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Vol. 54. Issue 6.
Pages 575-581 (1 June 2001)
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Vol. 54. Issue 6.
Pages 575-581 (1 June 2001)
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Fibrosis quística: aspectos nutricionales
Cystic fibrosis: Nutritional consideration
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M. Molina Arias
Corresponding author
molinaarias@worldonline.es

Correspondencia: Servicio de Gastroenterología y Nutrición. Hospital Infantil Universitario La Paz. P.° de la Castellana, 261. 28046 Madrid.
, G. Prieto Bozano, J. Sarría Osés, I. Polanco Allué
Servicio de Gastroenterología y Nutrición. Hospital Infantil Universitario La Paz. Madrid.
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La mejora durante las últimas décadas de las técnicas de tratamiento y de soporte nutricional de los pacientes con fibrosis quística ha permitido prolongar la supervivencia y aumentar la calidad de vida de estos pacientes. Existe una clara relación entre el desarrollo de la malnutrición y la disminución de los parámetros de función respiratoria y ambos se asocian con un peor pronóstico de la enfermedad.

La malnutrición es una complicación muy frecuente, presente al menos en el 20 % de los pacientes. Esto se debe a que, con frecuencia, se establece un balance energético y proteico negativo originado por el aumento del gasto energético y el aumento de las necesidades nutricionales junto con una disminución de los aportes ingeridos.

Debe monitorizarse de forma periódica el estado nutricional desde el punto de vista clínico, antropométrico y analítico, asegurando que la ingesta alcance los requerimientos y realizando un soporte nutricional más específico en aquellas situaciones en las que se produzca un fracaso nutricional.

La dieta del paciente con fibrosis quística debe ser hipercalórica e hiperproteica, rica en grasa, con aporte normal de hidratos de carbono y con aporte de suplementos pancreáticos y de vitaminas liposolubles cuando exista insuficiencia pancreática.

Palabras clave:
Fibrosis quística
Malnutrición
Balance energético
Soporte nutricional

During the last few decades, improved treatment measures and nutritional support in cystic fibrosis have increased survival and quality of life in these patients. There is a clear relationship between the development of malnutrition and worsening in respiratory function and both factors have been related to poor disease outcome. Malnutrition is a very frequent complication of this disease and is found in 20 % of patients, due to negative energy-proteic balance. This disequilibrium can be explained by increased energy expenditure, high nutritional requirements and decreased oral intake. Periodic monitoring of clinical, anthropometrical and functional nutritional status is mandatory. Intake must be greater than requirements and specific nutritional support should be established when required. Patients with cystic fibrosis must receive a hypercaloric and hyperproteotic diet, with a high fat content, a normal quantity of carbohydrates and with pancreatic and liposoluble vitamin supplements in case of pancreatic insufficiency.

Key words:
Cystic fibrosis
Malnutrition
Energy balance
Nutritional support
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Bibliografía
[1.]
The Cystic Fibrosis Foundation, Patient Registry 1997 Annual Data Report. Bethesda, 1999
[2.]
Levy LD, Durie PR, Pencharz PB, Corey M. Effects of long-term nutritional rehabilitation on body composition and clinical status in malnourished children and adolescents with cystic fibrosis. J Pediatr 1985; 225-230
[3.]
B.S. Zemel, A.F. Jawad, S. FitzSimmons, V.A. Stallings.
Longitudinal relationship among growth, nutritional status, and pulmonary function in children with cystic fibrosis: analysis of the Cystic Fibrosis Foundation National CF Patient Registry.
J Pediatr, 137 (2000), pp. 374-380
[4.]
E. Kerem, J. Reisman, M. Corey, G. Canny, H. Levinson.
Prediction of mortality in patients with cystic fibrosis.
N Engl J Med, 32 (1992), pp. 1187-1191
[5.]
J.S. Elborn, S.C. Bell.
Nutrition and survival in cystic fibrosis.
Thorax, 51 (1996), pp. 971-972
[6.]
C. Grunfeld.
The pathogenesis of wasting in AIDS: lessons for cystic fibrosis.
Pediatr Pulmonol, 10 (1994), pp. 120-122
[7.]
B.M. Winklhofer-Roob, H. Ellemunter, M. Frühwirth.
Plasma vitamin C concentrations in patients with cystic fibrosis: evidence of associations with lung inflammation.
Am J Clin Nutr, 65 (1997), pp. 1858-1866
[8.]
K. Gaskin.
Pediatric Gastrointestinal Disease, 3.a, pp. 1353-1370
[9.]
H.C. Lai, M.R. Kosorok, S.A. Sondel, S.T. Chen, S.C. Fitz Simmons, C.G. Green.
Growth status in children with cystic fibrosis based on the National Cystic Fibrosis Patient Registry data: evaluation of various criteria used to identify malnutrition.
J Pediatr, 132 (1998), pp. 478-485
[10.]
G. Haeusler, H. Frisch, T. Waldhor, M. Gotz.
Perspectives of longitudinal growth in cystic fibrosis from birth to adult age.
Eur J Pediatr, 153 (1994), pp. 158-163
[11.]
P.J. Byard.
Relationship between clinical parameters and linear growth in children with cystic fibrosis.
Am J Human Biol, 1 (1989), pp. 719-725
[12.]
S.A. McNaughton, R.W. Shepherd, R.G. Greer, G.J. Cleghorn, B.J. Thomas.
Nutritional status of children with cystic fibrosis measured by total body potassium as a marker of body cell mass.
lack of sensitivity of anthropometric measures. J Pediatr, 136 (2000), pp. 188-194
[13.]
H. Anthony, J. Bines, P. Phelan, S. Paxton.
Relation between dietary intake and nutritional status in cystic fibrosis.
Arch Dis Child, 78 (1998), pp. 443-447
[14.]
H. Zhao, T.F. Scanlin, J.L. Tomezsko, A. Cnaan, V.A. Stallings.
Longitudinal, prospective analysis of dietary intake in children with cystic fibrosis.
J Pediatr, 129 (1996), pp. 119-129
[15.]
J.J. Reilly, C.A. Edwards, L.T. Weaver.
Malnutrition in children with cystic fibrosis: the energy-balance equation.
J Pediatr Gastroenterol Nutr, 25 (1997), pp. 127-136
[16.]
L. Burdet, O. Hugli, J.D. Aubert, Y. Schutz, M. Roulet, J.W. Fitting.
Effect of elective antibiotic therapy on resting energy expenditure and inflammation in cystic fibrosis.
Eur J Pediatr, 158 (1999), pp. 711-716
[17.]
J.J. Reilly, J.M. Ralston, C.A. Edwards, J.Y. Paton, J. Wilkinson.
Energy balance during acute respiratory exacerbations in children with cystic fibrosis.
Eur Respir J, 13 (1999), pp. 804-809
[18.]
M.A. Thomson, R.W. Wilmott, C. Wainwright, B. Masters, P.J. Francis, R.W. Shepherd.
Resting energy expenditure, pulmonary inflammation, and genotype in the early course of cystic fibrosis.
J Pediatr, 129 (1996), pp. 367-373
[19.]
S.A. Ward, J.L. Tomezsko, D.S. Holsclaw, AM. Paolone.
Energy expenditure and substrate utilization in adults with cystic fibrosis and diabetes mellitus.
Am J Clin Nutr, 69 (1999), pp. 913-919
[20.]
B.S. Zemel, D.A. Kawchak, A. Cnaan, H. Zhao, T.F. Scanlin, V.A. Stallinhs.
Prospective evaluation of resting energy expenditure, nutritional status, pulmonary function, and genotype in children with cystic fibrosis.
Pediatr Res, 40 (1996), pp. 578-586
[21.]
D.N. Sheppard, M.J. Welsh.
Structure and function of the CFTR chloride channel.
Physiol Rev, 79 (1999), pp. 23-45
[22.]
H.C. Lai, M.R. Kosorok, A. Laxova, L.A. Davis, S.C. FitzSimmon, P.M. Farrell.
Nutritional status of patients with cystic fibrosis with meconium ileus: a comparison with patients without meco ileus and diagnosed early through neonatal screening.
Pediatrics, 105 (2000), pp. 53-61
[23.]
A. MacDonald.
Nutritional management of cystic fibrosis.
Arch Dis Child, 74 (1996), pp. 81-87
[24.]
B. Ramsey, P. Farrell, P. Pencharz.
Cystic Fibrosis Foundation.
Consensus Conferences, 1 (1990), pp. 1-15
[25.]
C. Pedrón, M.T. Conde.
Tratamiento dietético.
Fibrosis quística, pp. 201-208
[26.]
K.E. Holliday, J.R. Allen, D.L. Waters, M.A. Gruca, S.M. Thompson, K.J. Gaskin.
Growth of human milk-fed and formula-fed infants with cystic fibrosis.
pp. 77-79
[27.]
L. Ellis, D. Kalnins, M. Corey, J. Brennan, P. Pencharz, P. Durie.
Do infants with cystic fibrosis need a protein hydrosylate formula? A prospective, randomized, comparative study.
J Pediatr, pp. 270-276
[28.]
J.M. Erskine, C.D. Lingard, M.K. Sontag, F.J. Accurso.
Enteral nutrition for patients with cystic fibrosis: comparison of a semi-elemental and nonelemental formula.
J Pediatr, 132 (1998), pp. 265-269
[29.]
D.C. Wilson, D. Kalnins, C. Stewart.
Challenges in the dietary treatment of cystic fibrosis related diabetes mellitus.
Clin Nutr, 19 (2000), pp. 87-93
[30.]
J. Schwartz.
Role of polyunsaturated fatty acids in lung disease.
Am J Clin Nutr, 17 (2000), pp. 393-396
[31.]
S.D. Freedman, M.H. Katz, E.M. Parker, M. Laposata, M.Y. Urman, J.G. Alvarez.
A membrane lipid imbalance plays a role in the phenotypic expression of cystic fibrosis in cftrâ mice.
Pnas, 96 (1999), pp. 13995-14000
[32.]
C. Duggan, A.A. Colin, A. Agil, L. Higgins, N. Rifai.
Vitamin A status in acute exacerbations of cystic fibrosis.
Am J Clin Nutr, 64 (1996), pp. 635-639
[33.]
F. Salamoni, M. Roulet, F. Gudinchet, M. Pilet, D. Thiébaud, P. Burckhardt.
one mineral content in cystic fibrosis patients: correlation with fat-free mass.
Arch Dis Child, 74 (1996), pp. 314-318
[34.]
V. Grey, L. Lands, H. Pall, D. Drury.
Monitoring of 25-OH vitamin D levels in children with cystic fibrosis.
J Pediatr Gastroenterol Nutr, 30 (2000), pp. 314-319
[35.]
M.N. Pond, A.M. Morton, S.P. Conway.
Functional iron deficiency in adults with cystic fibrosis.
Respir Med, 90 (1996), pp. 409-413
[36.]
E. Jelalian, L.J. Stark, L. Reynolds, R. Seifer.
Nutrition intervention for weight gain in cystic fibrosis: a meta analysis.
J Pediatr, 132 (1998), pp. 486-492
[37.]
A.K. Akobeng, V. Miller, A. Thomas.
Percutaneous endoscopic gastrostomy feeding improves nutritional status and stabilizes pulmonary function in patients with cystic fibrosis.
J Pediatr Gastroenterol Nutr, 29 (1999), pp. 485-486
[38.]
S.A. Walker, D. Gozal.
Pulmonary function correlates in the prediction Pulmonary function correlates in the prediction gastrostomy tube feedings.
J Pediatr Gastroenterol Nutr, 27 (1998), pp. 53-56
[39.]
S.G.J. Williams, F. Ashworth, A. McAlweenie, S. Poole, M.E. Hodson, D. Westaby.
Percutaneous endoscopic gastrostomy feeding in patients with cystic fibrosis.
Gut, 44 (1999), pp. 87-90
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