of dosing schedules for PERT in fat absorption. Research should also establish reliable outcome measures and minimal clinically important differences. While RCTs with a cross-over design may have advantages over a parallel group design, an adequate washout period between intervention periods is essential.
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Affiliation(s)
- Christabella Ng
- Division of Child Health, Obstetrics & Gynaecology, School of Medicine, University of Nottingham, Nottingham, UK
| | - Giles Major
- Faculty of Medicine and Health Sciences, University of Nottingham, Nottingham, UK
| | - Alan R Smyth
- Division of Child Health, Obstetrics & Gynaecology, School of Medicine, University of Nottingham, Nottingham, UK
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Calvo-Lerma J, Boon M, Hulst J, Colombo C, Asseiceira I, Garriga M, Masip E, Claes I, Bulfamante A, Janssens HM, Roca M, Vicente S, Fornés V, Zazzeron L, van Schijndel B, Woodcock S, Pereira L, de Boeck K, Ribes-Koninckx C. Change in Nutrient and Dietary Intake in European Children with Cystic Fibrosis after a 6-Month Intervention with a Self-Management mHealth Tool. Nutrients 2021; 13:nu13061801. [PMID: 34073260 PMCID: PMC8229611 DOI: 10.3390/nu13061801] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2021] [Revised: 04/22/2021] [Accepted: 05/22/2021] [Indexed: 01/04/2023] Open
Abstract
Cystic Fibrosis (CF) is a life-long genetic disease, causing increased energy needs and a healthy diet with a specific nutrient distribution. Nutritional status is an indicator of disease prognosis and survival. This study aimed at assessing the effectiveness of a self-management mobile app in supporting patients with CF to achieve the dietary goals set by the CF nutrition guidelines. A clinical trial was conducted in pancreatic insufficient children with CF, followed in six European CF centres, where the self-management app developed within the MyCyFAPP project was used for six months. To assess secondary outcomes, three-day food records were compiled in the app at baseline and after 3 and 6 months of use. Eighty-four subjects (mean 7.8 years old) were enrolled. Compared to baseline, macronutrient distribution better approximated the guidelines, with protein and lipid increasing by 1.0 and 2.1% of the total energy intake, respectively, by the end of the study. Consequently, carbohydrate intake of the total energy intake decreased significantly (-2.9%), along with simple carbohydrate intake (-2.4%). Regarding food groups, a decrease in ultra-processed foods was documented, with a concomitant increase in meat and dairy. The use of a self-management mobile app to self-monitor dietary intake could become a useful tool to achieve adherence to guideline recommendations, if validated during a longer period of time or against a control group.
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Affiliation(s)
- Joaquim Calvo-Lerma
- Instituto de Investigación Sanitaria La Fe—Hospital Universitari i Politècnic La Fe, 46026 Valencia, Spain; (E.M.); (M.R.); (C.R.-K.)
- Correspondence: ; Tel.: +34-961-246-712
| | - Mieke Boon
- Center for Cystic Fibrosis, Department of Pediatrics, University Hospital Leuven, 3000 Leuven, Belgium; (M.B.); (I.C.); (K.d.B.)
| | - Jessie Hulst
- Division of Gastroenterology, Hepatology and Nutrition, Hospital for Sick Children, Toronto, ON M5G 1X8, Canada;
| | - Carla Colombo
- Cystic Fibrosis Center, University of Milan, IRCCS Ca ‘Granda, Maggiore Policlinico Hospital, 20122 Milan, Italy; (C.C.); (A.B.); (L.Z.)
| | - Inês Asseiceira
- Centro de Fibrose Quística, Hospital de Santa Maria, 1649-028 Lisbon, Portugal; (I.A.); (L.P.)
| | - María Garriga
- Unidad de Fibrosis Quística, Hospital Universitario Ramón y Cajal, 28010 Madrid, Spain; (M.G.); (S.V.)
| | - Etna Masip
- Instituto de Investigación Sanitaria La Fe—Hospital Universitari i Politècnic La Fe, 46026 Valencia, Spain; (E.M.); (M.R.); (C.R.-K.)
| | - Ine Claes
- Center for Cystic Fibrosis, Department of Pediatrics, University Hospital Leuven, 3000 Leuven, Belgium; (M.B.); (I.C.); (K.d.B.)
| | - Anna Bulfamante
- Cystic Fibrosis Center, University of Milan, IRCCS Ca ‘Granda, Maggiore Policlinico Hospital, 20122 Milan, Italy; (C.C.); (A.B.); (L.Z.)
| | - Hettie M. Janssens
- Department of Pediatrics, Division of Gastro-Enterology, Erasmus MC-Sophia Children’s Hospital, University Hospital Rotterdam, 14010 Rotterdam, The Netherlands; (H.M.J.); (B.v.S.); (S.W.)
- Department of Pediatrics, Division of Respiratory Medicine and Allergology, Erasmus MC-Sophia Children’s Hospital, University Hospital Rotterdam, 14010 Rotterdam, The Netherlands
| | - Maria Roca
- Instituto de Investigación Sanitaria La Fe—Hospital Universitari i Politècnic La Fe, 46026 Valencia, Spain; (E.M.); (M.R.); (C.R.-K.)
| | - Saioa Vicente
- Unidad de Fibrosis Quística, Hospital Universitario Ramón y Cajal, 28010 Madrid, Spain; (M.G.); (S.V.)
| | | | - Laura Zazzeron
- Cystic Fibrosis Center, University of Milan, IRCCS Ca ‘Granda, Maggiore Policlinico Hospital, 20122 Milan, Italy; (C.C.); (A.B.); (L.Z.)
| | - Bo van Schijndel
- Department of Pediatrics, Division of Gastro-Enterology, Erasmus MC-Sophia Children’s Hospital, University Hospital Rotterdam, 14010 Rotterdam, The Netherlands; (H.M.J.); (B.v.S.); (S.W.)
- Department of Pediatrics, Division of Respiratory Medicine and Allergology, Erasmus MC-Sophia Children’s Hospital, University Hospital Rotterdam, 14010 Rotterdam, The Netherlands
| | - Sandra Woodcock
- Department of Pediatrics, Division of Gastro-Enterology, Erasmus MC-Sophia Children’s Hospital, University Hospital Rotterdam, 14010 Rotterdam, The Netherlands; (H.M.J.); (B.v.S.); (S.W.)
- Department of Pediatrics, Division of Respiratory Medicine and Allergology, Erasmus MC-Sophia Children’s Hospital, University Hospital Rotterdam, 14010 Rotterdam, The Netherlands
| | - Luisa Pereira
- Centro de Fibrose Quística, Hospital de Santa Maria, 1649-028 Lisbon, Portugal; (I.A.); (L.P.)
| | - Kris de Boeck
- Center for Cystic Fibrosis, Department of Pediatrics, University Hospital Leuven, 3000 Leuven, Belgium; (M.B.); (I.C.); (K.d.B.)
| | - Carmen Ribes-Koninckx
- Instituto de Investigación Sanitaria La Fe—Hospital Universitari i Politècnic La Fe, 46026 Valencia, Spain; (E.M.); (M.R.); (C.R.-K.)
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Calvo-Lerma J, Roca M, Boon M, Colombo C, de Koning B, Fornés-Ferrer V, Masip E, Garriga M, Bulfamante A, Asensio-Grau A, Andrés A, de Boeck K, Hulst J, Ribes-Koninckx C. Association between faecal pH and fat absorption in children with cystic fibrosis on a controlled diet and enzyme supplements dose. Pediatr Res 2021; 89:205-210. [PMID: 32247283 DOI: 10.1038/s41390-020-0860-3] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/31/2019] [Revised: 12/31/2019] [Accepted: 02/19/2020] [Indexed: 11/09/2022]
Abstract
BACKGROUND Despite treatment with pancreatic enzyme replacement therapy (PERT), patients with cystic fibrosis (CF) can still suffer from fat malabsorption. A cause could be low intestinal pH disabling PERT. The aim of this study was to assess the association between faecal pH (as intestinal pH surrogate) and coefficient of fat absorption (CFA). Additionally, faecal free fatty acids (FFAs) were quantified to determine the amount of digested, but unabsorbed fat. METHODS In a 24-h pilot study, CF patients followed a standardised diet with fixed PERT doses, corresponding to theoretical optimal doses determined by an in vitro digestion model. Study variables were faecal pH, fat and FFA excretion, CFA and transit time. Linear mixed regression models were applied to explore associations. RESULTS In 43 patients, median (1st, 3rd quartile) faecal pH and CFA were 6.1% (5.8, 6.4) and 90% (84, 94), and they were positively associated (p < 0.001). An inverse relationship was found between faecal pH and total fat excretion (p < 0.01), as well as total FFA (p = 0.048). Higher faecal pH was associated with longer intestinal transit time (p = 0.049) and the use of proton pump inhibitors (p = 0.009). CONCLUSIONS Although the clinical significance of faecal pH is not fully defined, its usefulness as a surrogate biomarker for intestinal pH should be further explored. IMPACT Faecal pH is a physiological parameter that may be related to intestinal pH and may provide important physiopathological information on CF-related pancreatic insufficiency. Faecal pH is correlated with fat absorption, and this may explain why pancreatic enzyme replacement therapy is not effective in all patients with malabsorption related to CF. Use of proton pump inhibitors is associated to higher values of faecal pH. Faecal pH could be used as a surrogate biomarker to routinely monitor the efficacy of pancreatic enzyme replacement therapy in clinical practice. Strategies to increase intestinal pH in children with cystic fibrosis should be targeted.
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Affiliation(s)
- Joaquim Calvo-Lerma
- Cystic Fibrosis Unit, Instituto de Investigación Sanitaria La Fe de Valencia, 46026, Valencia, Spain. .,Research Institute of Food Engineering for Development, Universitat Politècnica de València, 46022, Valencia, Spain.
| | - Maria Roca
- Cystic Fibrosis Unit, Instituto de Investigación Sanitaria La Fe de Valencia, 46026, Valencia, Spain
| | - Mieke Boon
- Pediatric Pulmonology and Cystic Fibrosis Unit, Department of Pediatrics, University Hospitals, 3000, Leuven, Belgium
| | - Carla Colombo
- CF Center, Università degli Studi di Milano, Fondazione IRCCS Ca' Granda, Ospedale Maggiore Policlinico, 20122, Milan, Italy
| | - Barbara de Koning
- Erasmus Medical Center, Sophia Children's Hospital, Rotterdam, The Netherlands
| | | | - Etna Masip
- Cystic Fibrosis Unit, Instituto de Investigación Sanitaria La Fe de Valencia, 46026, Valencia, Spain
| | - Maria Garriga
- Hospital Universitario Ramón y Cajal, 28034, Madrid, Spain
| | - Anna Bulfamante
- CF Center, Università degli Studi di Milano, Fondazione IRCCS Ca' Granda, Ospedale Maggiore Policlinico, 20122, Milan, Italy
| | - Andrea Asensio-Grau
- Research Institute of Food Engineering for Development, Universitat Politècnica de València, 46022, Valencia, Spain
| | - Ana Andrés
- Research Institute of Food Engineering for Development, Universitat Politècnica de València, 46022, Valencia, Spain
| | - Kris de Boeck
- Pediatric Pulmonology and Cystic Fibrosis Unit, Department of Pediatrics, University Hospitals, 3000, Leuven, Belgium
| | - Jessie Hulst
- Division of Gastroenterology, Hepatology and Nutrition, The Hospital for Sick Children, Toronto, ON, Canada
| | - Carmen Ribes-Koninckx
- Cystic Fibrosis Unit, Instituto de Investigación Sanitaria La Fe de Valencia, 46026, Valencia, Spain
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Floch J, Vilarinho T, Zettl A, Ibanez-Sanchez G, Calvo-Lerma J, Stav E, Haro PH, Aalberg AL, Fides-Valero A, Bayo Montón JL. Users' Experiences of a Mobile Health Self-Management Approach for the Treatment of Cystic Fibrosis: Mixed Methods Study. JMIR Mhealth Uhealth 2020; 8:e15896. [PMID: 32673237 PMCID: PMC7381063 DOI: 10.2196/15896] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2019] [Revised: 11/28/2019] [Accepted: 04/28/2020] [Indexed: 12/12/2022] Open
Abstract
Background Despite a large number of clinical trials aiming at evaluating the digital self-management of chronic diseases, there is little discussion about users’ experiences with digital approaches. However, a good user experience is a critical factor for technology adoption. Understanding users’ experiences can inform the design of approaches toward increased motivation for digital self-management. Objective This study aimed to evaluate the self-management of cystic fibrosis (CF) with a focus on gastrointestinal concerns and the care of young patients. Following a user-centered design approach, we developed a self-management app for patients and parents and a web tool for health care professionals (HCPs). To evaluate the proposed solutions, a 6-month clinical trial was conducted in 6 European CF competence centers. This paper analyzes the user acceptance of the technology and the benefits and disadvantages perceived by the trial participants. Methods A mixed methods approach was applied. Data were collected through 41 semistructured qualitative interviews of patients, parents, and HCPs involved in the clinical trial. In addition, data were collected through questionnaires embedded in the self-management app. Results Support for enzyme dose calculation and nutrition management was found to be particularly useful. Patients and parents rapidly strengthened their knowledge about the treatment and increased their self-efficacy. Reported benefits include reduced occurrence of symptoms and enhanced quality of life. Patients and parents had different skills, requiring follow-up by HCPs in an introductory phase. HCPs valued obtaining precise information about the patients, allowing for more personalized advice. However, the tight follow-up of several patients led to an increased workload. Over time, as patient self-efficacy increased, patient motivation for using the app decreased and the quality of the reported data was reduced. Conclusions Self-management enfolds a collaboration between patients and HCPs. To be successful, a self-management approach should be accepted by both parties. Through understanding behaviors and experiences, this study defines recommendations for a complex case—the demanding treatment of CF. We identify target patient groups and situations for which the app is most beneficial and suggest focusing on these rather than motivating for regular app usage over a long time. We also advise the personalized supervision of patients during the introduction of the approach. Finally, we propose to develop guidance for HCPs to facilitate changes in practice. As personalization and technology literacy are factors found to influence the acceptance of digital self-management of other chronic diseases, it is relevant to consider the proposed recommendations beyond the case of CF.
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Affiliation(s)
| | | | | | | | - Joaquim Calvo-Lerma
- Universitat Politècnica de València, València, Spain.,Instituto de Investigación Sanitaria La Fe, València, Spain
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Boon M, Calvo-Lerma J, Claes I, Havermans T, Asseiceira I, Bulfamante A, Garriga M, Masip E, van Schijndel BAM, Fornes V, Barreto C, Colombo C, Crespo P, Vicente S, Janssens H, Hulst J, Witters P, Nobili R, Pereira L, Ruperto M, Van der Wiel E, Mainz JG, De Boeck K, Ribes-Koninckx C. Use of a mobile application for self-management of pancreatic enzyme replacement therapy is associated with improved gastro-intestinal related quality of life in children with Cystic Fibrosis. J Cyst Fibros 2020; 19:562-568. [PMID: 32335023 DOI: 10.1016/j.jcf.2020.04.001] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2019] [Revised: 04/02/2020] [Accepted: 04/04/2020] [Indexed: 02/06/2023]
Abstract
BACKGROUND Most patients with cystic fibrosis (CF) suffer from pancreatic insufficiency (PI), leading to fat malabsorption, malnutrition, abdominal discomfort and impaired growth. Pancreatic enzyme replacement therapy (PERT) is effective, but evidence based guidelines for dose adjustment are lacking. A mobile app for self-management of PERT was developed in the context of the HORIZON 2020 project MyCyFAPP. It contains an algorithm to calculate individual PERT-doses for optimal fat digestion, based on in vitro and in vivo studies carried out in the same project. In addition, the app includes a symptoms diary, educational material, and it is linked to a web tool allowing health care professionals to evaluate patient's data and provide feedback. METHODS A 6-month open label prospective multicenter interventional clinical trial was performed to assess effects of using the app on gastro-intestinal related quality of life (GI QOL), measured by the CF-PedsQL-GI (shortened, CF specific version of the Pediatric Quality of Life Inventory, Gastrointestinal Symptoms Module). RESULTS One hundred and seventy-one patients with CF and PI between 2 and 18 years were recruited at 6 European CF centers. Self-reported CF-PedsQL-GI improved significantly from month 0 (M0) (84.3, 76.4-90.3) to month 6 (M6) (89.4, 80.35-93.5) (p< 0.0001). Similar improvements were reported by parents. Lower baseline CF-PedsQL-GI was associated with a greater improvement at M6 (p < 0.001). CONCLUSIONS The results suggest that the MyCyFAPP may improve GI QOL for children with CF. This tool may help patients to improve self-management of PERT, especially those with considerable GI symptoms.
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Affiliation(s)
- M Boon
- Department of Pediatrics, Center for Cystic Fibrosis, University Hospital Leuven, Leuven, Belgium.
| | - J Calvo-Lerma
- Instituto de Investigación Sanitaria La Fe, Valencia, Spain
| | - I Claes
- Department of Pediatrics, Center for Cystic Fibrosis, University Hospital Leuven, Leuven, Belgium
| | - T Havermans
- Department of Pediatrics, Center for Cystic Fibrosis, University Hospital Leuven, Leuven, Belgium
| | - I Asseiceira
- Associação para a Investigação e Desenvolvimento da Faculdade de Medicina, Lisbon, Portugal
| | - A Bulfamante
- Università degli Studi di Milano, Fondazione IRCCS Ca" Granda, Ospedale Maggiore Policlinico, Milan, Italy
| | - M Garriga
- Unidad de Fibrosis Quística, Hospital Universitario Ramón y Cajal, Madrid, Spain
| | - E Masip
- Gastroenterology and Pediatric cystic Fibrosis Unit, La Fe Hospital, Valencia, Spain
| | - B A M van Schijndel
- Department of Pediatrics, div of Gastro-Enterology, Erasmus MC- Sophia Children's Hospital, University Hospital Rotterdam, the Netherlands
| | - V Fornes
- Instituto de Investigación Sanitaria La Fe, Valencia, Spain
| | - C Barreto
- Associação para a Investigação e Desenvolvimento da Faculdade de Medicina, Lisbon, Portugal
| | - C Colombo
- Università degli Studi di Milano, Fondazione IRCCS Ca" Granda, Ospedale Maggiore Policlinico, Milan, Italy
| | - P Crespo
- Instituto de Investigación Sanitaria La Fe, Valencia, Spain
| | - S Vicente
- Unidad de Fibrosis Quística, Hospital Universitario Ramón y Cajal, Madrid, Spain
| | - H Janssens
- Department of Pediatrics, div Respiratory Medicine and Allergology, Erasmus MC-Sophia Children's Hospital, University Hospital Rotterdam, the Netherlands
| | - J Hulst
- Department of Pediatrics, div of Gastro-Enterology, Erasmus MC- Sophia Children's Hospital, University Hospital Rotterdam, the Netherlands
| | - P Witters
- Department of Pediatrics, Center for Cystic Fibrosis, University Hospital Leuven, Leuven, Belgium
| | - R Nobili
- Università degli Studi di Milano, Fondazione IRCCS Ca" Granda, Ospedale Maggiore Policlinico, Milan, Italy
| | - L Pereira
- Associação para a Investigação e Desenvolvimento da Faculdade de Medicina, Lisbon, Portugal
| | - M Ruperto
- Unidad de Fibrosis Quística, Hospital Universitario Ramón y Cajal, Madrid, Spain
| | - E Van der Wiel
- Department of Pediatrics, div Respiratory Medicine and Allergology, Erasmus MC-Sophia Children's Hospital, University Hospital Rotterdam, the Netherlands
| | - J G Mainz
- Cystic Fibrosis Center for Children and Adults, Jena University Hospital, Germany; Cystic Fibrosis Center Brandenburg Medical School (MHB), University, Brandenburg an der Havel, Germany
| | - K De Boeck
- Department of Pediatrics, Center for Cystic Fibrosis, University Hospital Leuven, Leuven, Belgium
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Screening the impact of food co-digestion on lipolysis under sub-optimal intestinal conditions. Lebensm Wiss Technol 2020. [DOI: 10.1016/j.lwt.2019.108792] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
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9
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Boon M, Claes I, Havermans T, Fornés-Ferrer V, Calvo-Lerma J, Asseiceira I, Bulfamante A, Garriga M, Masip E, Woodcock S, Walet S, Barreto C, Colombo C, Crespo P, Van der Wiel E, Hulst J, Martinez-Barona S, Nobili R, Pereira L, Ruperto M, Vicente S, De Boeck K, Ribes-Koninckx C. Assessing gastro-intestinal related quality of life in cystic fibrosis: Validation of PedsQL GI in children and their parents. PLoS One 2019; 14:e0225004. [PMID: 31860639 PMCID: PMC6924691 DOI: 10.1371/journal.pone.0225004] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2019] [Accepted: 10/25/2019] [Indexed: 12/11/2022] Open
Abstract
BACKGROUND Most patients with cystic fibrosis (CF) suffer from pancreatic insufficiency, leading to fat malabsorption, malnutrition and abdominal discomfort. Until recently, no specific tool was available for assessing gastro-intestinal related quality of life (GI QOL) in patients with CF. As the Horizon2020 project MyCyFAPP aims to improve GI QOL by using a newly designed mobile application, a sensitive and reliable outcome measure was needed. We aimed to study the applicability of the existing child-specific Pediatric Quality of Life Inventory, Gastrointestinal Symptoms Scales and Module (PedsQL GI) in children with CF. METHODS A multicenter, prospective observational study was performed in 6 European centers to validate the PedsQL GI in children with CF during 3 months. RESULTS In total, 248 children and their parents were included. Within-patient variability of PedsQL GI was low (24.11), and there was reasonable agreement between children and parents (ICC 0.681). Nine of 14 subscales were informative (no ceiling effect). The PedsQL GI and the median scores for 4 subscales were significantly lower in patients compared to healthy controls. Positive associations were found between PedsQL GI and age (OR = 1.044, p = 0.004) and between PedsQL GI and BMI z-score (OR = 1.127, p = 0.036). PedsQL GI correlated with most CFQ-R subscales (r 0.268 to 0.623) and with a Visual Analogue Scale (r = 0.20). CONCLUSIONS PedsQL GI is a valid and applicable instrument to assess GI QOL in children with CF. Future research efforts should examine the responsiveness of the CF PedsQL GI to change in the context of clinical interventions and trials.
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Affiliation(s)
- Mieke Boon
- Cystic Fibrosis Center, Department of Pediatrics, University Hospital Gasthuisberg, Leuven, Belgium
- * E-mail:
| | - Ine Claes
- Cystic Fibrosis Center, Department of Pediatrics, University Hospital Gasthuisberg, Leuven, Belgium
| | - Trudy Havermans
- Cystic Fibrosis Center, Department of Pediatrics, University Hospital Gasthuisberg, Leuven, Belgium
| | | | | | - Inês Asseiceira
- Associação para a Investigação e Desenvolvimento da Faculdade de Medicina, Lisbon, Portugal
| | - Anna Bulfamante
- Università degli Studi di Milano, Fondazione IRCCS Ca’ Granda, Ospedale Maggiore Policlinico, Milan, Italy
| | | | - Etna Masip
- Instituto de Investigación Sanitaria La Fe de Valencia, Spain
| | - Sandra Woodcock
- Erasmus Medical Center, Sophia Children’s Hospital, Rotterdam, Netherlands
| | - Sylvia Walet
- Erasmus Medical Center, Sophia Children’s Hospital, Rotterdam, Netherlands
| | - Celeste Barreto
- Associação para a Investigação e Desenvolvimento da Faculdade de Medicina, Lisbon, Portugal
| | - Carla Colombo
- Università degli Studi di Milano, Fondazione IRCCS Ca’ Granda, Ospedale Maggiore Policlinico, Milan, Italy
| | - Paula Crespo
- Instituto de Investigación Sanitaria La Fe de Valencia, Spain
| | - Els Van der Wiel
- Erasmus Medical Center, Sophia Children’s Hospital, Rotterdam, Netherlands
| | - Jessie Hulst
- Erasmus Medical Center, Sophia Children’s Hospital, Rotterdam, Netherlands
| | | | - Rita Nobili
- Università degli Studi di Milano, Fondazione IRCCS Ca’ Granda, Ospedale Maggiore Policlinico, Milan, Italy
| | - Luisa Pereira
- Associação para a Investigação e Desenvolvimento da Faculdade de Medicina, Lisbon, Portugal
| | - Mar Ruperto
- Hospital Universitario Ramón y Cajal, Madrid, Spain
| | | | - Kris De Boeck
- Cystic Fibrosis Center, Department of Pediatrics, University Hospital Gasthuisberg, Leuven, Belgium
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