Food insecurity screening and local food access: Contributions to nutritional outcomes among children and adults with cystic fibrosis in the United States

Feeding the Need: A Study on Food Security Among People With Cystic Fibrosis in Turkey

BACKGROUND

Cystic fibrosis (CF) is a genetic disorder that necessitates high-calorie, protein-rich diets, leading to nutritional deficiencies. Food insecurity (FI) poses a significant challenge for people with CF (pwCF), impacting their ability to maintain the necessary dietary intake. This study aims to explore FI and dietary patterns among pwCF in Turkey.

METHODS

A cross-sectional study involving 290 pwCF from the Marmara University Selim Çöremen Cystic Fibrosis Center was conducted between April 2023 and February 2024. The "US Household Food Security Survey Module" and the "Your Current Life Situation" survey were used to assess FI and socioeconomic status among the participants. Nutritional data, including BMI, FEV1 values, and dietary intake, were recorded.

RESULTS

Among the participants, 52.7% were female, with a mean age of 13.3 ± 8.1 years. FI was detected in 46.8% of pwCF, with 18% facing very low food security. Higher income levels were associated with better food security (p = 0.008). Nutritional inadequacies were observed even among food-secure individuals, particularly in the consumption of legumes, nuts, and fish. BMI and BMI percentile values were significantly lower in the very low FS group compared to the high FS group (p = 0.03 and p = 0.02, respectively).

CONCLUSION

Ensuring adequate nutrition and calorie intake is crucial for pwCF. Our study highlights significant FI among pwCF in Turkey, with income levels influencing food security status. Nutritional inadequacies persist even among those classified as food secure. Based on these findings, targeted nutritional support will be provided to those in need to improve overall health and well-being.

Psychosocial and mental health in cystic fibrosis in the modern era of care: time to evolve

Cystic fibrosis (CF) treatment has revolutionised care over the past three decades with major advances in survival. Despite these advances, CF continues to create psychological and social challenges for people with CF (PWCF) throughout their life and is associated with worse health outcomes and higher healthcare costs. Anxiety and depression screening and management protocols are widely implemented within CF care; however, a much broader scope of psychosocial challenges exist which lack a standardised screening and management approach. The advent of CF transmembrane conductance regulator modulator therapies is transforming the psychosocial landscape for PWCF with new challenges and evolving psychosocial needs. What it means to have CF, the expectations, hopes and stressors are rapidly changing, and psychosocial care must keep pace if health outcomes are to be fully optimised. A symposium of international CF and psychosocial experts was convened in November 2022 to explore current and emerging issues in psychosocial health and identify opportunities and approaches to optimise psychosocial care. This state-of-the-art review summarises key symposium proceedings and highlights priorities for clinical practice and research in psychosocial health across the lifespan among PWCF. It also summarises state-of-the-art initiatives for screening and intervention to optimise CF psychosocial healthcare and patient outcomes.

"I eat chocolate milk for dinner because we just have nothing in our fridge": The invisible burden and dire consequences of food insecurity for people with cystic fibrosis in the United States

BACKGROUND

One-third of people with cystic fibrosis (pwCF) are food insecure, with profound negative implications for their health. This qualitative study explored lived experiences with food insecurity among pwCF or their caregivers and summarized their perspectives on food insecurity screening in the cystic fibrosis (CF) programs where they receive care.

METHODS

Semi-structured qualitative interviews were conducted with two groups: (1) adults with CF and (2) parents or caregivers of children with CF. PwCF or their caregivers with previously documented food insecurity were referred for participation by pediatric and adult CF programs across the United States. Interviews were recorded and transcribed, and data were coded and analyzed by two independent coders using a content-analysis approach with a constant comparative method to generate themes.

RESULTS

A total of 26 participants from 22 CF programs were interviewed. The sample included 17 adults with CF and nine parents of children with CF. Participants were predominantly White (88%) and female (92%). Five overarching themes emerged: (1) food insecurity among CF patients and their families is onerous, (2) financial constraints imposed by the CF disease contribute to food insecurity, (3) federal and state programs provide limited food assistance, and other support is minimal, (4) shame and stigma engulf conversations around food insecurity with CF care teams, and (5) food insecurity screening in clinical settings is critical.

CONCLUSIONS

Food insecurity among pwCF is invisible, but its consequences are dire. Assistance is limited, screening is inconsistent, and stigma is widespread. There is an urgent need to normalize food insecurity screening, standardize the screening process, and expand food assistance programs for pwCF.

Impact of Geospatial Food Access on Acute Pancreatitis Outcomes

BACKGROUND AND AIM

Food access is an important social determinant of health and refers to geographical and infrastructural aspects of food availability. Using publicly available data on food access from the United States Department of Agriculture (USDA), geospatial analyses can identify regions with variable food access, which may impact acute pancreatitis (AP), an acute inflammatory condition characterized by unpredictable outcomes and substantial mortality. This study aimed to investigate the association of clinical outcomes in patients with AP with geospatial food access.

METHODS

We examined AP-related hospitalizations at a tertiary center from January 2008 to December 2018. The physical addresses were geocoded through ArcGIS Pro2.7.0 (ESRI, Redlands, CA). USDA Food Access Research Atlas defined low food access as urban areas with 33% or more of the population residing over one mile from the nearest food source. Regression analyses enabled assessment of the association between AP outcomes and food access.

RESULTS

The study included 772 unique patients with AP residing in Massachusetts with 931 AP-related hospitalizations. One hundred and ninety-eight (25.6%) patients resided in census tracts with normal urban food access and 574 (74.4%) patients resided in tracts with low food access. AP severity per revised Atlanta classification [OR 1.88 (95%CI 1.21-2.92); p = 0.005], and 30-day AP-related readmission [OR 1.78(95%CI 1.11-2.86); p = 0.02] had significant association with food access, despite adjustment for demographics, healthcare behaviors, and comorbidities (Charlson Comorbidity Index). However, food access lacked significant association with AP-related mortality (p = 0.40) and length of stay (LOS: p = 0.99).

CONCLUSION

Low food access had a significant association with 30-day AP-related readmissions and AP severity. However, mortality and LOS lacked significant association with food access. The association between nutrition, lifestyle, and AP outcomes warrants further prospective investigation.

The impact of switching to race-neutral reference equations on FEV1 percent predicted among people with cystic fibrosis. J Cyst Fibros 2024;23:443-449. [PMID: 38556415 DOI: 10.1016/j.jcf.2024.03.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0]

RATIONALE

The American Thoracic Society recommended switching to race-neutral spirometry reference equations, as race is a social construct and to avoid normalizing disparities in lung function due to structural racism. Understanding the impact of the race-neutral equations on percent predicted forced expiratory volume in one second (ppFEV1) in people with cystic fibrosis (PwCF) will help prepare patients and providers to interpret pulmonary function test results.

OBJECTIVE(S)

To quantify the impact of switching from Global Lung Initiative (GLI) 2012 race-specific to GLI 2022 Global race-neutral reference equations on the distribution of ppFEV1 among PwCF of different races.

METHODS

Cross-sectional analysis of FEV1 among PwCF ages ≥6 years in the 2021 U.S. Cystic Fibrosis Foundation Patient Registry. We describe the absolute difference in ppFEV1 between the two reference equations by reported race and the effect of age and height on this difference.

RESULTS

With the switch to GLI Global, ppFEV1 will increase for White (median increase 4.7, (IQR: 3.1; 6.4)) and Asian (2.6 (IQR: 1.6; 3.7)) individuals and decrease for Black individuals (-7.7, (IQR: -10.9; -5.2)). Other race categories will see minimal changes in median ppFEV1. Individuals with higher baseline ppFEV1 and younger age will see a greater change in ppFEV1 (i.e., a greater improvement among White and Asian individuals and a greater decline among Black individuals).

CONCLUSIONS

Switching from GLI 2012 race-specific reference equations to GLI 2022 Global race-neutral equations will result in larger reductions in ppFEV1 among Black individuals with CF than increases among White and Asian people with CF.