Abnormal glucose tolerance in a pediatric cystic fibrosis cohort: Trends in clinical outcomes and associated factors in the preceding years

• Published in: Nutrition, metabolism, and cardiovascular diseases metabolism, and cardiovascular diseases, 2021-01, Vol.31 (1), p.277-285
• Main Authors: Nguyen, Cécile Q.T., Denis, Marie-Hélène, Chagnon, Miguel, Rabasa-Lhoret, Rémi, Mailhot, Geneviève
• Format: Article
• Language: English
• Subjects: Adolescent; Age Factors; Biomarkers - blood; Blood Glucose - metabolism; Child; Cystic fibrosis; Cystic Fibrosis - complications; Cystic Fibrosis - diagnosis; Cystic fibrosis-related diabetes; Female; Glucose Intolerance - blood; Glucose Intolerance - diagnosis; Glucose Intolerance - etiology; Glycated Hemoglobin A - metabolism; Humans; Impaired glucose tolerance; Male; Pediatric cohort; Prognosis; Retrospective Studies; Risk Assessment; Risk Factors; Time Factors
• ISSN: 0939-4753; 1590-3729
• DOI: 10.1016/j.numecd.2020.07.044

Deterioration of anthropometric and lung function parameters was shown to precede the onset of cystic fibrosis-related diabetes (CFRD) in adults. In children, studies have been conducted in small cohorts with relatively short observation period. Study objectives were to document the longitudinal trends of anthropometric, pulmonary, nutritional and metabolic parameters from cystic fibrosis (CF) diagnosis to the ascertainment of abnormal glucose tolerance and identify parameters associated with the incidence of such abnormalities in a pediatric CF cohort. Retrospective cohort study of 281 children with CF. Longitudinal trends of anthropometric, lung function, nutritional and metabolic data were generated from CF diagnosis to the ascertainment of abnormal glucose tolerance defined as the presence of either impaired glucose tolerance (IGT), unconfirmed CFRD or CFRD. Cox models and Kaplan–Meier curves were used to identify factors associated with developing abnormal glucose tolerance. Forty-five percent of cohort had normal glucose tolerance (NGT), 27% IGT, 10% unconfirmed CFRD and 18% CFRD. Children who developed CFRD displayed lower height z-scores from a very early age. Conversely, HbA1c levels began to rise closer to CFRD ascertainment. Height z-scores (HR: 0.45; CI 95% [0.29–0.69]) and HbA1c (HR: 2.43; CI 95% [1.86–3.18]) in years preceding ascertainment were associated with the risk of developing CFRD. Children who developed CFRD display distinctive trends for height z-scores from a very early age, whereas HbA1c appears as a marker of established glucose metabolism derangements. •Growth impairment in the first life decade precedes the onset of pediatric cystic fibrosis-related diabetes (CFRD).•Chronic malnutrition in the first life decade is linked with a greater risk of CFRD.•Catch-up growth in the first life decade is associated with a lower risk of CFRD.•HbA1c is a marker of glucose metabolism derangements preceding CFRD ascertainment.