CF: Assessment: Validity and Reliability of Nutrition Assessment Methods (2017-19)

Assessment
In pediatric participants with CF, which composite nutrition scores (assessment and screening tools) are valid and reliable compared to reference standards, as measured by validity and/or reliability studies?
- Conclusion
  The Nutrition Risk Screening Tool (NRST) for cystic fibrosis (CF) had moderate validity and high reliability compared to the CFF Consensus report and RDN assessment. The Proposed Nutritional Risk Identification Tool, which included more components, had high validity and reliability compared to the NRST for CF but low validity and reliability compared to the CFF Consensus Report.
- Grade: II
  - 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 pediatric participants with CF, which composite nutrition scores (assessment and screening tools) are valid and reliable compared to reference standards, as measured by validity and/or reliability studies?
- Search Plan and Results: CF: Validity and Reliability of Nutrition Assessment Methods 2018
In pediatric participants with CF, 2 years of age and younger, which weight and growth parameters are valid and reliable compared to reference standards, as measured by validity and/or reliability studies?
- Conclusion
  In children with cystic fibrosis (CF) ≤2 years of age WHO growth charts were less likely to classify children as being underweight based on weight-for-age (WFA) and weight-for-length (WFL) <50^thpercentile compared to CDC growth charts. Validity was low for growth standards or velocities at 4-12 months for predicting WFA and length-for-age (LFA) growth failure at 24 months.
- Grade: II
  - 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 pediatric participants with CF, 2 years of age and younger, which weight and growth parameters are valid and reliable compared to reference standards, as measured by validity and/or reliability studies?
- Search Plan and Results: CF: Validity and Reliability of Nutrition Assessment Methods 2018
In pediatric participants with CF 2-20 years of age, which weight and growth parameters are valid and reliable compared to reference standards, as measured by validity and reliability studies?
- Conclusion
  In children with cystic fibrosis (CF) 2-20 years of age, BMI percentiles for age more accurately identified malnutrition risk compared to percentage of ideal body weight, which under or overestimated malnutrition risk for those with short or tall stature, respectively.
- 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 pediatric participants with CF 2-20 years of age, which weight and growth parameters are valid and reliable compared to reference standards, as measured by validity and reliability studies?
- Search Plan and Results: CF: Validity and Reliability of Nutrition Assessment Methods 2018
In pediatric participants with CF, which body composition parameters are valid and reliable compared to reference standards, as measured by validity and/or reliability studies?
- Conclusion
  In pediatric participants with cystic fibrosis (CF), dual energy x-ray absorptiometry (DEXA) is considered the gold standard to measure body composition in clinical practice. Bioelectrical impedance analysis (BIA) estimates may be accurate for measuring body composition compared to DEXA if CF-specific equations are used, but evidence is limited. There were differences in fat mass and fat-free mass measured by equations utilizing 2 or 4 site skinfold measurements compared to gold standards and the degree and direction of bias was variable according to individuals’ sex and body composition.
- 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 pediatric participants with CF, which body composition parameters are valid and reliable compared to reference standards, as measured by validity and/or reliability studies?
- Search Plan and Results: CF: Validity and Reliability of Nutrition Assessment Methods 2018
In pediatric participants with CF, what is the validity and/or reliability of Nutrition Focused Physical Exam and Handgrip Strength valid compared to reference standards?
- Conclusion
  In pediatric participants with cystic fibrosis (CF), there were no studies identified that examined the validity or reliability of Nutrition Focused Physical Exam or Handgrip Strength to assess nutrition status compared to reference standards.
- 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: Validity and Reliability of Nutrition Assessment Methods 2018
In adults with CF, which weight parameters are valid and reliable compared to reference standards, as measured by validity and/or reliability studies?
- Conclusion
  In adult participants with cystic fibrosis (CF), using a BMI cut-off of ≤18.5 kg/m² to identify malnutrition may misclassify those who have a BMI higher than 18.5 kg/m² but are malnourished based on low fat-free mass.
- Grade: II
  - 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 adults with CF, which weight parameters are valid and reliable compared to reference standards, as measured by validity and/or reliability studies?
- Search Plan and Results: CF: Validity and Reliability of Nutrition Assessment Methods 2018
In adults with CF, which body composition parameters are valid and reliable compared to reference standards, as measured by validity and/or reliability studies?
- Conclusion
  In adults with cystic fibrosis (CF), DEXA is considered the gold standard to measure body composition in clinical practice. Compared to DEXA, assessment of fat free mass using skinfold measures or bioelectrical impedance with equations intended for the general population under- or overestimated fat free mass by a mean of -3.3kg to 2.9kg for adults with CF (low validity).
- Grade: II
  - 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 adults with CF, which body composition parameters are valid and reliable compared to reference standards, as measured by validity and/or reliability studies?
- Search Plan and Results: CF: Validity and Reliability of Nutrition Assessment Methods 2018
In adults with CF, what is the validity and/or reliability of Composite Nutrition Scores, Nutrition Focused Physical Exam and Handgrip Strength compared to reference standards?
- Conclusion
  In adults with cystic fibrosis (CF), there were no studies included that examined the validity and/or reliability of Composite Nutrition Scores, Nutrition Focused Physical Exam and Handgrip Strength compared to reference standards, as measured by validity/reliability studies.
- 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: Validity and Reliability of Nutrition Assessment Methods 2018