Cystic fibrosis nutrition: Addressing emerging trends following the 2024 ESPEN-ESPGHAN-ECFS guidelines. Expert opinion recommendations.

BACKGROUND

Advancements in clinical care and scientific research in cystic fibrosis (CF) have transformed, and continue to shape, nutritional management and related practices. Front line clinicians delivering nutritional support require 'living guidelines' with regular updates to address emerging issues in the rapidly changing world of CF. In this paper we wish to provide context and framework recommendations on key issues that are becoming increasingly important in clinical practice where current international nutrition guidelines provide limited or no recommendations.

METHODS

The study was developed by an international multidisciplinary working group made up of previous authors of the ESPEN-ESPGHAN-ECFS 2024 guidelines. Key topics were identified and new internationally recognised expert authors were allocated to provide additional expertise as required. Statements were produced and a modified Delphi was used to gain consensus.

RESULTS

The working group developed recommendations to complement current guidelines on the quality of diet, the changes in pancreatic enzyme supplementation in the age of modulator therapy, evaluation and treatment of overweight and obesity, withdrawing tube feeding, nutritional support in cancer and nutrition care in older adults. These were endorsed by the ECFS Nutrition Group. The topics identified and examined in this paper represent issues that will need to be addressed in the next revision of the ESPEN-ESPGHAN-ECFS guideline. This paper therefore serves as a preliminary step in preparation for this update.