The Effect of Nutritional Counseling via Printed Recipe Cards Versus Verbal on Growth of a Cohort of Egyptian Children with Cystic Fibrosis

Abstract

Background: Nutritional management in cystic fibrosis children has a dramatic effect on growth and survival. Aim of the work: to assess the effect of structured recipe cards nutritional protocol versus verbal nutritional counselling on growth of children cystic fibrosis (CF). Methods: We prospectively studied a cohort study of 40 children recruited from the CF Clinic and following at Nutrition Clinic, Children`s hospital, Cairo University whose caretakers were counselled and were provided with ready-made multiple calculated recipe cards that allowed preparation of specific meals to ensure adequate salt supplementation, high calorie, high fat diet and pancreatic enzyme dose of (1000IU lipase per 1g fat). Anthropometric parameters were recorded at the beginning, after 3 months and 6 months and compared to those of a historical cohort of 13 children with CF who received verbal nutritional counselling only. Results: Malnutrition was highly prevalent with 64% of patients underweight and 70% stunted. Weight z-score, height z-scores, body mass index z score and middle upper arm circumference improved from -2.64, -2-77, -1.41 to -1.9, -2.22, -1 (p<0.001, p= 0.008, p<0.001) respectively after the intervention. Statistically significant elevation of hemoglobin, albumin and sodium from 11.49gm/dl, 3.85g/dl, 136.6mEq/l to 12.3, 4.44, 139 (p<0.001, p<0.001, p=0.04) respectively and statistically significant reduction of total leucocytic count (TLC), C-reactive protein and CRP/ albumin ratio were detected after the intervention. There was no difference between achieved weight, height and BMI z-scores between both groups (p=0.485, p=0.499 and p=0.227 respectively). Mean care taker nutritional counseling session time was 17.9 ±3.8 min for those who received the recipe cards, which was significantly shorter than the mean (48.2±7.3 min) of the other group (p<0.001). Conclusion: Optimization of nutritional status in children with CF patients resulted in significant improvement of anthropometric, laboratory and inflammatory parameters. Providing care takers with recipe cards allowed shorter counselling session time, and achieved same positive effect on growth as those verbally instructed without recipe cards.

Keywords

• nutrition
• cystic fibrosis
• anthropometric parameters
• salt supplementation
• high fat diet
• recipe cards.