Background

Optimization of nutritional status is recommended in patients with cystic fibrosis (CF) given the association between lower body mass index (BMI) and poor clinical outcomes. However, higher BMI and body fat correlate with glucose impairment and higher leptin levels in the general population. Differences in body composition and leptin levels between the categories of glucose tolerance were assessed in youth with CF and healthy controls.

Methods

In a cross-sectional study, 59 adolescents and young adults with CF and 15 healthy controls matched by age and gender, underwent body composition analysis using dual energy X-ray absorptiometry (DXA) and a 2-hour oral glucose tolerance test (OGTT). Measures of insulin sensitivity, β-cell insulin secretion and fasting leptin levels were obtained.

Results

Of the participants with CF, 62% were classified as abnormal glucose tolerant and 22% with cystic fibrosis related diabetes (CFRD). Patients with CFRD had a lower fat mass index (FMI) z-score, wt z-score and leptin levels compared to the control group (-1.86 vs. - 0.59, p=0.01; -1.86 vs 0.44, p=<0.001 and 7.9 vs vs. 27.7 µg/L, p=0.01). Leptin correlated positively with FMI z-score, BMI, weight z-score and indices of insulin secretion. FMI z-score correlated positively with higher insulin resistance (HOMA-IR), and lower insulin sensitivity (Matsuda index) (r=0.31; p =0.01 and r=-0.29; p=0.02, respectively) in the CF group.

Conclusions

This study shows that despite new therapeutic strategies, youth with CF have lower body fat, weight z-score and leptin levels, particularly in subjects with early onset CFRD.

中文翻译：

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囊性纤维化青少年的身体成分、瘦素水平和血糖失调之间的关系

 背景

鉴于较低的体重指数 (BMI) 与不良临床结果之间的关联，建议囊性纤维化 (CF) 患者优化营养状况。然而，在一般人群中，较高的体重指数和体脂与葡萄糖损伤和较高的瘦素水平相关。对患有 CF 的青少年和健康对照者评估了不同葡萄糖耐量类别之间身体成分和瘦素水平的差异。

 方法

在一项横断面研究中，59 名患有 CF 的青少年和年轻人以及 15 名年龄和性别相匹配的健康对照者，使用双能 X 射线吸收测定法 (DXA) 和 2 小时口服葡萄糖耐量试验 (OGTT) 进行了身体成分分析。获得胰岛素敏感性、β细胞胰岛素分泌和空腹瘦素水平的测量值。

 结果

在患有 CF 的参与者中，62% 的人被归类为糖耐量异常，22% 的人患有囊性纤维化相关糖尿病 (CFRD)。与对照组相比，CFRD 患者的脂肪质量指数 (FMI) z 得分、wt z 得分和瘦素水平较低（-1.86 与 - 0.59，p=0.01；-1.86 与 0.44，p=<0。 001 和 7.9 对比 27.7 µg/L，p=0.01）。瘦素与 FMI z 得分、BMI、体重 z 得分和胰岛素分泌指数呈正相关。 CF 组中，FMI z 评分与较高的胰岛素抵抗 (HOMA-IR) 和较低的胰岛素敏感性（松田指数）呈正相关（分别为 r=0.31；p=0.01 和 r=-0.29；p=0.02）。

 结论

这项研究表明，尽管有新的治疗策略，患有 CF 的青少年的体脂、体重 z 得分和瘦素水平较低，特别是在患有早发 CFRD 的受试者中。