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. 2015 Nov;167(5):1081-8.e1.
doi: 10.1016/j.jpeds.2015.07.044. Epub 2015 Sep 2.

Early Life Growth Trajectories in Cystic Fibrosis are Associated with Pulmonary Function at Age 6 Years

Don B Sanders  1 , Aliza Fink  2 , Nicole Mayer-Hamblett  3 , Michael S Schechter  4 , Gregory S Sawicki  5 , Margaret Rosenfeld  6 , Patrick A Flume  7 , Wayne J Morgan  8
Affiliations

Early Life Growth Trajectories in Cystic Fibrosis are Associated with Pulmonary Function at Age 6 Years

Don B Sanders et al. J Pediatr. 2015 Nov.

Abstract

Objective: To determine whether severity of lung disease at age 6 years is associated with changes in nutritional status before age 6 within individual children with cystic fibrosis (CF).

Study design: Children with CF born between 1994 and 2005 and followed in the CF Foundation Patient Registry from age ≤2 through 7 years were assessed according to changes in annualized weight-for-length (WFL) percentiles between ages 0 and 2 years and body mass index (BMI) percentiles between ages 2 and 6 years. The association between growth trajectories before age 6 and forced expiratory volume in 1 second (FEV1)% predicted at age 6-7 years was evaluated using multivariable linear regression.

Results: A total of 6805 subjects met inclusion criteria. Children with annualized WFL-BMI always >50th percentile (N = 1323 [19%]) had the highest adjusted mean (95% CI) FEV1 at 6-7 years (101.8 [100.1, 103.5]). FEV1 at 6-7 years for children whose WFL-BMI increased >10 percentile points by age 6 years was 98.3 (96.6, 100.0). This was statistically significantly higher than FEV1 for children whose WFL-BMI was stable (94.4 [92.6, 96.2]) or decreased >10 percentile points (92.9 [91.1, 94.8]). Among children whose WFL-BMI increased >10 percentile points, achieving and maintaining WFL-BMI >50th percentile at younger ages was associated with significantly higher FEV1 at 6-7 years.

Conclusions: Within-patient changes in nutritional status in the first 6 years of life are significantly associated with FEV1 at age 6-7 years. The establishment of a clear relationship between early childhood growth measurements and later lung function suggests that early nutritional interventions may impact on eventual lung health.

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Figures

Figure 1
Figure 1
Diagram of study cohort
Figure 2
Figure 2
Mean WFL-BMI percentile by age for each category of growth trajectories. There were 1,323 children with annualized WFL-BMI always >50th percentile through 6 years. Among children with at least one annualized WFL-BMI <50th percentile, WFL-BMI increased >10 percentile points for 3,205, remained stable for 1,184, and decreased >10 percentile points for 973.
Figure 3
Figure 3
Mean FEV1 % predicted at ages 6-7 years associated with (A) age at which subjects whose WFL-BMI increased >10 percentile points first reached and maintained WFL-BMI >50th percentile and (B) the lowest annualized WFL-BMI percentile for subjects whose WFL-BMI decreased >10 percentile points. The vertical bars represent the 95% confidence intervals.
See this image and copyright information in PMC

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