Cystic Fibrosis

CF: Medical Nutrition Therapy (2018-19)

• Intervention
  In participants with CF, how does medical nutrition therapy (MNT or nutrition counseling) provided by a registered dietitian or international equivalent affect mortality?

  • Conclusion

    In participants with cystic fibrosis (CF), there were no studies identified that reported on the effect of medical nutrition therapy provided by a registered dietitian nutritionist on mortality and survival. 

  • Grade: V
    • Grade I means there is Good/Strong evidence supporting the statement;
    • Grade II is Fair;
    • Grade III is Limited/Weak;
    • Grade IV is Expert Opinion Only;
    • Grade V is Not Assignable.
    • High (A) means we are very confident that the true effect lies close to that of the estimate of the effect;
    • Moderate (B) means we are moderately confident in the effect estimate;
    • Low (C) means our confidence in the effect estimate is limited;
    • Very Low (D) means we have very little confidence in the effect estimate.
    • Ungraded means a grade is not assignable.
  • Search Plan and Results: CF: Medical Nutrition Therapy 2018
     
  In participants with CF, how does medical nutrition therapy (MNT or nutrition counseling) provided by a registered dietitian or international equivalent affect lung function?

  • Conclusion

    In pediatric participants with cystic fibrosis (CF) ages three to 19, limited observational evidence suggests that increasing MNT to one to two sessions per month for one to two and a half years or weekly therapy for nine weeks, when compared to standard MNT care for CF (CFF minimum of one MNT visit per year), did not affect FEV1.

  • Grade: III
    • Grade I means there is Good/Strong evidence supporting the statement;
    • Grade II is Fair;
    • Grade III is Limited/Weak;
    • Grade IV is Expert Opinion Only;
    • Grade V is Not Assignable.
    • High (A) means we are very confident that the true effect lies close to that of the estimate of the effect;
    • Moderate (B) means we are moderately confident in the effect estimate;
    • Low (C) means our confidence in the effect estimate is limited;
    • Very Low (D) means we have very little confidence in the effect estimate.
    • Ungraded means a grade is not assignable.
  • Evidence Summary: In participants with CF, how does medical nutrition therapy (MNT or nutrition counseling), provided by a registered dietitian or international equivalent, affect lung function?
    • Detail
    • Quality Rating Summary
      For a summary of the Quality Rating results, click here.
    • Worksheets
      • Ledger S, Owen E, Prasad S, Goldman A, Willams J ,Aurora P. A pilot outreach physiotherapy and dietetic quality improvement initiative reduces IV antibiotic requirements in children with moderate-severe cystic fibrosis. Journal of Cystic Fibrosis 2013; 12:766-72
      • Ramírez I, Filbrun A, Hasan A, Kidwell K, Nasr S. Improving nutritional status in a pediatric cystic fibrosis center. Pediatric Pulmonology. 2015; 50:544-551
      • Stark L, Opipari-Arrigan L, Quittner A, Bean J, Powers S. The effects of an intensive behavior and nutrition intervention compared to standard of care on weight outcomes in CF. Pediatric Pulmonology. 2011; 46:31-35.
  • Search Plan and Results: CF: Medical Nutrition Therapy 2018
     
  In participants with CF, how does medical nutrition therapy (MNT or nutrition counseling) provided by a registered dietitian or international equivalent affect quality of life?

  • Conclusion

    In pediatric participants with moderate-to-severe cystic fibrosis (CF) ages four to 15, one small quality-improvement study suggested that increasing individualized therapy by a dietitian to a minimum of one to two monthly sessions in combination with more regular physiotherapy for one year did not affect quality of life, though session duration and previous MNT care was not described.

  • Grade: III
    • Grade I means there is Good/Strong evidence supporting the statement;
    • Grade II is Fair;
    • Grade III is Limited/Weak;
    • Grade IV is Expert Opinion Only;
    • Grade V is Not Assignable.
    • High (A) means we are very confident that the true effect lies close to that of the estimate of the effect;
    • Moderate (B) means we are moderately confident in the effect estimate;
    • Low (C) means our confidence in the effect estimate is limited;
    • Very Low (D) means we have very little confidence in the effect estimate.
    • Ungraded means a grade is not assignable.
  • Evidence Summary: In participants with CF, how does medical nutrition therapy (MNT or nutrition counseling) provided by a registered dietitian or international equivalent affect quality of life?
    • Detail
    • Quality Rating Summary
      For a summary of the Quality Rating results, click here.
    • Worksheets
      • Ledger S, Owen E, Prasad S, Goldman A, Willams J ,Aurora P. A pilot outreach physiotherapy and dietetic quality improvement initiative reduces IV antibiotic requirements in children with moderate-severe cystic fibrosis. Journal of Cystic Fibrosis 2013; 12:766-72
  • Search Plan and Results: CF: Medical Nutrition Therapy 2018
     
  In participants with CF, how does medical nutrition therapy (MNT or nutrition counseling) provided by a registered dietitian or international equivalent affect anthropometric measures and growth?

  • Conclusion

    In pediatric participants with cystic fibrosis (CF) ages two to 20, the preponderance of observational evidence suggests that increasing individualized nutrition therapy from a dietitian to a minimum of at least quarterly may improve BMI percentile or decrease decline in BMI Z-score, though baseline MNT frequency was not described.

  • Grade: III
    • Grade I means there is Good/Strong evidence supporting the statement;
    • Grade II is Fair;
    • Grade III is Limited/Weak;
    • Grade IV is Expert Opinion Only;
    • Grade V is Not Assignable.
    • High (A) means we are very confident that the true effect lies close to that of the estimate of the effect;
    • Moderate (B) means we are moderately confident in the effect estimate;
    • Low (C) means our confidence in the effect estimate is limited;
    • Very Low (D) means we have very little confidence in the effect estimate.
    • Ungraded means a grade is not assignable.
  • Evidence Summary: In participants with CF, how does medical nutrition therapy (MNT/nutrition counseling) provided by a registered dietitian or international equivalent, affect anthropometric measures and growth?
    • Detail
    • Quality Rating Summary
      For a summary of the Quality Rating results, click here.
    • Worksheets
      • Ledger S, Owen E, Prasad S, Goldman A, Willams J ,Aurora P. A pilot outreach physiotherapy and dietetic quality improvement initiative reduces IV antibiotic requirements in children with moderate-severe cystic fibrosis. Journal of Cystic Fibrosis 2013; 12:766-72
      • Ramírez I, Filbrun A, Hasan A, Kidwell K, Nasr S. Improving nutritional status in a pediatric cystic fibrosis center. Pediatric Pulmonology. 2015; 50:544-551
      • Savant A, Britton L, Petren K, McColley S, Gutierrez H. Sustained improvement in nutritional outcomes at two paediatric cystic fibrosis centres after quality improvement collaboratives. BMJ Quality & Safety. 2014; 23:i81-i89
      • Stark L, Opipari-Arrigan L, Quittner A, Bean J, Powers S. The effects of an intensive behavior and nutrition intervention compared to standard of care on weight outcomes in CF. Pediatric Pulmonology. 2011; 46:31-35.
  • Search Plan and Results: CF: Medical Nutrition Therapy 2018
     
  In participants with CF, how does medical nutrition therapy (MNT or nutrition counseling) provided by a registered dietitian or international equivalent affect morbidities (length of stay, antibiotic use)?

  • Conclusion

    In participants with moderate-to-severe cystic fibrosis (CF) ages four to 15 years, a small quality-improvement study demonstrated a 23% decrease in days required for inpatient intravenous (IV) antibiotic treatment and a 20% decrease in days required for outpatient antibiotic treatment when physiotherapy and individualized dietetic therapy were increased for one year, though duration of MNT sessions and previous MNT care were not reported.

  • Grade: III
    • Grade I means there is Good/Strong evidence supporting the statement;
    • Grade II is Fair;
    • Grade III is Limited/Weak;
    • Grade IV is Expert Opinion Only;
    • Grade V is Not Assignable.
    • High (A) means we are very confident that the true effect lies close to that of the estimate of the effect;
    • Moderate (B) means we are moderately confident in the effect estimate;
    • Low (C) means our confidence in the effect estimate is limited;
    • Very Low (D) means we have very little confidence in the effect estimate.
    • Ungraded means a grade is not assignable.
  • Evidence Summary: In participants with CF, how does medical nutrition therapy (MNT or nutrition counseling), provided by a registered dietitian or international equivalent, affect morbidities (length of stay, antibiotic use)?
    • Detail
    • Quality Rating Summary
      For a summary of the Quality Rating results, click here.
    • Worksheets
      • Ledger S, Owen E, Prasad S, Goldman A, Willams J ,Aurora P. A pilot outreach physiotherapy and dietetic quality improvement initiative reduces IV antibiotic requirements in children with moderate-severe cystic fibrosis. Journal of Cystic Fibrosis 2013; 12:766-72
  • Search Plan and Results: CF: Medical Nutrition Therapy 2018
     
  In participants with CF, how does medical nutrition therapy (MNT or nutrition counseling) provided by a registered dietitian or international equivalent affect gastrointestinal symptoms?

  • Conclusion

    In participants with cystic fibrosis (CF), there were no studies identified that reported on the effect of medical nutrition therapy provided by a registered dietitian nutritionist on gastrointestinal symptoms.

  • Grade: V
    • Grade I means there is Good/Strong evidence supporting the statement;
    • Grade II is Fair;
    • Grade III is Limited/Weak;
    • Grade IV is Expert Opinion Only;
    • Grade V is Not Assignable.
    • High (A) means we are very confident that the true effect lies close to that of the estimate of the effect;
    • Moderate (B) means we are moderately confident in the effect estimate;
    • Low (C) means our confidence in the effect estimate is limited;
    • Very Low (D) means we have very little confidence in the effect estimate.
    • Ungraded means a grade is not assignable.
  • Search Plan and Results: CF: Medical Nutrition Therapy 2018
     
  In participants with CF, how does medical nutrition therapy (MNT or nutrition counseling) provided by a registered dietitian or international equivalent affect laboratory measures?

  • Conclusion

    In participants with cystic fibrosis (CF), there were no studies identified that reported on the effect of medical nutrition therapy (MNT) provided by a registered dietitian nutritionist on laboratory measures.

  • Grade: V
    • Grade I means there is Good/Strong evidence supporting the statement;
    • Grade II is Fair;
    • Grade III is Limited/Weak;
    • Grade IV is Expert Opinion Only;
    • Grade V is Not Assignable.
    • High (A) means we are very confident that the true effect lies close to that of the estimate of the effect;
    • Moderate (B) means we are moderately confident in the effect estimate;
    • Low (C) means our confidence in the effect estimate is limited;
    • Very Low (D) means we have very little confidence in the effect estimate.
    • Ungraded means a grade is not assignable.
  • Search Plan and Results: CF: Medical Nutrition Therapy 2018