By ACCORDANT HEALTH SERVICES
Nutrients are in the food we eat that we use to live and grow. Most of the nutrients in food get taken into the body through the small intestine. Nutrients can only be taken into the body if enzymes from the pancreas are present. In about 93 out of 100 people with CF, mucus blocks the ducts of the pancreas. This stops the enzymes from getting to the food in the small intestine. Without enzymes, food cannot be broken down for use by the body. Food passes out of the body without being digested. This is called malabsorption.
Malabsorption of nutrients can lead to malnutrition. Malnutrition means that the body is not getting enough nutrients to work the right way. Because nutrients are not being absorbed, people with CF can be malnourished even if they are hungry and eat a lot of food. They may be shorter and weigh less than a healthy person who is their same age and gender.
Taking enzymes helps delay malnutrition. Most people with CF need to take enzyme pills with all their meals and large snacks. Babies need enzymes with their formula or breast milk. These enzymes replace the natural ones that cannot get through the blocked pancreas ducts.
Nutrition and Lung Health
Enzymes alone do not always stop malnutrition. Because of lung disease, people with CF need many more calories than other people do. With CF, it takes more energy to breathe. At rest, a person with CF is still spending more energy than a person who does not have CF. Even mild lung disease calls for many calories to fight swelling and infection.
After age two, everyone with CF needs 110% to 200% more calories than others do. For some teens and adults, this may mean eating as many as 5,000 calories a day. Compare that to the average adult who should only eat about 2,000 calories each day. Children may need up to 2,800 calories a day. But, when people do not feel well, they may not feel hungry. Many also have CFRD (cystic fibrosis-related diabetes) or other CF problems. These factors also lead to malnutrition.
The better your diet is, the better your lung function is likely to be. When your diet is poor, lung disease is much more likely to develop. The good news is that forceful nutrition can slow down or put off lung problems. Great nutrition may even help people with CF live longer. One reason for this is that good nutrition and a good supply of calories help the body fight lung infections. Less lung infections means stronger lungs, which often allows for a longer, healthier life. Most of the time, a higher body weight means better lung function.
The Importance of Early Care
Eating right early on is one of the best ways to avoid malnutrition. Thanks to newborn testing for CF, many parents can now give their child high quality nutrition right from birth. When a person is diagnosed later, CF care providers pay special attention to nutrition in the first 12 months after the diagnosis.
Research shows that a child's nutrition rank at age three can predict how well their lungs will work at age six. Since children with CF are at high risk for malnutrition, it is best to form good eating habits when children are young.
This is not always easy. One study of the eating habits of CF children under age 12 showed that most of them:
There are many ways to improve nutrition. Research shows that the methods all work well, but the most important thing is to start using them early. When good nutrition is started before problems begin, there is a better chance of success. Good early nutrition can have a good effect on health for the rest of a child's life.
Because of the important role that nutrition plays in CF, preventing malnutrition is a main goal. Nutritional treatment for CF includes three basic parts:
If malnutrition, slow growth, or slow weight gain are problems, more forceful steps can be taken to help nutrition. Some choices are:
Checking Nutrition Level
Both children and adults need to have their nutrition level reviewed often. Everyone with CF should have a checkup at least four times a year.
The best way to tell if a person's nutrition is good is to see if their weight is right for their height. For children, growth in height is also important. Both of these are measured by body mass index (BMI). BMI is a number that stands for a person's height and weight. A higher BMI most often means better lung function.
Three different BMI scales are used: one for babies and children under age two, one for children and teens ages 2-20, and one for adults 20 and older.
More than half of adults with CF have a BMI that is lower than the recommended level. This is also true for children. A low BMI is a worry for both adults and children because of the link between good nutrition and living longer. A dietician is a healthcare expert who specializes in helping people get the right amount of nutrients. You or your child should see a dietician who has experience in managing people with CF.
There are easy-to-use BMI calculators for children and adults on the Center for Disease Control and Prevention Web site. Go to www.cdc.gov and type "BMI calculator" in the search box.
If these signs are present, the type of enzymes or how much you take may need to be changed. Never raise or lower the dose of enzymes without talking to your doctor or dietitian. Taking too many enzymes can harm the large bowel. Taking too few enzymes may cause DIOS (distal obstructive syndrome), a block in the bowel.
Other Signs of Poor Nutrition
There are two other signs that suggest nutrition is poor. These are:
Ten Tips for Adding Extra Calories
Remember: fats – found in foods such as butter, oil, nuts, cheese, and cream – have 9 calories per gram. That's more than twice as many calories as you get from a gram of protein or carbohydrates!
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Last Modified Date: March 19, 2009 © Accordant Health Services, a CVS/Caremark company. �All rights reserved.
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