Cystic fibrosis

New nutrition guidelines for cystic fibrosis

New nutritional guidelines for people with cystic fibrosis have advised against the routine use of complementary therapies, and highlighted a growing overweight and obesity problem among patients with the disease.

The comprehensive 284-page guidelines also recommend a high salt diet for most people with CF and routine supplementation of fat soluble vitamins (A,D,E, K) particularly in those who are pancreatic insufficient.

The Nutrition Guidelines for Cystic Fibrosis in Australia and New Zealand Project was spearheaded by the Thoracic Society of Australia and New Zealand (TSANZ), with collaboration from the Dietitians Association of Australia (DAA), Dietitians New Zealand (DNZ), Cystic Fibrosis Australia (CFA), and the Cystic Fibrosis Association of New Zealand (CFANZ).

They are an update on the previous 2006 guidelines and have taken some five years to develop, said key project facilitator Natalie van der Haak, a dietitian at the Women’s and Children’s Hospital in South Australia.

She said more than 65 people had spent thousands of hours examining the evidence available to come up with evidence-based and consensus recommendations.

“We know there are strong links between good nutrition status and good lung function,” she said.

“The latest update has all the evidence-based and consensus recommendations in one user-friendly document.”

Ms van der Haak said the significant differences to the previous guidelines were sections addressing the use of complementary therapies and also the growing issue of overweight/obesity among CF patients.

“I think the consumer population would probably be very surprised by the very little evidence that is out there to support the use of complementary therapies,” she told the limbic. “We can’t recommend it routinely.”

The report recommended that people with CF be encouraged to discuss herbal and complementary therapies with their interdisciplinary CF team prior to commencing any form of supplementation, given the “limited evidence surrounding dosing, safety or efficacy of most herbal supplements.”

“There is insufficient evidence to recommend routine supplementation of any complementary nutritional therapies (including probiotics, garlic, ginseng, curcumin, coconut oil),” the guidelines state.

The report also revealed it was “becoming more common to see people with CF who are overweight and patients should be screened for both under and over nutrition.”

“The relationship between lung function, survival and nutrition in CF is well established. More specifically, normal body weight is associated with better preservation of lung function,” it states.

The guidelines strongly encourage nutritional assessments at every clinical visit, with a comprehensive assessment completed on an annual basis.

“Diet recommendations for people with CF are moving closer to general population guidelines,” the report states.

“Aim to achieve and maintain optimal weight status and encourage people with CF to be physically active and choose amounts of nutritious foods and drinks to meet individual energy needs.”

While CF patients are often recommended to have high fat, high salt diets, Ms van der Haak said it was often difficult for patients to understand the meaning of this, and the guidelines put this in perspective.

“Having a high fat diet and a high salt diet is healthy for CF,” she said. “It doesn’t mean eating lots of junk food, but looking at good fats.”

She said the release of the report had been welcomed by the CF and wider health professional community.

“We’ve had a huge response, a really good response and lots of emails from health professionals wanting access,” she said.

The report is also getting plenty of international attention. Ms van der Haak presented the guidelines to the European CF Society conference in Seville, Spain, and said delegates had been impressed by the size and scope of the report.

“They were really surprised actually that we’d managed to cover so much and had so many dieticians involved,” she said.

Meanwhile, the collaborators will have a few years before they start the process all over again. She said work on the update was slated to start in 2021.

“I think now that we’ve got this really comprehensive document it’s going to be easier,” she said.

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