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Francis Hollander dietitian Julius Center for Health Science

Dietary treatment in adult patients with Cystic Fibrosis Related Diabetes. Francis Hollander dietitian Julius Center for Health Sciences and Primary Care Department of Dietetics Cystic Fibrosis Centre Utrecht The Netherlands

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Francis Hollander dietitian Julius Center for Health Science

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  1. Dietary treatment in adult patients with Cystic Fibrosis Related Diabetes Francis Hollander dietitian Julius Center for Health Sciences and Primary Care Department of Dietetics Cystic Fibrosis Centre Utrecht The Netherlands 13 June 2007

  2. University Medical Center

  3. Academic Hospital 140 adult CF patients (40 CFRD)

  4. Medical Faculty

  5. Wilhelmina Children’s Hospital 250 children with CF

  6. Importance of adequate CFRD treatment 1. Survival Median survival Men CF: 49.5 yrs Men CFRD: 47.4 yrs Female CF: 47.0 yrs Female CFRD: 30.7 yrs Milla et al. Diabetes Care 2005 2. Influence lung function (FEV1) Milla et al. Am J Resp Crit Care Med 2001

  7. Conflicting recommendations of the usual dietarymanagement of CF and diabetes mellitus Dutch Elsevier diet protocols diabetes mellitus (1998) and cystic fibrosis (2002)

  8. Study design Aim To investigate the need for new or adjusted recommendations in dietary treatment of adult patients with CFRD Methods → Literature research based on papers found in the databases PubMed, and Cochrane → Members of the Dutch working group “Adult Cystic Fibrosis Specialist Dietitians” have discussed and amended recommendations, providing a final guideline

  9. Results of the literature research

  10. Flowchart dietary treatment in CFRD

  11. General recommendations in CFRD • GENERAL DIETARY RECOMMENDATIONS FOR CFRD Evidence-based • normalisation of blood glucose by insulin  Experience-based • minimum of 0,8-1,0 g protein / kg bodyweight • 35-40 en% fat • dietary fiber 3 g/MJ 3,4,9,10,11 References References

  12. Survival ↑ (1) Carbohydrates for ↑ energy intake (3) Foods containing dietary fibre tend to have a low energy density (4) Cardiovascular disease rarely occurs (8,10) SPECIFIC DIETARY RECOMMENDATIONS FOR WEIGHT GROUPS: BMI < 18,5 underweight BMI < 18,5 kg/m2 References • ENERGY  • weight gain • 120-150% RDA for energy • CARBOHYDRATES  • no restrictions • FIBER  • high-fiber foods should not compromise energy-intake disturbed blood lipid levels? yes • SATURATEDFAT  • no restrictions

  13. SPECIFIC DIETARY RECOMMENDATIONS FOR WEIGHT GROUPS: BMI 18,5 - 25 healthy weight BMI 18,5 - 25 kg/m2 References • ENERGY  • weight maintenance • 100-150% RDA for energy • CARBOHYDRATES  • restrict sugar-sweetened drinks between meals • To maintain body weight (3) • To avoid fluctuations in blood glucose levels (2,3,8,12) • To prevent ↑blood lipid levels (2,6) disturbed blood lipid levels? yes • SATURATEDFAT  • discuss preference for unsaturated fats

  14. SPECIFIC DIETARY RECOMMENDATIONS FOR WEIGHT GROUPS: BMI > 25 overweight BMI > 25 kg/m2 References • ENERGY  • prevent further weight gain • 100% RDA for energy • CARBOHYDRATES  • restrict sugar-sweetened drinks • FIBER  • promote high-fiber foods to prevent obesity • RDA for energy to prevent obesity (2) • To ↓energy intake and fluctuations of blood glucose levels (2,11) • Dietary fibre provide bulk to a meal to promote fullness and satiety (4) • To prevent ↑blood lipid levels and macro vascular complications (8,10) disturbed blood lipid levels? yes • SATURATEDFAT  • restrict up to 10 en%

  15. Conclusions about dietary treatment of adult CFRD patients:

  16. Adequate treatment of patients with CFRD can lead to…

  17. References 1) Dray et al. Journal of Clinical Nutrition (2005) 59, 152-154 2) Meeting Dutch working group Adult CF specialist Dietitians Utrecht; 2006 Nov 3) Wilson, D.C. et al. Clinical Nutrition (Edinburgh, Scotland). 2000 Apr ;19(2):87-93. 4) Management of cystic fibrosis related diabetes mellitus report of the UK cystic fibrosis trust diabetes working group, June 2004 5) van der Laag J. et al. Informatorium voor Voeding en Diëtetiek (maart 2004), p. XVIIIa–1-XVIIIa–2 6) Winder-Bakker E. et al. Dieetbehandelingsrichtlijn Cystic Fibrosis, Elsevier protocol 2002 7) Lanng, S. Paediatric respiratory reviews. 2001 Sep; 2(3):253-9 8) Brennan, A.L.et al. Journal of cystic fibrosis, 2004 Dec; 3(4):209-22. Epub 2004 Oct 27 9) Moran, A. et al. Diabetes research and clinical practice, 1999 Aug;45(1):61-73 10) Costa, M. et al. Diabetes & metabolism, 2005 Jun; 31(3 Pt 1):221-32 11) Dieetbehandelingsrichtlijn Diabetes mellitus, Elsevier protocol, 1998 december 12) Dutch Diabetes Federation, Dietary guidelines in diabetes, edition 2006 13) Rafii, M. et al. The American journal of clinical nutrition, 2005 Feb;81(2):421-6 14) Lanng, S. et al. BMJ (clinical research ed.) 1995 Sep 9;311(7006):655-9. For a full list of references send a mail to: F.Hollander@umcutrecht.nl

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