- •Six distinct trajectories of early growth were identified using group based trajectory modeling.
- •Growth trajectories that met nutritional guideline recommendations by age 6 were associated with higher FEV1pp.
- •Optimizing nutritional status in childhood remains a crucial aspect of early CF management, particularly for those children who do not currently qualify for HEMT.
Higher growth percentiles are associated with more favorable lung function in cystic fibrosis (CF), prompting the creation of CF Foundation (CFF) nutritional guidelines.
To describe early childhood growth trajectories within CF, to determine if growth trajectories are associated with differences in lung function at age six, and to identify factors that differ between trajectory groups.
Retrospective cohort study of children diagnosed with CF and born 2000–2011 using the US CFF Patient Registry. Annualized growth parameters prior to age six were included in group-based trajectory modeling to identify unique early life growth trajectories. FEV1 percent predicted (FEV1pp) at age six was compared between trajectory groups using linear regression. Factors associated with group membership were identified using multinomial logistic regression.
6,809 children met inclusion criteria. Six discrete growth trajectories were identified, including three groups that began with growth parameters >50th percentile, termed: “always high”, “gradual decliner”, “rapid decliner”, and three which began with growth parameters <50th percentile, termed: “rapid riser”, “gradual riser”, “always low”. FEV1pp at age six was highest for the Always High trajectory. The Always Low trajectory was nearly 10% lower than the Always High trajectory. Sex, ethnicity, newborn screening and pancreatic function were associated with trajectory class membership.
Distinct early life growth trajectories were identified within CF. Trajectories that met CFF nutritional guideline recommendations were associated with higher FEV1pp at age six. CF care teams should continue to partner with families to encourage interventions to support optimal growth to improve lung function in CF.
Abbreviations:CF (cystic fibrosis), BMI (body mass index), NBS (newborn screening), FEV1pp (forced expiratory volume in one second as a percentage of predicted value), CFF (Cystic Fibrosis Foundation), CFFPR (Cystic Fibrosis Foundation Patient Registry), WFL (weight-for-length), GBTM (group-based trajectory modeling), APPC (average posterior probability of classification), OCC (odds of correct classification), ANOVA (analysis of variance), RRR (relative risk ratio), CI (confidence interval), Pa (Pseudomonas aeruginosa), MRSA (methicillin-resistant Staphylococcus aureus), HEMT (highly effective modulator therapies)
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Published online: February 28, 2023
Accepted: February 20, 2023
Received in revised form: February 11, 2023
Received: November 8, 2022
Publication stageIn Press Corrected Proof
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