Nutritional counseling and education should occur at the time of diagnosis and regularly thereafter. Infants and children under the age of 2 years presenting with growth failure should be evaluated weekly or every other week until normal weight gain is achieved, then every 2 to 3 months. Patients should be seen at least once a year by a registered dietitian, who can make accurate anthropoTable 21-1. Nutritional Risk Factors in Cystic Fibrosis
Increased resting energy expenditure Chronic cough Pulmonary infections Poor and deteriorating lung function
Possibly a genotype-dependent, energy-requiring cellular defect Increased nutrient losses Pancreatic insufficiency Reduced bile acid and bile salt pool Cough-emesis cycle
Esophagitis from gastroesophageal reflux Depression metric measurements (including arm anthropometrics), analyze dietary intake, help evaluate adequacy ol pancreatic enzyme therapy, and make dietary recommendations.
Table 21-2. Special Aspects of Nutritional Assessment in Cystic Fibrosis
Medical History Pulmonary
Number of pulmonary exacerbations Change in pulmonary function tests Gastrointestinal
History of gastrointestinal disease, meconium ileus, DIOS, intussuception, or gastrointestinal surgery Symptoms of malabsorption, eg, gas and bloating, frequent, bulky, loose stools, floating, fatty, foul-smelling, frothy stools Abdominal pain, vomiting, gastroesophageal reflux Endocrine
Polyuria, polydipsia, steroid use, history of abnormal blood sugars Liver disease
History of biliary cirrhosis, ascites, or esophageal varices
Weight, height, head circumference, midarm circumference, and triceps skinfold thickness, measured every 3 to 6 months Diet History
Total calorie and protein intake
Percent of total calories from fat and/or grams of fat per meal
Food allergies or intolerances
Appetite changes with illness
Use of nutritional supplements or tube feeding
Types and amounts of vitamin supplements
Use of complementary/alternative medicines
Timing and method of pancreatic supplementation Number of enzymes with meals, snacks and/or tube feeding Units of lipase/kg of body weight per day, or per gram of fat Other medications
Antibiotics, acid blockers (H2 antagonists), steroids, alternative medicines
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