Letters to the Editor
Nutritional Dear
status
of infants
with
cystic
et al (1)
concerning
fibrosis
Sir:
The
recent
publication
nutritional Wisconsin
by
status of infants screening program
the
investigation For unspecified document either the individual description
Marcus
with cystic fibrosis (CF) raises many concerns
and management of infants reasons the authors chose the absorptive or pancreatic
patients. Instead, they or their own subjective
the
from the regarding
with CF. not to objectively function status
of many
of
relied on either the mother’s impression of the infants’
erage Note almost
1 SD below
evidence
absorption or that based and is inappropriate. In a large study of the
can
because,
CF (aged pancreatic and/or zyme
therapy.
pancreatic
8 wk)
48%
studies In fact,
of the
subsequently these results
function
(2) and
therefore
infants
had
pancreatic
function
appropriate measuring
oral enzyme-replacement the absorptive status,
absorption
the
who
expense
did
not
and
an extra
require
interpretation up to 12 mo
of infants’ of age, and
any meaningful requirements.
For
conclusions instance,
and biochemical indices infants with appropriate
(3). The Objective
intervention.
status
further
for
absorptive
Finally, to feed
Am
therefore
only
The
and even therapy
infants
J C/in Nuir
with
promote CF
1992:56:955-61.
despite
the the
health-
Printed
cost
and
complicates
the
in USA.
predigested the
natural
provide
infants
the benefits
good
formulas be questioned
far-less-expensive,
to
standard-
better.
Wisconsin for CF
program for deteris valid, it is vital that
is carried
out
in an objective
of the subsequent could invalidate
or disadvantages
data any
of screening.
Children’s
Institute
of Paediatric
Clinical
Dorney
Nutrition
Hospital Sydney
References 1. Marcus
formula desire
Downloaded from https://academic.oup.com/ajcn/article-abstract/56/5/955/4715574 by Washington University, Law School Library user on 09 April 2018
assessin av-
NSW 2050 Australia
in infants of their
© 1992 American
Fairfax
Camperdown,
and
in the majority of CF and supplements.”
use ofa
(4)
or the with
P0 Box 34
status.
the authors
by an results
Stuart
to administer
about dietary intakes be made after an assessment
the if not
of the screening
of these
regarding
study
Kevin Gaskin Donna Waters Jane Allen James
growth and biochemical data it virtually impossible to make
can be achieved dietary intervention
on
conclusions
necessity
is an unnecessary
for parents
infants do as well,
we
about energy and micronutrient they conclude that “normal growth
Recommendations
CF can
certainly, regimens
6of of
(2-4 wk, ofenzyme
observations
scientific fashion. If not, then any be questioned, and very importantly,
importance definition the
These
management
(age a figure
the median.
the practice of feeding predigested CF from a screening program should
and can
However, it may well be that a sizeable proportion ofthese infants had pancreatic sufficiency with normal absorption and therefore would have thrived with normal biochemical status without any with
with
(as determined function status),
the
en-
A recent
breast-feeding, formula,
near the zero Z score up until 2 y of age. et al study average weight at 6 mo was
Given the importance mining whether or not
therapy. The error of not as was the case in the Marcus
it, which
average makes
require
sufficiency,
determines
burden
patients to receive. Not knowing the absorptive
not diagnosis
et al study, led to delays in starting therapy longer in some cases) or to the administration care
with
that 37% had stimulation tests, did
ofscreening
confirmed in a later report cannot be overemphasized.
pancreatic
to some
infants
be misleading
of 78 infants
to demonstrate by pancreatic
at the time
and
that
feeding
0-4 y), we were able sufficiency as defined fat-balance
gazing”
breast-feeding.
if necessary or pancreatic
growth at or very that in the Marcus
of malabsorption. evaluation of mal-
“stool
to continue
enzyme supplements ment of absorptive
stools to determine the presence or absence We suggest that in the current era, historical on
mothers
of infants with CF has demonstrated that use of a standard cow milk-protein-containing
Society
MS, Sondel SA, Farrell PM, et a!. Nutritional status of infants with cystic fibrosis associated with early diagnosis and intervention. Am I Clin Nutr 199 l;54:578-85. 2. Waters DL, Dorney SFA, Gaskin KJ, Gruca MA, O’Halloran M, Wilcken B. Pancreatic function in infants identified as having cystic fibrosis in a neonatal screening program. N Engl I Med 1990;322: 303-8. 3. Gaskin K, Waters D, Dorney 5, Gruca M, O’Halloran M, Wilcken B. Assessment ofpancreatic function in screened infants with cystic fibrosis. Pediatr Pulmonol 199 1;7(suppl):69-7 1. 4. Holliday KE, Allen IR, Waters DL, Gruca MA, Thompson SM, Gaskin KJ. Growth ofhuman milk-fed and formula-fed infants with cystic fibrosis. I Pediatr 199 1 ; 1 18:77-9.
for Clinical
Nutrition
955