1

Cystic Fibrosis: A Case Study

NDFS 4560

Jacob Newman

2
Introduction
The patient was admitted to the hospital after a three day fever of 102.3oF and cough. The
patient had course breathing sounds in left lower quadrant. Pneumonia was noted in left lower
quadrant by X-ray, and tested positive for pseudomonas aeroginosa. Pneumonia caused complications
for the patients cystic fibrosis (CF) of which he was diagnosed at age three. The patient reported poor

appetite for two weeks with a five pound weight loss prior to admittance. The patient was treated for
pneumonia over a two week course once pneumonia subsided The patient was discharged. The
following case study will discuss the medical nutrition therapy for CF, as well as diagnosis, intervention,
and review of the patients (pt) medical history.
Patient Profile and Social History
The patient was a married Caucasian white male age 25. Pt denied any tobacco, alcohol, or any
illicit drug use. Social worker noted pt is concerned with cost of hospitalization. The patient was covered
under parents insurance but had responsibility for copay, which was a concern. Pt did not attend prior
meeting with medical doctor or registered dietitian, and hasnt used inhaled Tobramycin at home due to
cost. Social worker evaluated possible sources of assistance to pay for hospital stay and prescriptions.
Medical History
The patient was diagnosed with CF at three years of age by sweat and DNA tests, where double
Delta F-508 mutation was found. The patient had ongoing complications of growth failure due to CF.
Gastrostomy tube (GT) was placed resulting in improved growth of 15 pounds, and was weight (wt)
stable for two years with a recent five pound weight loss. Skin was pale with dry patches around the
mouth, eye sockets were found to be dark and sunken. The patient had hard, palpated stool in right
colon indicating constipation. The patient had a latex allergy. Family history consists of: siblings having

3
bipolar disorder and attention deficit disorder, mother had dysplasia, and from mothers side a history of
lung cancer, none of which were expressed by the patient.
Literature Review

Diagnosis
The patient was diagnosed with CF at age three after a 2 year history of poor growth
and feeding difficulties. To diagnose CF, various tests are performed. Genetic testing can
identify the CF gene, but additional testing is required to distinguish if the patient carries both
copies of the CFTR gene coding for CF. A sweat test is the golden standard to identify high salt
content in the sweat indicating CF. Pancreatic function can be assessed by measuring fecal fat
excretion or concentration of human pancreatic elastases in the fecal matter. This identifies the
pancreatic involvement in CF. Various respiratory assessments examine the function of the
lungs and other components of the respiratory system. 1,3,5,7 In the case of The patient, both a
sweat and DNA (double Delta F-508) test were administered to diagnose his CF.
CF is the most common genetic disease in the Caucasian race, affecting 1 in 4750 live
births.1 While primarily impacting Caucasians, persons of any race may be affected. About
30,000 Americans live with CF and 1 in 31 Americans are carriers of the defective gene.
The gene mutation causes the CFTR (transmembrane conductance regulator protein)
transporter to malfunction disallowing chlorine to cross the cellular membrane. This causes
increased sodium reabsorption and a decreased chloride secretion. As a result, cells retain
water leading to viscous mucosal secretions. Thickened secretions cause the obstruction of
glands and ducts in the skin, pulmonary, biliary, gastrointestinal, and genitourinary systems
leading to malabsorption.1,2,3

In order to successfully manage a progressive disease, a multidisciplinary team is

needed. Professionals such as doctors, pulmonologist, social workers, dietitians, respiratory
therapists, nurses, and physical therapists provide different medical treatment for CF patients.
Ensuring optimal nutrition, preventing further complication, implementing exercise, and
providing psychosocial support are the focus of treatment. 3
Respiratory
Respiratory complications are the leading cause of mortality in CF patients. Sticky
mucous in the upper respiratory system attracts bacteria causing nasal polyposis and chronic or
recurrent sinusitis. Scarring of the pulmonary system occurs from recurrent infections,
decreasing lung elasticity, and oxygen exchange. Coughing is a common complaint with
respiratory complications and is often paired with sputum, vomiting, gagging, and disrupted
sleep.4 Physical deformities include barrel-chest and cyanosis which are common complications
of disease progression. As CF progresses in adolescents and adults, pneumothorax, hemoptysis,
and heart failure secondary to respiratory hypertension are additional complications. 2,5
Respiratory complication treatments include percussion and vibration methods, physical
therapy, hypertonic saline, and antibiotic therapy to assist in loosening mucus in the lungs and
fighting bronchial infections. 4,5,6 Oxygen therapy is recommended for patients who experience
severe respiratory insufficiencies. The use of dornase alfa with 7% hypertonic saline slows the
rate of respiratory complications.4 Ibuprofen at concentration of 50 to 10 ug/ml has slowed the
rate of respiratory complications in children 5 to 13 years of age by aiding in the reduction of
inflammation. Oral corticosteroids are used as part of treatment for patients with inflammatory

complications. It should be noted, patients using corticosteroids are at risk for diabetes and
linear growth retardation.2,5,7
The patient was recently admitted to the hospital and found to have pneumonia for
which he was given multiple medications and treatments. The medications and treatment the
patient underwent, for pneumonia at the hospital were: Tobramycin, Colistin, and vest
treatment three times daily.
Gastrointestinal/Pancreas/Liver
The gastrointestinal (GI) tract is the gateway for nutrients to enter the body. The
pancreas secretes the enzymes lipase, amylase, and a variety of proteases into the GI tract.
These enzymes assist in the digestion of food. Due to specific CF genetic mutations, mucus clogs
the pancreas causing pancreatic insufficiency(PI). 2,3,5 PI causes fat malabsorption which is
manifested as steatorrhea leading to vitamin deficiencies, anemia, and hypoalbuminemia.
Complications include frequent foul-smelling stools, abdominal cramping, and intussusception
of the small and large bowel.1,3,5,7 The patient has taken pancreatic enzymes orally since he was
diagnosed with CF at 3 years old to aid in the absorption of energy. The patient consumed
multivitamin daily, Cholecalciferol, and Aquadek to help with vitamin and mineral deficiencies.
GI complications can start at birth, manifesting as bowel obstructions. Vomiting,
distention, and the absence of a bowel movement are signs of the bowel obstruction.
Treatment includes the flushing of the colon through enemas, lavage solution, or stool
softeners.5
Due to the abnormalities in the chloride transport system, liver bile increases in
viscosity. However, liver disease has a slow progression which is masked by the complications

of CF, making it obscured until cirrhosis. Other complications include portal hypertension,
esophageal varices, and fatty liver.1,5
Sweat Glands
Sweat glands are commonly affected by CF.3 Abnormalities in sodium levels can lead to
complications. Sodium is not absorbed back into the blood as it travels to the skin leaving CF
patients with low sodium levels. As a result, there is irregularity in the bodys ability to detect
thirst which often leads to dehydration. To prevent dehydration, CF patients need to replace
low levels of sodium and fluid. The sodium recommendation is 4-5 grams per day.10 This
recommendation may vary based upon sodium labs or if the patient lives in hot climates that
induce frequent sweating.3 The patient was to consume 5 grams of sodium a day, due to his low
levels of sodium.
MNT
CF patients have poor growth due to poor intake, pancreatic insufficiency, and increased
nutrient needs which is displayed through low BMI, poor bone mass, low serum nutrient status,
and high infection rates. Early detection of this poor growth allows for appropriate treatment. 3
CF patients have high resting energy expenditure (REE) due to bacterial infection and
pulmonary complications which causes kilocalorie (kcal) needs to increase to 110-200% of the
RDA. Energy needs are further impacted by malabsorption. Due to such high needs, CF patients
often do not achieve adequate calorie intake.8 Inadequate intake leads to growth deficiency
which is common in CF, making adequate nutrition of high concern. 8 Common diagnoses
related to intake include inadequate energy intake, increased nutrient needs, malnutrition, and
involuntary weight loss. 3,9 In order to obtain adequate calories, it is recommended that CF

patients power pack meals and eat frequently. The patient consumed 125% RDA kcals to
maintain weight, of which 25% was fed via GT overnight.
Lung function and overall health in CF patient is highly dependent upon adequate
nutrition and sufficient energy intake. Without adequacy, wasting of pulmonary muscles and
severe weight loss can occur.9 If needs are not being met by oral intake, a tube feeding may be
recommended by a patients doctor to prevent malnutrition in CF patients. 3 Enteral feeding is
recommend when dietary manipulation and supplementation has failed, the patients BMI is
under 19, or when a weight loss of 5% has occurred over 2 months. Enteral feeding can be
implemented during end stage CF when lung function is diminished to achieve optimal nutrition
until lung transplantation is possible. Enteral nutrition is associated with weight gain, and
increase in BMI, and stabilization of lung function.13
Fat malabsorption, due to pancreatic insufficiency, can be corrected though pancreatic
enzyme replacement.8 Pancreatic enzymes are available in powder or tablet form and are
coated to protect the enzyme from destruction in the acidic environment of the stomach.
Enzymes products include amylase, proteases, and lipase. It should be noted, that enzyme
medication varies in composition due to how they are obtained. 3 Pancreatic enzymes are
activated in the duodenum and jejunum, allowing fat to be absorbed at 85-90%.9 A high fat diet,
consisting of 35-40% of kcals from fat, is important to compensate for fat malabsorption.
Common diagnoses involving fat and CF include inappropriate intake of fat, inappropriate
intake of vitamins/minerals, and limited adherence to nutrition-related recommendations. 3
Although pancreatic enzyme replacement therapy (PERT) increases absorption, fat
absorption still remains inadequate in most CF patients. This is likely caused from the

inaccurate dosing of pancreatic enzymes.8 The enzyme dosage is based upon the patients diet,
nutritional status, degree of pancreatic insufficiency, intestinal pH, and GI autonomy and
physiology.
Supplementation of vitamins A, D, E and K is recommended because of PI. 3
Supplementation of these vitamins is based upon age, intake, and disease progression. Yearly
laboratory monitoring of these vitamins is needed to ensure adequate amounts are consumed.3
Inadequate amounts of fat soluble vitamins may lead to complications. Vitamin A is important
for vision and proliferation of cells therefore inadequate amounts may affect vision and
healing. Vitamin D plays an important role in calcium absorption, because vitamin D is deficient
in CF patients, a calcium deficiency may be present making calcium supplementation important
to reduce osteoporosis risk. Vitamin K is necessary for clotting and bone formation. Deficiency
can lead to poor wound healing, excessive bleeding, and osteoporosis. Vitamin E is a powerful
antioxidant, and deficiencies can cause hemolytic anemia, neuromuscular degeneration, and
cognitive function.
Minerals such as zinc and iron may need to be supplemented. Recent studies conclude
that zinc absorption is impaired in CF patients, which needs to be monitored closely and
possibly supplemented. Because of concurrent inflammation in CF patients, it is unknown if
iron levels are falsely high due to inflammation or an underlying cause and should also be
closely monitored. 11 To help with vitamin and mineral absorption the patient was to consume
Cholecalciferol 20,000 2 times a day, and Aquadek 2 times a day.
In conclusion, CF is a genetic disorder managed by a multidisciplinary team that affect
the skin, pulmonary, biliary, gastrointestinal, and genitourinary systems and has no cure.

Improved prognosis requires adequate nutrition status including energy intake, fat intake,
calcium and fat soluble vitamin supplementation. Medical nutrition therapy plays an important
role managing CF by closely monitoring energy intake, BMI, weight, bone status, fat intake, and
vitamin and mineral status.3
Anthropometrics
The patients height was 177.25 centimeters and weight was 76.81 kilograms (kg) upon
admit. Ideal body weight (IBW) for the patient was 75.45 kg, and was at 102% IBW. His body
mass index (BMI) was 24.5; the patient was at an appropriate wt range. Waist to hip ratio
(WHR) was 0.81 indicating normal range. After placement of gastrointestinal (GT) tube the
patient was weight stable for two years. Prior to admit the patient experienced a 2.27 kg weight
loss which wasnt significant, at follow up appointment the patient weighed 77.27 kg, indicating
he was wt stable. (See appending A).
Laboratory Data
Laboratory data pertinent to the patients medical/nutritional status:
Lab

Admit

Normal Values

Hgb

11.5 L

12-16

Hct

33 L

36-46

Ferritin

19 L

20-120

Na

133 L

136-145

Bilirubin

.3 H

<.3

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Vitamin D

19 L

30-120

PT

19 H

11-16

Upon admission, the patient had low Hct, Hgb, and ferritin which indicated possible
anemia, iron labs were requested to properly diagnose anemia. Low Hct, Hgb, and borderline
BUN indicating pt was dehydrated. Pt had low sodium (Na), due to CF and cell retention of Na,
the patient needed to consume more Na. Ferritin (Fe) and vitamin D were low indicating
patient needs to consume more, and needed more time in the sun for vitamin D synthesis. (See
appendix A).
Clinical Evaluation
The patient was admitted after three day course of fever, with a temperature of
102.3oF, and cough, pneumonia was noted in lower left quadrant, as well as pseudomonas
aeroginosa. The patient was given two weeks IV antibiotics. Pt was given a probiotic for
pseudomonas aeroginosa. Due to inadequate fluid consumption the patient had a hard
palpated stool in his right colon indicating constipation. His skin was also pale with dry patches
around mouth, and sunken/dark eye sockets. (See appendix A).
Medications
The patient had numerous medications while at the hospital including a two week
course of IV tobramycin and inhaled Colistin followed by vest treatment three times a day for
30 minutes to treat his pneumonia. Two capfuls of Miralax were given daily to help resolve pts

11

constipation. Due to CF the patient was prescribed to consume three Zenpep 20,000U with
every meal and nightly GT feed, two Zenpep 20,000U w/ snacks. Cholecalciferil 20,000U was
given two times daily, along with Aquadek two times daily. Pt was to consume a probiotic daily,
given the choice of Activia or Kefir. At follow up appointment Pt had consumed prescribed
medications and was doing well, it was expected, due to behavior, the patient will continue his
medications and improve personal health. (See appendix A).
Dietary Evaluation
Pts energy needs were estimated based using the World Health Organization (WHO)
recommendations, of 25-30 kcal/kg, and were estimated at 2496-2995 Kcals/day. Due to CF
energy needs were to be multiplied by a factor of 1.25 equaling 3120- 3744 Kcals/day. Based on
the patients wt history and oral energy intake 3200 Kcals was sufficient to maintain wt, caloric
needs were adjusted accordingly. Pt had GT placed August 2008, and had diet order for GT
feedings was to be 25% of estimated needs, the patient was to consume 2400 Kcals orally and
800 kilocalories via GT continuous drip from 11 pm to 6 am every night. Protein needs were
estimated at 77 grams a day. Fluid needs were estimated using WHO criteria, and the patient
was to consume 2304-2688 mL/day. The patient reported poor appetite due to infection and
CF, the patient was to consume a probiotic of Activia or Kefir daily. The patients diet was
diagnosed based on CF disease; he was to consume 40% of his diet from fat and 5000 mg of Na
a day.
Upon admittance assessment of the patients dietary journal, consisting of three days
prior to admittance, it was found the patient didnt consume an adequate diet: multiple

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vitamins and minerals including fat soluble vitamins and Na consumption were low, but there
was an adequate fat intake (see appendix B). Upon admittance prescribed diet well tolerated by
the patient. Two week food record analysis showed adequately consumed water soluble
vitamins, Na, and fat (see appendix C). The patient reported it was difficult to maintain Na
intake, and fat intake. Often consumptions of high fat and salt caused stomach ache, and
sensation of overfull.
Conclusion
The patient was discharged from the hospital. Pt was admitted for three day fever and
cough, with pneumonia in lower left quadrant. Pt received IV Tobramycin and inhaled Colistin
with vest therapy for 30 minutes three times a day. The patient was given medications for
pneumonia, which resolved. The patient was given a diet order to consume 3200 kcals, 2400
kcals orally, and 800 kcals via GT, GT was to help pt consume adequate kcals, 8 five grams salt,
and fat soluble vitamins to reach adequate intake amounts. After hospitalization the patient
was consuming an adequate diet to meet caloric needs and treat CF. The patient continued to
consume prescribed diet which maintained wt, and proper health.

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Appendix A
Nutrition Care Plan and Note at Discharge
Assessment: Pt is 25 y/o male. Pt diagnosed at 3 y/o w/ CF-related pneumonia. Pt ht. 177.25
cm, pt wt 76.81 kg, and BMI 24.5 indicating pt wt appropriate. Pt is weight stable x 2 yr. Pt WHR
is .81 WNL. Pt triceps skin fold 28 mm. PT has high PT, low Vit. D, Na is low, ferritin is low, Hgb
and Hct are low, BUN is borderline low. Hgb, Hct, BUN indicate slight dehydration. Skin pale, dry
around mouth. Pt has sunken/dark eye sockets. Latex allergy. Pt has chronic sinusitis w/ daily
saline washes, pharynx is red w/ postnasal drainage. Pt has hard, palpated stool in right colon
indicating constipation. Miralax x 2 capfuls daily. Poor appetite x 2 weeks w/ 5 lb wt loss, pt on
GT feeds and po. PI w/ PERT: 3-zenpep 20,000U w/ meals, 2-Zenpep 20,000U w/ snacks. Pt
takes Cholecalciferos 20,000U 2 x daily, Aquadek x 2 daily. Probiotic x 1 daily Activia or Kefir
yogurt sufficient. Pt Ca, K, Vit A, Vit D, Vi B12, and fiber low. 3 day food record indicates pt
average Kcal consumption 2400. Lack of fat soluble vitamins, and low sodium intake. Pt does
cardio exercise 30 min 6 x week. [Vitamin intake FH-1.6.1.1, FH-1.6.1.3, FH-1.6.1.5,
Mineral/element intake FH-1.6.2.3, 1.6.2.7, Total fiber intake FH-1.5.4.1, Total fat intake FH1.5.1.1]
WHO recommends 25-30Kcal/kg x 1.3 for CF patients, based on pt wt 76.81 Kg 2496 - 2995
Kcals/day. Pt wt stable PTA on intake of ~3200 Kcals/day. G tube to meet 25% of Kcals 800
Kcals.
Protein needs 1 g/Kg, Pt needs 77 g/day protein.
WHO recommends 30-35 mL/Kg, based on pt wt 76.81 Kg, Pt to consume 2304 mL 2688 mL
fluid daily.
Diagnosis: Fat and cholesterol (NI-5.6) r/t CF AEB less than desirable fat soluble vitamins in diet
recall: vitamin A 489ug, vitamin D 2ug, vitamin K 96ug.
Inadequate mineral intake sodium (NI-5.10.2.7) r/t inadequate intake of salt AEB diet recall
average: 3385mg/day sodium.
Intervention: Fat-modified diet (ND-1.2.5)
Pt to continue to consume 40% of diet from fat.
Pt to consume adequate amount of fat soluble vitamins: A, D, E, K.
Pt will keep food long.
Vitamin and Mineral Supplements (ND-3.2.7)

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Pt to consume salt meals to reach 5000 mg/Na/day.

Pt to consume MVI daily.
Pt to consume fluids with meals and snacks to reach ~ 2 L/day.

Monitoring/Evaluation: RD to follow up with pt in two weeks to assess food log/diet adherence

(FH-5.1.1), total fat intake (FH-1.5.1.1), and Mineral/element intake (1.6.2.7).
We expect to see patient weight stable due to increase of fat intake, hydrated due to liquid
consumption, and energetic in relation to proper energy consumption.

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Appendix B

tbari2's Nutrients Report 02/24/14 - 02/26/14

Your plan is based on a 2800 Calorie allowance.

Nutrients

Target

Average Eaten

Status

Total Calories

2800 Calories

2326 Calories

Under

Protein (g)***

56 g

67 g

OK

Protein (% Calories)***

10 - 35% Calories 11% Calories

OK

Carbohydrate (g)***

130 g

OK

Carbohydrate (% Calories)***

45 - 65% Calories 45% Calories

OK

Dietary Fiber

38 g

Under

Total Fat

20 - 35% Calories 47% Calories

Over

Saturated Fat

< 10% Calories

14% Calories

Over

Monounsaturated Fat

No Daily Target
or Limit

18% Calories

No Daily Target
or Limit

Polyunsaturated Fat

No Daily Target
or Limit

11% Calories

No Daily Target
or Limit

Linoleic Acid (g)***

17 g

26 g

OK

Linoleic Acid (% Calories)***

5 - 10% Calories

10% Calories

OK

-Linolenic Acid (g)***

1.6 g

2.0 g

OK

0.8% Calories

OK

-Linolenic Acid (% Calories)*** 0.6 - 1.2%

Calories

260 g

28 g

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Omega 3 - EPA

No Daily Target
or Limit

2 mg

No Daily Target
or Limit

Omega 3 - DHA

No Daily Target
or Limit

29 mg

No Daily Target
or Limit

Cholesterol

< 300 mg

331 mg

Over

Minerals

Target

Average Eaten

Status

Calcium

1000 mg

717 mg

Under

Potassium

4700 mg

3099 mg

Under

Sodium**

< 2300 mg

3385 mg

Over

Copper

900 g

2336 g

OK

Iron

8 mg

12 mg

OK

Magnesium

400 mg

404 mg

OK

Phosphorus

700 mg

1272 mg

OK

Selenium

55 g

121 g

OK

Zinc

11 mg

11 mg

OK

Vitamins

Target

Average Eaten

Status

Vitamin A

900 g RAE

489 g RAE

Under

Vitamin B6

1.3 mg

2.1 mg

OK

Vitamin B12

2.4 g

2.3 g

Under

Vitamin C

90 mg

46 mg

Under

Vitamin D

15 g

2 g

Under

17

Vitamin E

15 mg AT

15 mg AT

OK

Vitamin K

120 g

96 g

Under

Folate

400 g DFE

376 g DFE

Under

Thiamin

1.2 mg

1.3 mg

OK

Riboflavin

1.3 mg

1.5 mg

OK

Niacin

16 mg

17 mg

OK

Choline

550 mg

307 mg

Under

Information about dietary supplements.

** If you are African American, hypertensive, diabetic, or have chronic kidney disease, reduce your sodium to 1500 mg a day. In
addition, people who are age 51 and
older need to reduce sodium to 1500 mg a day. All others need to reduce sodium to less than 2300 mg a day.

*** Nutrients that appear twice (protein, carbohydrate, linoleic acid, and -linolenic acid) have two separate
recommendations:

1) Amount eaten (in grams) compared to your minimum recommended intake.

2) Percent of Calories eaten from that nutrient compared to the recommended range.

You may see different messages in the status column for these 2 different recommendations.

18

Appendix C

tbari2's Nutrients Report 03/17/14 - 03/30/14

Your plan is based on a 2800 Calorie allowance.

Nutrients

Target

Average Eaten

Status

Total Calories

2800 Calories

2475 Calories

Under

Protein (g)***

56 g

105 g

OK

Protein (% Calories)***

10 - 35% Calories

17% Calories

OK

Carbohydrate (g)***

130 g

229 g

OK

Carbohydrate (% Calories)***

45 - 65% Calories

37% Calories

Under

Dietary Fiber

38 g

23 g

Under

Total Sugars

No Daily Target or
Limit

89 g

No Daily Target or
Limit

Added Sugars

No Daily Target or
Limit

26 g

No Daily Target or
Limit

Total Fat

20 - 35% Calories

48% Calories

Over

Saturated Fat

< 10% Calories

16% Calories

Over

Polyunsaturated Fat

No Daily Target or
Limit

11% Calories

No Daily Target or
Limit

Monounsaturated Fat

No Daily Target or
Limit

17% Calories

No Daily Target or
Limit

Linoleic Acid (g)***

17 g

26 g

OK

19

Linoleic Acid (% Calories)***

5 - 10% Calories

10% Calories

OK

-Linolenic Acid (% Calories)***

0.6 - 1.2% Calories

0.9% Calories

OK

-Linolenic Acid (g)***

1.6 g

2.5 g

OK

Omega 3 - EPA

No Daily Target or
Limit

105 mg

No Daily Target or
Limit

Omega 3 - DHA

No Daily Target or
Limit

160 mg

No Daily Target or
Limit

Cholesterol

< 300 mg

266 mg

OK

Minerals

Target

Average Eaten

Status

Calcium

1000 mg

1351 mg

OK

Potassium

4700 mg

3004 mg

Under

Sodium**

< 2300 mg

5334 mg

Over

Copper

900 g

1742 g

OK

Iron

8 mg

17 mg

OK

Magnesium

400 mg

360 mg

Under

Phosphorus

700 mg

1720 mg

OK

Selenium

55 g

146 g

OK

Zinc

11 mg

14 mg

OK

Vitamins

Target

Average Eaten

Status

Vitamin A

900 g RAE

1726 g RAE

OK

Vitamin B6

1.3 mg

3.7 mg

OK

20

Vitamin B12

2.4 g

10.5 g

OK

Vitamin C

90 mg

178 mg

OK

Vitamin D

15 g

14 g

Under

Vitamin E

15 mg AT

31 mg AT

OK

Vitamin K

120 g

224 g

OK

Folate

400 g DFE

1068 g DFE

Over

Thiamin

1.2 mg

3.3 mg

OK

Riboflavin

1.3 mg

3.7 mg

OK

Niacin

16 mg

46 mg

OK

Choline

550 mg

340 mg

Under

Information about dietary supplements.

** If you are African American, hypertensive, diabetic, or have chronic kidney disease, reduce your sodium to 1500 mg a day. In
addition, people who are age 51 and
older need to reduce sodium to 1500 mg a day. All others need to reduce sodium to less than 2300 mg a day.

*** Nutrients that appear twice (protein, carbohydrate, linoleic acid, and -linolenic acid) have two separate
recommendations:

1) Amount eaten (in grams) compared to your minimum recommended intake.

2) Percent of Calories eaten from that nutrient compared to the recommended range.

You may see different messages in the status column for these 2 different recommendations.

21

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Nutritional intervention in patients with Cystic Fibrosis: A systematic review. Journal of
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LLC; 2012.
3. Nelms M, Sucher KP, Lacey K, Roth SL, Habash D, Nelms RG. Nutrition Therapy &
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http://www.health.qld.gov.au/nutrition/resources/paeds_saltrplcmnt.pdf
11. Borowitz D, Baker RD, Stallings V. Consensus Report on Nutrition for Pediatric Patients
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