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June 12, 2007
Using Nutrition to Stay Healthy with CF: Presentation
This Web cast is supported by an unrestricted educational grant from Genentech, Inc.
Using Nutrition to Stay Healthy with CF
Drucy Borowitz, M.D.Joseph Cronin, M.D.
Christine Coburn-Miller, M.S.R.D.
Our goal is healthy, full lives
From childhood…
Taylor S.
Throughadulthood!
Nancy M. and her daughter
For children under 2 years of age weight-for-length is used
Body Mass Index (BMI) Percentile is
used for people ages 2-20 years
BMI = weight(height)2
BMI Calculator at www.cdc.gov
BMI is used for people over age 20 years
BMI = weight(height)2
BMI Calculator at www.cdc.gov
BMI PercentileMales Females
FEV 1
% P
redi
cted
50556065707580859095
100
<5 5 10 15 20 25 30 35 40 45 50 55 60 65 70 75 80 85 90 95
FEV1 % Predicted vs. BMI PercentileAges 6 to 20 years
BMI PercentileMales Females
FEV 1
% P
redi
cted
50556065707580859095
100
<5 5 10 15 20 25 30 35 40 45 50 55 60 65 70 75 80 85 90 95
FEV1 % Predicted vs. BMI PercentileAges 6 to 20 years
BMI PercentileMales Females
FEV 1
% P
redi
cted
50556065707580859095
100
<5 5 10 15 20 25 30 35 40 45 50 55 60 65 70 75 80 85 90 95
FEV1 % Predicted vs. BMI PercentileAges 6 to 20 years
BMI PercentileMales Females
FEV 1
% P
redi
cted
50556065707580859095
100
<5 5 10 15 20 25 30 35 40 45 50 55 60 65 70 75 80 85 90 95
FEV1 % Predicted vs. BMI PercentileAges 6 to 20 years
90
FEV1 % Predicted vs. BMI Ages 21 to 40 years
FEV 1
% P
redi
cted
BMIMales Females
25303540455055606570758085
15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30
Females ≥ 22 BMIMales ≥ 23 BMI
90
FEV1 % Predicted vs. BMI Ages 21 to 40 years
FEV 1
% P
redi
cted
BMIMales Females
25303540455055606570758085
15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30
Females ≥ 22 BMIMales ≥ 23 BMI
2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21Age in years
0123456789
10
Hei
ght v
eloc
ity, c
m/y
r
<10Weight Percentiles
>50
The more you weigh early in life, the taller you’ll be as an adult
2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21Age in years
0123456789
10
Hei
ght v
eloc
ity, c
m/y
r
<10Weight Percentiles
>50
The more you weigh early in life, the taller you’ll be as an adult
2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21Age in years
0123456789
10
Hei
ght v
eloc
ity, c
m/y
r
<10Weight Percentiles
>50
The more you weigh early in life, the taller you’ll be as an adult
2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21Age in years
0123456789
10
Hei
ght v
eloc
ity, c
m/y
r
<10Weight Percentiles
>50
The more you weigh early in life, the taller you’ll be as an adult
2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21Age in years
0123456789
10
Hei
ght v
eloc
ity, c
m/y
r
<10Weight Percentiles
>50
The more you weigh early in life, the taller you’ll be as an adult
Slide courtesy of Judy Marciel, C.P.N.P.
Slide courtesy of Judy Marciel, C.P.N.P.
Slide courtesy of Judy Marciel, C.P.N.P.
Slide courtesy of Judy Marciel, C.P.N.P.
Lipase digests fats
Slide courtesy of Judy Marciel, C.P.N.P.
Proteasedigests proteins
Slide courtesy of Judy Marciel, C.P.N.P.
Amylase digests starches
Basics of Preventive Nutrition• Eat high-calorie, high-fat
meals and snacks every day• Establish good meal-time
behaviors• Take enzymes with every
meal and snack if your pancreas isn’t working
• Take CF vitamins every day
June 12, 2007
Using Nutrition to Stay Healthy with CF: Presentation
Number of Adults with CF in U.S.A.
19750
2000400060008000
1000012000
1970 1980 1990 2000 20061970 1975 1980 1985 1990 1995 2000 2005 2006Year
2000
4000
6000
8000
10000
12000
0
Education - Adults with CF
Some College
34%
9%
27%
30%
Less than High School
High School diploma
College graduate
2005 CF Foundation’s Patient Registry
Employment - Adults with CF Homemaker
Student
Retired
36%
27%
14%
10%
8%4%
1%
Full-time
Part-time
Unemployed
Disabled
2005 CF Foundation’s Patient Registry
Marital Status - Adults with CF
SingleMarried/Living
Together
WidowedSeparated/Divorced 0.2%4.9%
36%58.9%
2005 CF Foundation’s Patient Registry
June 12, 2007
Using Nutrition to Stay Healthy with CF: Presentation
What if Eating Becomes a Challenge?
• Try simple behavioral changes
• Seek an expert’s advice• Think about using tube
feedings (e.g., gastrostomy,G-tube, GT, button, NG)
ChildBehavior
Typical Parent Response
BehavioralChange
Taking bites • Not noticing Compliment child on eating
Excess talking
• Instructing child to eat
• Feeding child
Ignore child until they take a bite, then answer questions or engage in conversation
ChildBehavior
Typical Parent Response
BehavioralChange
Complaints:• Not liking
food• Negotiating
• Coaxing• Prompting• Making other
meals
Ignore complaints & compliment child for eating foods
Leaving the table
• Coax child to return
• Instruct child to return
Set rules about staying at table during meals
Guide back to table with minimal discussion
ChildBehavior
Typical Parent Response
BehavioralChange
Complaints of being full
• Coax• Prompt• Feeding• Negotiating
amount of food during the meal
Set appropriate food intake expectations and meal length and set rewards
Nutrition: How to Encourage Health Eating www.cff.org
• A tube is inserted directly into the stomach through the skin
• A high-calorie liquid goes into the stomach at night
• The tube is disconnected during the day and closed
Gastrostomy Feedings
June 12, 2007
Using Nutrition to Stay Healthy with CF: Presentation
Gastrostomy button as a
fashion statement!
• Originally broadcast in 2007• Now in 2 parts
– Presentation – Part 1– Questions and Answers – Part 2
• Please contact your CF Care Center or the CF Foundation to get your questions answered– CF Foundation - [email protected] or 1-800 FIGHT CF
June 12, 2007Using Nutrition to Stay Healthy with CF
June 12, 2007
Using Nutrition to Stay Healthy with CF: Presentation