Pediatric Nutrition in Practice

246 Wilschanski^

Adolescence

This stage is associated with increased growth,
puberty and increased physical activity. This adds
up to markedly increased nutritional require-
ments which are often difficult to attain. Pulmo-
nary infections are more common, as is the onset
of CF-related diabetes and, in a small minority of
cases, CF-related liver disease. Female patients
are at a greater risk of nutritional failure at this
age [11]. This may be partly due to dissatisfaction
with weight and body shape in healthy adolescent
females. Growth retardation and pubertal delay
occur with increased social pressure and psycho-
social stress. These factors must be considered
when nutritional advice is provided to teenagers.
Ideally, dietary advice should be passed on before
conception as a low prepregnancy BMI is associ-

ated with reduced birth weight. Nutrition should

be optimized throughout pregnancy and vitamin

levels should be monitored [12].

Bone Health

A decrease in bone mineral density (BMD) in pa-

tients with CF may begin at a young age [13].

There are many factors that influence bone health

both in healthy individuals and in patients with

CF; these include nutritional status, calcium, vita-

mins D and K, pulmonary infection, exercise, glu-

cocorticoids and the class of CFTR mutation. The

causes of poor BMD, a reflection of bone health,

are thus multifactorial. Evidence for the efficacy

of treatments for maintaining and improving

bone health is lacking in CF; however, consensus

Cellular

defect? Psychogenic

Biliary Gastrointestinal

Vomiting

Energy deficit

Needs Losses Intake

Weight loss Pulmonary

infections

Immune

dysfunction

Deteriorating lung function

Pancreatic

Intestinal

Iatrogenic

Respiratory

muscles

Lung

parenchyma

++

Anorexia

Fig. 1. The pathogenesis of energy
imbalance in CF.

Koletzko B, et al. (eds): Pediatric Nutrition in Practice. World Rev Nutr Diet. Basel, Karger, 2015, vol 113, pp 244–249

DOI: 10.1159/000367876