ORIGINAL ARTICLENutritional status, perceived body image and eating behaviours in adults with cystic fibrosis
Introduction
The relationship between poor nutritional status and decreased survival in cystic fibrosis (CF) has been documented.1, 2, 3 Pulmonary infection is associated with an increased resting energy expenditure and anorexia, and undernourished patients have more severe respiratory disease.4, 5 Achieving and maintaining an ideal nutritional status is therefore an integral aim in the treatment of CF,6, 7 and emphasis is continually placed on dietary intake and weight gain. Satisfactory body weight is aimed for with a body mass index (BMI) of at least 19 kg/m2. Individuals with CF have increased energy requirements and a dietary target of between 120% and 150% of the recommended daily allowance for energy has been suggested with as much as 35–40% of the energy provided by fat.8 Requirements are increased during periods of chest exacerbation/infection when appetite is often suppressed. Even when patients are free from infection they often do not have large appetites.9
Between 85% and 90% of patients have pancreatic maldigestion and malabsorption of nutrients, particularly of dietary fats and fat-soluble vitamins.10 Pancreatic enzyme replacement therapy reduces the degree of malabsorption although many patients continue to malabsorb.11 The gastrointestinal problems in CF may be compounded with symptoms of abdominal pain and disturbed bowel habits, which may also suppress appetite. Individuals may avoid foods that they associate with such symptoms or reduce their overall food intake.12 If these increased nutritional requirements cannot be achieved by dietary means and nutritional status is poor or weight loss has continued over a 6-month period, in adults oral nutritional supplements are typically prescribed (1–2 kcal per ml). For patients who become undernourished with a BMI of 18.5 kg/m2 or less, those who fail to respond to oral supplementation and those with poor nutrition listed for transplant, intensive feeding by nasogastric (NG) or gastrostomy tube is indicated.13, 14 A percutaneous endoscopically placed gastrostomy (PEG) tube is most commonly used.
Previous work has shown that body image is extremely important to adults and adolescents15, 16, 17, 18, 19 and children20 with CF. However, compared with healthy adolescents, no increased incidence in eating disorders has been observed.21 Generally, CF females were happy with their body shape whereas CF males desired to be much heavier. Despite this, 3% of males and 12% of females reported excessive dieting and approximately 5% of males and 9% of females reported an intense preoccupation with food with bulimic tendencies.15 Given these data, it is unclear how nutritional interventions impact on patients’ perceptions and behaviours concerning body image, food and eating. This work aimed to provide a psychosocial profile and compare patients with CF receiving nutritional interventions (enteral tube feeding with nutritional supplements and nutritional supplements only) with CF controls and healthy controls concerning (a) demographic and clinical variables of age, BMI and lung function (b) eating behaviours and attitudes, (c) the perception of body image by comparing actual, perceived and desired BMI, (d) body satisfaction and self-esteem, and (e) quality of life (QoL).
Section snippets
Subjects
The study was a cross sectional questionnaire design. Two-hundred and ninety-one patients with CF and 243 controls were invited to participate. Two hundred and twenty-one CF adults (104 male, 117 female) and 148 healthy controls (74 male, 74 female) consented and were recruited into the study. Patients attended the adult CF Units in Manchester and Leeds in the UK. Healthy controls were recruited from University staff (administrative, cleaning/catering and teaching) and students. Approval was
Response rates
The response rates were 76% for adults with CF and 61% for healthy controls. The mean age, FEV1% predicted and BMI of CF adults who declined to take part in the study was not significantly different from study participants.
Demographic and clinical variables
Mean values of the four groups, segregated by gender, are tabulated for age, FEV1% predicted, and BMI in Table 1. A main effect for groups was observed for FEV1% predicted, BMI, weight and height. Significant decreases in FEV1% predicted between the four groups were observed,
Discussion
The nutritional status of adolescents and adults with CF is associated with eating attitudes, body satisfaction and life quality in addition to the clinical variables of age, lung function, BMI and height. Overall, adults with CF were not as tall as the healthy controls and those who were enterally tube fed had the shortest stature. This is an adult population and perhaps earlier intervention would have enabled maximum growth potential. Enteral feeding occurred in younger patients who had
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