An 8-week behavioral intervention can improve weight gain in children with cystic fibrosis
Article Outline
- Powers SW, Jones JS, Ferguson KS, Piazza-Waggoner C, Daines C, Acton JD. Randomized clinical trial of behavioral and nutrition treatment to improve energy intake and growth in toddlers and preschoolers with cystic fibrosis. Pediatrics 2005;116:1442-50
- References
- Copyright
Powers SW, Jones JS, Ferguson KS, Piazza-Waggoner C, Daines C, Acton JD. Randomized clinical trial of behavioral and nutrition treatment to improve energy intake and growth in toddlers and preschoolers with cystic fibrosis. Pediatrics 2005;116:1442-50
Question Among children with cystic fibrosis (CF), will a behavioral and nutrition intervention (BEH) result in improved and sustained weight gain, compared to the usual care control condition (CTL)?
Design Randomized, controlled clinical trial.
Setting Cincinnati Children’s Hospital Medical Center, Ohio.
Participants 10 children (out of 14 eligible from their CF Center), aged 18 to 48 months at the start of the trial.
Methods BEH consisted of eight weekly sessions that included nutrition counseling to increase energy intake (via types of foods and addables/spreadables) and child behavioral management training to teach parents differential attention and contingency management skills. CTL was consistent with the 2002 CF Foundation Consensus Conference Guidelines for nutritional care. Following the first phase of the trial, those randomized to CTL, were allowed to enter the BEH intervention (5 of 6 chose to do so).
Outcomes The primary outcome was energy intake pre-treatment and post-treatment. The secondary goal was the percentage of children who met the energy goal of 120% of the recommended daily allowance of energy per day or greater.
Results BEH led to greater increases in energy intake pre-treatment to post-treatment than CTL as measured by calories per day (842 kcal/day vs -131 kcal/day change). On receiving BEH, the change in energy intake was replicated with the CTL group (892 kcal/day change). At 3- and 12-month follow-up, energy intake was maintained (672 kcal/day increase from baseline and 750 kcal/day increase from baseline, respectively). Children in this study met or exceeded normal weight and height velocities from pre-treatment to the 3-month follow-up (mean weight, 1.4 kg/6 months; mean height, 5.1 cm/6 months) and from post-treatment to the 12-month follow-up (mean weight, 2.5 kg/12 months; mean height, 8.3 cm/12 months).
Conclusions Toddlers and preschoolers who have CF and received BEH were able to meet the energy intake recommendations for this disease and maintain these gains up to 12 months after treatment. In addition, these children demonstrated weight and height velocities from pretreatment to 12-month follow-up, consistent with the goal of normal growth. BEH is a promising, evidence-based, early nutritional intervention for children with CF. An upcoming multisite clinical trial will test BEH versus an attention control condition using a larger sample (N=100), providing additional evidence about the efficacy of this treatment for energy intake and growth in young children with CF.
Comment Failure to thrive and malnutrition is common in cystic fibrosis with incidence of 40.3%.1 Patients with cystic fibrosis, especially young children are requiring energy intake of ≥ 120% of the recommended dietary allowance and percentage of fat intake of 35% to 40% per day, to meet their goal of normal growth.2 Good nutrition and growth early in life may lead to improved lung function and decreased morbidity and mortality.3
This study demonstrated that a behavioral and nutritional intervention (BEH) was superior to a usual care control condition (CTL) in achieving the goal of increasing energy intake over an 8-week study period. While the eight weeks involved intensive training, it appears that this is a reasonable length of time to change behavior for patients and families. Not only did the intervention increase caloric intake during the study, it also resulted in sustained benefit at one-year. This is a very promising study, since BEH is a non-invasive technique that leads to meaningful improvements in the nutritional status of the study patients. Also, BEH can help develop better attitudes towards high calorie diet by both patients and parents and can lead to a reduced stress level around mealtimes. This program, even though time consuming and intense, is feasible to implement in CF centers with patients prior to considering more invasive ways to improve caloric intake. As noted by the authors, a larger scale multi-center study would be beneficial to confirm the results of this study.
References
- . Patient Registry 2004 (Annual Data Report) . Bethesda, MD: Cystic Fibrosis Foundation; 2005;
- . Consensus report on nutrition for pediatric patients with cystic fibrosis . J Pediatr Gastroenterol Nutr . 2002;35:246–259
- . Longitudinal changes in growth parameters are correlated with changes in pulmonary function in children with cystic fibrosis . Pediatrics . 2003;112:588–592
PII: S0022-3476(06)00261-7
doi:10.1016/j.jpeds.2006.03.042
© 2006 Elsevier Inc. All rights reserved.
