IMPROVEMENT OF NUTRITIONAL AND LIPOPROTEIN STATUS IN CYSTIC FIBROSIS (CF) PATIENTS AFTER IV ANTIBIOTHERAPY (IV AB) ON AN EQUICALORIC BASIS

Abstract

Malnutrition, pulmonary and digestive disease are interrelated in CF. If the effects ol nutrition on pulmonary function were closely studied, the adverse is not true, particularly concerning AB and nutritional status. To determine the per se effect of AB on nutritional and lipoprotein status, 7 patients (m = 13.3 ± 1.9 yrs) were studied prospectively before and after a 14-day course of IV AB on an equicaloric (2618 ± 353 vs 2745 ± 392 kcal/d; NS) and equilipidic (97 ± 18 vs 109 ± 20 g/d: NS) spontaneous intake basis.

Results : without change in lipid absorption coefficient, IV AB lead to a significant increase of weight (d : 1157 ± 485 g; p<.05) and both mid-arm circumference and triceps skinfold were improved. This gain of weight was significantly correlated (p<.01) to an increase of IGF1- somatomedin-C (d : 0.64 ± 0.15 U/l) and of retinol binding protein (d : 17 ± 4 mg/l). Serum lipids (mmol/l) and apoproteins (mg%) are tabulated below:

The significant increases in C and Ph were noted in both LDL and HDL tractions (p<01) but not in VLDL. However, Apoprotein B was not significantly modified. On the other hand, inflammatory serum parameters (ESR, IgG, elastase-complex) were unchanged despite notable improvement of pulmonary function tests. In addition, cytokines (tumor necrosis factor (TNF) and inlerleukin-l alpha and beta), which could influence the lipoprotein metabolism, were measured and found only occasionnaly elevated.

In summary, this prospective study showed that profound changes in nutritional and lipoprotein status are induced by IV AB in the absence of modification of caloric or lipidic intake or absorption in patients with CF. Cachectin-like activity of TNF at levels below the assay detection limit could contribute to this metabolic phenomenon.

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