Joaquim Calvo-Lerma1, Sandra Martínez-Barona2, Etna Masip3, Victoria Fornés4, Carmen Ribes-Koninckx3. 1. Gastroenterología y Hematología Pediátrica, Instituto de Investigación Sanitaria La Fe, España. 2. Enfermedad Celiaca e Inmunopatología digestiva, Instituto de Investigación Sanitaria La Fe, Valencia, España. 3. Gastroenterología y Hepatología Pediátrica,, Hospital Universitario y Politécnico La Fe,. 4. Bioestadística, Instituto de Investigación Sanitaria La Fe, Valencia.
Abstract
OBJECTIVES: Pancreatic enzyme replacement therapy (PERT) remains a backbone in the nutritional treatment of cystic fibrosis. Currently, there is a lack of an evidence-based tool that allows dose adjustment. To date, no studies have found an association between PERT dose and fat absorption. Therefore, the aim of the study was to assess the influence of both the PERT dose and the variability in this dose on the coefficient of fat absorption (CFA). METHODS: This is a retrospective longitudinal study of 16 pediatric patients (192 food records) with three consecutive visits to the hospital over a twelve-month period. Dietary fat intake and PERT were assessed via a four-day food record and fat content in stools was determined by means of a three-day stool sample collection. A beta regression model was built to explain the association between the CFA and the interaction between the PERT dose (lipase units [LU]/g dietary fat) and the variability in the PERT dose (standard deviation [SD]). RESULTS: The coefficient of fat absorption increased with the PERT dose when the variability in the dose was low. In contrast, even at the highest PERT dose values, the CFA decreased when the variability was high. The confidence interval suggested an association, although the analysis was not statistically significant. CONCLUSION: The variability in the PERT dose adjustment should be taken into consideration when performing studies on PERT efficiency. A clinical goal should be the maintenance of a constant PERT dose rather than trying to obtain an optimal value.
OBJECTIVES:Pancreatic enzyme replacement therapy (PERT) remains a backbone in the nutritional treatment of cystic fibrosis. Currently, there is a lack of an evidence-based tool that allows dose adjustment. To date, no studies have found an association between PERT dose and fat absorption. Therefore, the aim of the study was to assess the influence of both the PERT dose and the variability in this dose on the coefficient of fat absorption (CFA). METHODS: This is a retrospective longitudinal study of 16 pediatric patients (192 food records) with three consecutive visits to the hospital over a twelve-month period. Dietary fat intake and PERT were assessed via a four-day food record and fat content in stools was determined by means of a three-day stool sample collection. A beta regression model was built to explain the association between the CFA and the interaction between the PERT dose (lipase units [LU]/g dietary fat) and the variability in the PERT dose (standard deviation [SD]). RESULTS: The coefficient of fat absorption increased with the PERT dose when the variability in the dose was low. In contrast, even at the highest PERT dose values, the CFA decreased when the variability was high. The confidence interval suggested an association, although the analysis was not statistically significant. CONCLUSION: The variability in the PERT dose adjustment should be taken into consideration when performing studies on PERT efficiency. A clinical goal should be the maintenance of a constant PERT dose rather than trying to obtain an optimal value.
Authors: Joaquim Calvo-Lerma; Jessie Hulst; Mieke Boon; Carla Colombo; Etna Masip; Mar Ruperto; Victoria Fornés-Ferrer; Els van der Wiel; Ine Claes; Maria Garriga; Maria Roca; Paula Crespo-Escobar; Anna Bulfamante; Sandra Woodcock; Sandra Martínez-Barona; Ana Andrés; Kris de Boeck; Carmen Ribes-Koninckx Journal: PLoS One Date: 2019-03-12 Impact factor: 3.240
Authors: Joaquim Calvo-Lerma; Victoria Fornés-Ferrer; Irene Peinado; Ana Heredia; Carmen Ribes-Koninckx; Ana Andrés Journal: PLoS One Date: 2019-02-22 Impact factor: 3.240
Authors: Mieke Boon; Ine Claes; Trudy Havermans; Victoria Fornés-Ferrer; Joaquim Calvo-Lerma; Inês Asseiceira; Anna Bulfamante; María Garriga; Etna Masip; Sandra Woodcock; Sylvia Walet; Celeste Barreto; Carla Colombo; Paula Crespo; Els Van der Wiel; Jessie Hulst; Sandra Martinez-Barona; Rita Nobili; Luisa Pereira; Mar Ruperto; Saioa Vicente; Kris De Boeck; Carmen Ribes-Koninckx Journal: PLoS One Date: 2019-12-20 Impact factor: 3.240