Year

2025

Season

Spring

Paper Type

Doctoral Project

College

Brooks College of Health

Degree Name

Doctor of Clinical Nutrition (DCN)

Department

Nutrition & Dietetics

NACO controlled Corporate Body

University of North Florida. Department of Nutrition & Dietetics

Committee Chairperson

Dr. Casey Colin

Second Advisor

Dr. Lauri Wright

Third Advisor

Dr. Melissa Kay

Fourth Advisor

Dr. Patricia Davidson

Abstract

Background: As Cystic Fibrosis Transmembrane Conductance Regulator (CFTR) modulator treatments for Cystic Fibrosis (CF) continue to advance, patients are experiencing new challenges related to their nutrition. Many patients have gone from fighting to gain weight to working to maintain or lose weight. These shifts in nutrition have left providers without nutrition care standards or guidelines to assist patients in achieving an optimal nutritional status. This study aimed to explore providers' knowledge, attitudes, and practices regarding the current nutritional concerns in the era of CFTR modulators.

Methods: We conducted an exploratory survey among physicians and registered dietitians (RDs) currently practicing in adult CF care centers (n=97) to explore the knowledge, attitudes, and practices related to current nutritional concerns according to the most recent research. Knowledge scores were calculated by assigning correct responses one point and wrong or unsure answers zero points. Attitude and practice scores were measured using Likert scales and calculated by averaging the total score. Qualitative interviews were conducted among a sample of RDs practicing in adult CF care centers via Zoom (n=13) to further explore current providers' attitudes and practices regarding nutritional concerns in adult CF patients.

Results: Providers had moderate knowledge scores (M=66.48, SD=8.57), relatively high attitude scores (M=83.65, SD=6.33), and fair practice scores (M=68.13, SD=8.54). Interview data reflected three main themes: 1) RDs’ approach to the mental and emotional effects of weight gain (e.g. sensitivity of questions, lack of knowledge and skills to address concerns, importance of unified CF care team approach); 2) Practice Approach to weight concerns (e.g. patient led weight loss and weight neutral approach, lifestyle changes); and 3) Lack of research for nutrition care in the setting of CFTR modulators (e.g. lack of guidance on vitamin and minerals, calorie and protein estimations, use of BMI as nutrition indicator)

Conclusion: Providers continue to struggle with addressing nutritional concerns in the setting of CFTR modulators due to the lack of research and nutritional guidelines. Providers expressed the need for evidence-based research regarding the effects of weight gain, the efficacy of BMI as a nutrition indicator, vitamin and mineral supplementation, and calorie and protein recommendations to ensure they provide the best patient care.

Available for download on Monday, April 15, 2030

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