Cystic FibrosisGAIANCT01401439
Assessment of Fat Free Mass Index and Its Impact on Health in Children With Cystic Fibrosis
An observational study of Cystic Fibrosis, run by University of Arkansas at 1 site in United States.
Trial summary
The purpose of this study is to find out whether measurement of body composition has a prognostic value on clinical and overall outcome in pediatric patients with cystic fibrosis. Read more about this study
- Who is it for?
- Ages 7 to 17 years
- Conditions the study is for
- Cystic Fibrosis
- How many people
- 24 participants
- Where
- 1 siteUnited States
- Study dates
- Jun 2012to Jul 2016
- Phase
- Observational
- Are there results?
- None posted in the registry
Key requirements
Who can take part, as listed by the sponsor. Only the study team can confirm whether you are eligible, so take this list to your doctor.
- Ages 7 to 17 years
- All sexes
- No healthy volunteers
- Child
Study population: Children with cystic fibrosis 7-17 years followed at Arkansas Children's hospital Cystic Fibrosis Care Center
Who may be able to join
- Subjects who already have a diagnosis of CF based on universal diagnostic criteria
- Age 7 to 17 years at the time of enrollment
- Under routine medical control at the CF center of Arkansas Children's Hospital(ACH)
- Clinically stable in CF symptoms as determined by investigators
Who cannot join
- Unstable current diagnosis of metabolic diseases including liver (cirrhosis) or renal disease
- Failure to give informed consent
- Individuals with pacemakers
- Pregnancy in females of childbearing age. A pregnancy test will be performed on females who are post-menarche before performing a DEXA scan
Trial locations and contacts
1 site in 1 country.
United States1 site
Arkansas Children's Hospital
Little Rock, Arkansas, 72202
About this study
Official title: Longitudinal Assessment of Fat Free Mass Index and Its Impact on Lung Health and Overall Health Metrics in Pediatric Patients With Cystic Fibrosis
The purpose of this study is to find out whether measurement of body composition has a prognostic value on clinical and overall outcome in pediatric patients with cystic fibrosis.
Read the detailed description
Cystic fibrosis (CF) is one of the most common life-threatening inherited disorders affecting 1/35000 individuals in the US. In the past decades, the median predicted survival of CF patients has increased significantly from 10-12 to over 37 years (1). One of the major factors contributing to increased survival has been the understanding of the role of optimal nutrition on overall health status of individuals with CF.
Forced expiratory volume in one second (FEV1) is currently the best predictor of pulmonary health in CF, and malnutrition in a person of any age with CF has a negative impact on lung function with a more rapid yearly decline in FEV1. Recent data from the Cystic Fibrosis Foundation (CFF) patient registries in the United States and Canada were analyzed to determine whether any association existed between pulmonary function as measured by FEV1 and Body mass index (BMI) for age. BMI-for-age percentile values >50th percentile were associated with well-preserved lung function and lower values of BMI were associated with incrementally lower values of FEV1 (2). Thus, the CFF recommended that children with CF between the ages of 2 and 20 years maintain a BMI a≥50th percentile for age and sex. However, several publications have demonstrated that fat free muscle (FFM) wasting is evident even in individuals with a BMI > 50th percentile, and it is unknown whether BMI percentile adequately reflects changes in body composition in this group of patients; therefore, BMI might not be the best marker indicating an optimal nutritional status.
Limitations of BMI as a marker of optimal Nutrition: fat mass versus muscle mass In individuals with CF, BMI is used to assess appropriateness of weight to height for age and sex. Since there is a strong association between BMI and overall health metrics, especially lung health, the CFF recommends that children with CF maintain a BMI ≥50th percentile for age and sex. However, an apparent loss of skeletal muscle may occur in CF patients who retain their normal body weight, indicating that BMI does not provide any information about body compartments and may fail to detect subtle alterations in body composition. Although several epidemiologic studies showed that CF patients who maintain BMI> 50th percentile will have improved lung functions and survival, recent data indicate that the preserved FFM instead of BMI may have an impact on overall survival in CF (7). Because of the variability in the levels of both fat mass and fat-free mass, and the many combinations of fat mass index and FFM index associated with the same BMI, this weight-height index needs to be carefully interpreted. Because high levels of BMI-for-age are associated with substantial increases in fat mass, BMI is most useful as a measure of obesity. In chronic inflammatory diseases, a change in regional fat distribution is observed with a shift to a more central fat distribution. The latter is associated with an increase in low-grade chronic inflammation, insulin resistance, and cardiovascular risk (8). Therefore, BMI is a good index for assessment of obesity in otherwise normal children, but not adequate or sufficient in the CF population.
In summary, some pediatric patients with CF may have a decreased Fat-free Mass Index (FFMI) with a well preserved BMI of ≥50th percentile. Conversely, some patient might have a BMI<50th percentile with normal FFMI associated with overall well-being. Current practice forces CF patients to consume high fat and caloric nutrients to maintain a BMI >50th percentiles incurring the costs of causing anxiety, stress, daily struggle in the family with a potential increase in the pro-inflammatory state due to central fat accumulation. The outcome of the proposed study will contribute to the understanding of the relationships between BMI, muscle wasting and markers of health and wellbeing. If our study demonstrates that a well maintained FFMI rather than the BMI correlates better with good health status in CF, it may result in changes of current nutrition practice in CF at the national or even international level.
- Conditions
- Cystic Fibrosis
- Keywords
- cystic fibrosis, body mass index, fat free mass, Children with cystic fibrosis
- Medical subject headings
- Cystic Fibrosis
What is being measured
The primary outcome is the main question the study is designed to answer.
body composition (bone mineral density)
Compare Dual Energy X-Ray Absorptiometry (DEXA) analysis to GAIA device
Measured: change from baseline to 18 months
Timeline
From the start of the study to its completion; the mark is today. Estimated dates are the sponsor’s plan.
- First posted25 Jul 2011 (estimated)
- Study startJun 2012
- Primary completionJul 2016
- Study completionJul 2016
Resources
- Official record on ClinicalTrials.govThe registry entry this page is built from, with its full change history.
- Publications (10)Papers the sponsor has linked to this study.
- Other trials for Cystic FibrosisStudies of the same condition, open and under way.
- More trials run by University of ArkansasThe sponsor's other registered studies.
- What the trial phases meanHow a treatment moves from first tests in people to approval.
More details
For doctors and researchers: how the study is designed, who runs it, and its registry IDs.
Study design
- Study type
- Observational
- Observational model
- Cohort
- Time perspective
- Prospective
- Enrolment
- 24 participants (actual)
Sponsor and investigators
- Lead sponsor
- University of Arkansas
- Sponsor type
- University, hospital or other
- Collaborators
- Arkansas Children's Hospital Research Institute
- Responsible party
- Sponsor
- Investigators
- Ariel Berlinski, MD, Principal investigator, University of Arkansas for Medical Sciences/Arkansas Children's Hospital
IDs, dates and publications
- ClinicalTrials.gov ID
- NCT01401439
- Sponsor's protocol ID
- 131677
- Acronym
- GAIA
- Status last verified
- Aug 2016
- First submitted
- 22 Jul 2011
- Last updated
- 9 Aug 2016
- Results posted
- No
- Data monitoring committee
- No
Publications
Zemel BS, Jawad AF, FitzSimmons S, Stallings VA. Longitudinal relationship among growth, nutritional status, and pulmonary function in children with cystic fibrosis: analysis of the Cystic Fibrosis Foundation National CF Patient Registry. J Pediatr. 2000 Sep;137(3):374-80. doi: 10.1067/mpd.2000.107891.
PubMed 10969263Ionescu AA, Evans WD, Pettit RJ, Nixon LS, Stone MD, Shale DJ. Hidden depletion of fat-free mass and bone mineral density in adults with cystic fibrosis. Chest. 2003 Dec;124(6):2220-8. doi: 10.1378/chest.124.6.2220.
PubMed 14665504Bolton CE, Ionescu AA, Evans WD, Pettit RJ, Shale DJ. Altered tissue distribution in adults with cystic fibrosis. Thorax. 2003 Oct;58(10):885-9. doi: 10.1136/thorax.58.10.885.
PubMed 14514945Wolfe RR. Regulation of muscle protein by amino acids. J Nutr. 2002 Oct;132(10):3219S-24S. doi: 10.1093/jn/131.10.3219S.
PubMed 12368421Reeds PJ, Fjeld CR, Jahoor F. Do the differences between the amino acid compositions of acute-phase and muscle proteins have a bearing on nitrogen loss in traumatic states? J Nutr. 1994 Jun;124(6):906-10. doi: 10.1093/jn/124.6.906. No abstract available.
PubMed 7515956Ionescu AA, Nixon LS, Evans WD, Stone MD, Lewis-Jenkins V, Chatham K, Shale DJ. Bone density, body composition, and inflammatory status in cystic fibrosis. Am J Respir Crit Care Med. 2000 Sep;162(3 Pt 1):789-94. doi: 10.1164/ajrccm.162.3.9910118.
PubMed 10988084Moriconi N, Kraenzlin M, Muller B, Keller U, Nusbaumer CP, Stohr S, Tamm M, Puder JJ. Body composition and adiponectin serum concentrations in adult patients with cystic fibrosis. J Clin Endocrinol Metab. 2006 Apr;91(4):1586-90. doi: 10.1210/jc.2005-2135. Epub 2006 Feb 7.
PubMed 16464949Engelen MP, Schols AM, Does JD, Wouters EF. Skeletal muscle weakness is associated with wasting of extremity fat-free mass but not with airflow obstruction in patients with chronic obstructive pulmonary disease. Am J Clin Nutr. 2000 Mar;71(3):733-8. doi: 10.1093/ajcn/71.3.733.
PubMed 10702166Black LF, Hyatt RE. Maximal respiratory pressures: normal values and relationship to age and sex. Am Rev Respir Dis. 1969 May;99(5):696-702. doi: 10.1164/arrd.1969.99.5.696. No abstract available.
PubMed 5772056Quittner AL, Sweeny S, Watrous M, Munzenberger P, Bearss K, Gibson Nitza A, Fisher LA, Henry B. Translation and linguistic validation of a disease-specific quality of life measure for cystic fibrosis. J Pediatr Psychol. 2000 Sep;25(6):403-14. doi: 10.1093/jpepsy/25.6.403.
PubMed 10980045
Study at a glance
From the registry record, last updated by the sponsor on 9 Aug 2016. Recruitment status is as the sponsor reported it: confirm with the study team.
- Official title
- Longitudinal Assessment of Fat Free Mass Index and Its Impact on Lung Health and Overall Health Metrics in Pediatric Patients With Cystic Fibrosis
- ClinicalTrials.gov ID
- NCT01401439
- Acronym / sponsor ID
- GAIA / 131677
- Conditions
- Cystic Fibrosis
- Keywords
- cystic fibrosis, body mass index, fat free mass, Children with cystic fibrosis
- Study type
- Observational
- Recruitment status
- Completed
- Enrolment
- 24 participants (actual)
- Lead sponsor
- University of ArkansasUniversity, hospital or other
- Collaborators
- Arkansas Children's Hospital Research Institute
- Study start
- Jun 2012
- Primary completion
- Jul 2016 (actual)
- Study completion
- Jul 2016 (actual)
- First posted
- 25 Jul 2011 (estimated)
- Results
- Not posted in the source record
Clinical summary
The research question as the sponsor registered it. This describes what the study plans to test, not what it found.
The purpose of this study is to find out whether measurement of body composition has a prognostic value on clinical and overall outcome in pediatric patients with cystic fibrosis.
Detailed description
Cystic fibrosis (CF) is one of the most common life-threatening inherited disorders affecting 1/35000 individuals in the US. In the past decades, the median predicted survival of CF patients has increased significantly from 10-12 to over 37 years (1). One of the major factors contributing to increased survival has been the understanding of the role of optimal nutrition on overall health status of individuals with CF.
Forced expiratory volume in one second (FEV1) is currently the best predictor of pulmonary health in CF, and malnutrition in a person of any age with CF has a negative impact on lung function with a more rapid yearly decline in FEV1. Recent data from the Cystic Fibrosis Foundation (CFF) patient registries in the United States and Canada were analyzed to determine whether any association existed between pulmonary function as measured by FEV1 and Body mass index (BMI) for age. BMI-for-age percentile values >50th percentile were associated with well-preserved lung function and lower values of BMI were associated with incrementally lower values of FEV1 (2). Thus, the CFF recommended that children with CF between the ages of 2 and 20 years maintain a BMI a≥50th percentile for age and sex. However, several publications have demonstrated that fat free muscle (FFM) wasting is evident even in individuals with a BMI > 50th percentile, and it is unknown whether BMI percentile adequately reflects changes in body composition in this group of patients; therefore, BMI might not be the best marker indicating an optimal nutritional status.
Limitations of BMI as a marker of optimal Nutrition: fat mass versus muscle mass In individuals with CF, BMI is used to assess appropriateness of weight to height for age and sex. Since there is a strong association between BMI and overall health metrics, especially lung health, the CFF recommends that children with CF maintain a BMI ≥50th percentile for age and sex. However, an apparent loss of skeletal muscle may occur in CF patients who retain their normal body weight, indicating that BMI does not provide any information about body compartments and may fail to detect subtle alterations in body composition. Although several epidemiologic studies showed that CF patients who maintain BMI> 50th percentile will have improved lung functions and survival, recent data indicate that the preserved FFM instead of BMI may have an impact on overall survival in CF (7). Because of the variability in the levels of both fat mass and fat-free mass, and the many combinations of fat mass index and FFM index associated with the same BMI, this weight-height index needs to be carefully interpreted. Because high levels of BMI-for-age are associated with substantial increases in fat mass, BMI is most useful as a measure of obesity. In chronic inflammatory diseases, a change in regional fat distribution is observed with a shift to a more central fat distribution. The latter is associated with an increase in low-grade chronic inflammation, insulin resistance, and cardiovascular risk (8). Therefore, BMI is a good index for assessment of obesity in otherwise normal children, but not adequate or sufficient in the CF population.
In summary, some pediatric patients with CF may have a decreased Fat-free Mass Index (FFMI) with a well preserved BMI of ≥50th percentile. Conversely, some patient might have a BMI<50th percentile with normal FFMI associated with overall well-being. Current practice forces CF patients to consume high fat and caloric nutrients to maintain a BMI >50th percentiles incurring the costs of causing anxiety, stress, daily struggle in the family with a potential increase in the pro-inflammatory state due to central fat accumulation. The outcome of the proposed study will contribute to the understanding of the relationships between BMI, muscle wasting and markers of health and wellbeing. If our study demonstrates that a well maintained FFMI rather than the BMI correlates better with good health status in CF, it may result in changes of current nutrition practice in CF at the national or even international level.
Study design
- Observational model
- Cohort
- Time perspective
- Prospective
Who may qualify
- Ages
- 7 to 17 years
- Sex
- All
- Healthy volunteers
- Not accepted
- Age groups
- Child
- Study population
- Children with cystic fibrosis 7-17 years followed at Arkansas Children's hospital Cystic Fibrosis Care Center
Key inclusion criteria (4 listed)
- Subjects who already have a diagnosis of CF based on universal diagnostic criteria
- Age 7 to 17 years at the time of enrollment
- Under routine medical control at the CF center of Arkansas Children's Hospital(ACH)
- Clinically stable in CF symptoms as determined by investigators
Key exclusion criteria (4 listed)
- Unstable current diagnosis of metabolic diseases including liver (cirrhosis) or renal disease
- Failure to give informed consent
- Individuals with pacemakers
- Pregnancy in females of childbearing age. A pregnancy test will be performed on females who are post-menarche before performing a DEXA scan
Eligibility is decided by the study team after screening; this overview does not establish that a patient qualifies. Full inclusion and exclusion criteria.
Primary outcome
body composition (bone mineral density)
Time frame: change from baseline to 18 months
Compare Dual Energy X-Ray Absorptiometry (DEXA) analysis to GAIA device
Results and safety
The study is completed, but results are not available in the source record. That does not mean the treatment did or did not work.
Research links
- Official record on ClinicalTrials.govLast updated by the sponsor 9 Aug 2016.
- Background: PubMed 10969263Zemel BS, Jawad AF, FitzSimmons S, Stallings VA. Longitudinal relationship among growth, nutritional status, and pulmonary function in children with cystic fibrosis: analysis of the Cystic Fibrosis Foundation National CF Patient Registry. J Pediatr. 2000 Sep;137(3):374-80. doi: 10.1067/mpd.2000.107891.
- Background: PubMed 14665504Ionescu AA, Evans WD, Pettit RJ, Nixon LS, Stone MD, Shale DJ. Hidden depletion of fat-free mass and bone mineral density in adults with cystic fibrosis. Chest. 2003 Dec;124(6):2220-8. doi: 10.1378/chest.124.6.2220.
- Background: PubMed 14514945Bolton CE, Ionescu AA, Evans WD, Pettit RJ, Shale DJ. Altered tissue distribution in adults with cystic fibrosis. Thorax. 2003 Oct;58(10):885-9. doi: 10.1136/thorax.58.10.885.
- Background: PubMed 12368421Wolfe RR. Regulation of muscle protein by amino acids. J Nutr. 2002 Oct;132(10):3219S-24S. doi: 10.1093/jn/131.10.3219S.
- Background: PubMed 7515956Reeds PJ, Fjeld CR, Jahoor F. Do the differences between the amino acid compositions of acute-phase and muscle proteins have a bearing on nitrogen loss in traumatic states? J Nutr. 1994 Jun;124(6):906-10. doi: 10.1093/jn/124.6.906. No abstract available.
- Background: PubMed 10988084Ionescu AA, Nixon LS, Evans WD, Stone MD, Lewis-Jenkins V, Chatham K, Shale DJ. Bone density, body composition, and inflammatory status in cystic fibrosis. Am J Respir Crit Care Med. 2000 Sep;162(3 Pt 1):789-94. doi: 10.1164/ajrccm.162.3.9910118.
- Background: PubMed 16464949Moriconi N, Kraenzlin M, Muller B, Keller U, Nusbaumer CP, Stohr S, Tamm M, Puder JJ. Body composition and adiponectin serum concentrations in adult patients with cystic fibrosis. J Clin Endocrinol Metab. 2006 Apr;91(4):1586-90. doi: 10.1210/jc.2005-2135. Epub 2006 Feb 7.
- Background: PubMed 10702166Engelen MP, Schols AM, Does JD, Wouters EF. Skeletal muscle weakness is associated with wasting of extremity fat-free mass but not with airflow obstruction in patients with chronic obstructive pulmonary disease. Am J Clin Nutr. 2000 Mar;71(3):733-8. doi: 10.1093/ajcn/71.3.733.
- Background: PubMed 5772056Black LF, Hyatt RE. Maximal respiratory pressures: normal values and relationship to age and sex. Am Rev Respir Dis. 1969 May;99(5):696-702. doi: 10.1164/arrd.1969.99.5.696. No abstract available.
- Background: PubMed 10980045Quittner AL, Sweeny S, Watrous M, Munzenberger P, Bearss K, Gibson Nitza A, Fisher LA, Henry B. Translation and linguistic validation of a disease-specific quality of life measure for cystic fibrosis. J Pediatr Psychol. 2000 Sep;25(6):403-14. doi: 10.1093/jpepsy/25.6.403.
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Referral and contact
AzTrials does not enrol participants or take referrals. Contact the study team or a site listed below; they decide who can take part. This study is not recruiting at the moment.
Ariel Berlinski, MD principal investigator
University of Arkansas for Medical Sciences/Arkansas Children's Hospital
1 site in 1 country: see every site and its status.
Questions about this trial
What is this clinical trial studying?
An observational study of Cystic Fibrosis, run by University of Arkansas at 1 site in United States.
The full registered description is in the About this study section and the official record.
Who may be eligible to take part?
The sponsor lists 4 inclusion and 4 exclusion criteria. Eligibility is decided by the study team after screening, so read the full criteria and contact a listed site.
Is this clinical trial currently recruiting?
The record says: finished, as of the sponsor's last update on 9 Aug 2016. Status can change between updates, so confirm with the study contact before making plans.
Where is the study taking place?
The record lists 1 site in United States. Whether a site is taking part right now should be confirmed with that site. See every site.
What are the possible benefits and risks?
They depend on the study and the treatment, and no study can promise a benefit. The study team explains the known risks during informed consent, before anyone joins; the record itself does not list them.
Are results available for this study?
The study is completed, but results are not available in the source record. That does not mean the treatment did or did not work.
How can a doctor refer a patient or contact the research team?
The record lists no contact. The official record names the sponsor, who can be asked directly. AzTrials does not enrol participants or take referrals.
What does the primary outcome measure?
body composition (bone mineral density) (time frame: change from baseline to 18 months). It is what the study was designed to measure, not a finding.
Where can I read the original study information?
On the ClinicalTrials.gov record for NCT01401439, which also lists 10 linked publications.
Does a listing mean the treatment is approved or proven to work?
No. A listing means the study is registered. It does not show that the treatment is safe, works, or is approved by a regulator.
How often is this information updated?
AzTrials copies changed records from ClinicalTrials.gov every night and reloads the whole registry every week. The sponsor last updated this record on 9 Aug 2016.