Cystic Fibrosis

CF: Assessment: Validity and Reliability of Nutrition Assessment Methods (2018-19)

• 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?
    • Detail
    • Quality Rating Summary
      For a summary of the Quality Rating results, click here.
    • Worksheets
      • McDonald C. Validation of a nutrition risk screening tool for children and adolescents with cystic fibrosis ages 2-20 years. Journal of Pediatric Gastroenterology and Nutrition 2008; 46:438-46
      • Souza Dos Santos Simon M, Forte G, da Silva Pereira J, da Fonseca Andrade Procianoy E, Drehmer M. Validation of a Nutrition Screening Tool for Pediatric Patients with Cystic Fibrosis. Journal of the Academy of Nutrition and Dietetics 2016; 116:813-8
  • 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^th percentile 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?
    • Detail
    • Quality Rating Summary
      For a summary of the Quality Rating results, click here.
    • Worksheets
      • Heltshe S, Borowitz D, Leung D, Ramsey B, Mayer-Hamblett N. Early attained weight and length predict growth faltering better than velocity measures in infants with CF. Journal of Cystic Fibrosis 2014; 13:723-9
      • Machogu E, Cao Y, Miller T, Simpson P, Levy H, Quintero D, Goday P. Comparison of WHO and CDC growth charts in predicting pulmonary outcomes in cystic fibrosis. Journal of Pediatric Gastroenterology and Nutrition 2015; 60:378-83
      • Zhang Z, Shoff S, Lai H. Comparing the Use of Centers for Disease Control and Prevention and World Health Organization Growth Charts in Children with Cystic Fibrosis through 2 Years of Age. The Journal of Pediatrics 2015; 167:1089-95
  • 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?
    • Detail
    • Quality Rating Summary
      For a summary of the Quality Rating results, click here.
    • Worksheets
      • Woestenenk J,Gulmans V,van der Ent C,Houwen R. Height Assessment in the Dutch-Origin Pediatric Cystic Fibrosis Population. Nutrition in Clinical Practice 2017; 32:130-132
      • Zhang Z, Lai H. Comparison of the use of body mass index percentiles and percentage of ideal body weight to screen for malnutrition in children with cystic fibrosis. American Journal of Clinical Nutrition 2004; 80:982-91
  • 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?
    • Detail
    • Quality Rating Summary
      For a summary of the Quality Rating results, click here.
    • Worksheets
      • Charatsi A, Dusser P, Freund R, Maruani G, Rossin H, Boulier A, Le Bourgeois M, Chedevergne F, de Blic J, Letourneur A, Casimir G, Jais J, Sermet-Gaudelus I. Bioelectrical impedance in young patients with cystic fibrosis: Validation of a specific equation and clinical relevance. Journal of Cystic Fibrosis 2016; 15:825-833
      • Murphy A, Buntain H, Wong J, Greer R, Wainwright C, Davies P. The use of air displacement plethysmography in children and adolescents with cystic fibrosis. European Journal of Clinical Nutrition 2004; 58:985-9
      • Puiman P, Francis P, Buntain H, Wainwright C, Masters B, Davies P. Total body water in children with cystic fibrosis using bioelectrical impedance. Journal of Cystic Fibrosis 2004; 3:243-7
      • Wells G, Heale L, Schneiderman J, Wilkes D, Atenafu E, Coates A, Ratjen F. Assessment of body composition in pediatric patients with cystic fibrosis. Pediatric Pulmonology 2008; 43:1025-32
      • Williams J, Wells J, Wilson C, Haroun D, Lucas A, Fewtrell M. Evaluation of Lunar Prodigy dual-energy X-ray absorptiometry for assessing body composition in healthy persons and patients by comparison with the criterion 4-component model. The American Journal of Clinical Nutrition 2006; 83:1047-54
      • Williams J, Wells J, Benden C, Jaffe A, Suri R, Wilson C, Fewtrell M. Body composition assessed by the 4-component model and association with lung function in 6-12-y-old children with cystic fibrosis. American Journal of Clinical Nutrition 2010; 92:1332-43
  • 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?
    • Detail
    • Quality Rating Summary
      For a summary of the Quality Rating results, click here.
    • Worksheets
      • Hollander F, van Pierre D, de Roos N, van de Graaf E, Iestra J. Effects of nutritional status and dietetic interventions on survival in Cystic Fibrosis patients before and after lung transplantation. Journal of Cystic Fibrosis 2014; 13:212-8
      • Hollander F, De Roos N, De Vries J, Van Berkhout F. Assessment of nutritional status in adult patients with cystic fibrosis: whole-body bioimpedance vs body mass index, skinfolds, and leg-to-leg bioimpedance. Journal of the American Dietetic Association 2005; 105:549-55
      • King S, Nyulasi I, Strauss B, Kotsimbos T, Bailey M, Wilson J. Fat-free mass depletion in cystic fibrosis: associated with lung disease severity but poorly detected by body mass index. Nutrition (Burbank, Los Angeles County, Calif.) 2009; 26:753-9
  • 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?
    • Detail
    • Quality Rating Summary
      For a summary of the Quality Rating results, click here.
    • Worksheets
      • Hollander F, De Roos N, De Vries J, Van Berkhout F. Assessment of nutritional status in adult patients with cystic fibrosis: whole-body bioimpedance vs body mass index, skinfolds, and leg-to-leg bioimpedance. Journal of the American Dietetic Association 2005; 105:549-55
      • King S, Wilson J, Kotsimbos T, Bailey M, Nyulasi I. Body composition assessment in adults with cystic fibrosis: comparison of dual-energy X-ray absorptiometry with skinfolds and bioelectrical impedance analysis. Nutrition (Burbank, Los Angeles County, Calif.) 2005; 21:1087-94
  • 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