Reasons for Malnutrition

A variety of complex organic and psychosocial factors contribute to malnutrition in CF.

Malabsorption Pancreatic exocrine secretions contain less enzymes and bicarbonate, have a lower pH, and are of a smaller volume, and the physical properties of proteins and mucus within the lumen are affected. This results in obstruction to the small ducts and secondary damage to pancreatic digestive enzyme secretions causing malabsorption. Other problems, such as gastric hypersecretion, reduced duodenal bicarbonate concentration and pH, disorders of bile salt metabolism, disordered intestinal motility and permeability, liver disease, and short bowel syndrome after intestinal resection in the neonatal period, may contribute to malabsorption. The severity of malabsorption is variable, and there can be significant malabsorption of protein and fat-soluble vitamins despite adequate use of enzyme supplements.

Increased energy expenditure Resting energy expenditure, an estimate of basal metabolic rate, is 10-20% greater than in healthy controls and may contribute to energy imbalance. Increased REE appears to be closely associated with declining pulmonary function and subclinical infection. Bronchial sepsis leads to local release of leukotrienes, free oxygen radicals, and cytokines, including tumour necrosis factor-a. Antibiotics have been shown to reduce energy requirements of moderately ill patients with chronic Pseudomonas aeruginosa.

Anorexia and low energy intake Inadequate energy intake is often the main reason for growth failure in CF. Factors associated with a reduced appetite include

Chronic respiratory infection and other complications of CF, such as distal ileal obstruction syndrome, abdominal pain, GOR resulting in oesophagitis, pain, and vomiting Behavior feeding problems in preschool and schoolage children

Media pressure to eat a healthy low-fat, low-sugar diet

Inappropriate concepts regarding body image Depression

Eating disorders in teenagers Poor use of dietary supplements Dislike of high-energy foods

Breaking Bulimia

Breaking Bulimia

We have all been there: turning to the refrigerator if feeling lonely or bored or indulging in seconds or thirds if strained. But if you suffer from bulimia, the from time to time urge to overeat is more like an obsession.

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