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Energy balance and the accuracy of reported energy intake in preadolescent children with cystic fibrosis^1,2,3

¹ From the Divisions of Gastroenterology and Nutrition (JT, JIS, BSZ, and VAS), Biostatistics and Data Management Core (RFI), and Child Development and Rehabilitation Medicine (MY and YD), The Children’s Hospital of Philadelphia, Department of Pediatrics, University of Pennsylvania School of Medicine, Philadelphia, PA, and the Department of Bioscience and Biotechnology, Drexel University, Philadelphia, PA (IEO)

Background: Suboptimal growth and nutritional status are common among children with cystic fibrosis (CF) and pancreatic insufficiency (PI). A better understanding of energy balance is required to improve prevention and treatment of malnutrition.

Objective: Our objective was to characterize energy balance and the reporting accuracy of dietary intake in children with CF by evaluating the relations between energy intake (EI), energy expenditure (EE), fecal energy loss, nutritional status, and growth.

Design: The subjects were participants of a 24-mo prospective study of children 6–10 y of age with CF and PI. EE, EI, fecal energy loss, and anthropometric measures were obtained at baseline and at 24 mo.

Results: The children (n = 69) had suboptimal growth at baseline ( ± SD: weight-for-age z score, –0.53 ± 1.19; adjusted height-for-age z score, –0.67 ± 1.06; body mass index z score, –0.29 ± 1.12), and these variables remained suboptimal at 24 mo. The median ratios of EI to EE at baseline and 24 mo were 1.15 and 1.18, respectively, which decreased to 1.09 and 1.10, respectively, when adjusted for fecal energy loss (EI_–FL:EE). At baseline, 7% of subjects were underreporters, 64% were accurate reporters, and 23% were overreporters of energy intake; the percentages were similar at 24 mo.

Conclusions: Although EI_–FL:EE ratios were higher than expected at both baseline and 24 mo, this cohort showed only age-appropriate weight gain. Self-reported dietary intake data at the individual level should be interpreted with caution, and weight gain velocity may serve as an objective measure of long-term energy balance.

Key Words: Cystic fibrosis • children • energy intake • energy expenditure • doubly labeled water • fecal fat