1.  Growth & Nutrition in Cystic Fibrosis Assessing differences between two Wisconsin cohorts Claire Clemens, MS, RD Pediatric Pulmonary Center Trainee January 24, 2012

2. Background  2005 MSN Benchmarking visit  2006 Return to clinic algorithm  2005 CFF recommendations: BMI goal = 50%tile  2009 CFF Infant Care Guidelines Assume  Greater focus on NUTRITION

3. Research Question  Does increased focus on nutrition improve growth outcomes in children with CF from 0-2 years?

4. Methodology  Retrospective medical record analysis  Growth  Feeding  Madison and Milwaukee CF centers  Cohort comparison:  Born 2000-2004  Born 2006-2010

5. Cohort Characteristics Characteristic2000-2004 (n=53)2006-2010 (n=37) Age: Dx (mo)Mean0.98-- Median0.30-- Age: First visit (mo)Mean1.481.00 Median0.690.63 GenderMale26 (49%)16 (43%) Female27 (51%)21 (57%) PhenotypeMI8 (15%)5 (13%) PS6 (11%)11 (30%) PI39 (74%)21 (57%) Birth Wt (g)33033260

6. Growth Outcomes p = 0.5458 p = 0.0408 p = 0.0072

7. Growth Outcomes: PI p = 0.0184 p = 0.8406 p = 0.0570

8. Feeding Practices: Breastfeeding Feeding practice 2000-20042006-2010 Ever BF # 4.995.59 Ex BF1.261.63 Phenotype2000-20042006-2010 MI3/80/5 PS2/64/11 PI20/394/21 Never breastfed: Average breastfeeding duration (mos): # Ever BF = Ex BF + Partial BF *p = 0.0108

9. Feeding Practices: Supplementation  High calorie formula or shakes  No difference in age when supplementation began Phenotype2000-20042006-2010 MI3/80/5 PS5/66/11 PI27/392/21 Phenotype of subjects not receiving high calorie supplementation: *p < 0.0001

10. Clinic Visits Cumulative clinic visits through 24 months *P = 0.0014 # P = 0.0002 + P < 0.0001 * * # # + +

11. Infection Mean positive sputum cultures through age 2 yr

12. Limitations  Small population with high variability  Feeding groups  Phenotype groups  Retrospective  Dependent on data contained in chart

13. Conclusions In more recent cohort:  More aggressive nutrition intervention may contribute to improved weight-for-length percentiles prior to age 2  More children were breastfed  More children received high calorie supplementation

14. Thank You!  Tami Miller  Dr. Lai’s lab:  Zhumin Zhang  Suzanne Shoff  Mary Marcus