Effects of Cystic Fibrosis on Growth and Development
Reviewed by: HU Medical Review Board | Last reviewed: September 2019 | Last updated: June 2022
Poor growth in children and trouble keeping weight on during adulthood are symptoms of malabsorption, a common side effect of cystic fibrosis.
What are the causes of poor growth/low weight?
Poor growth and low weight gain tend to occur in people with CF because the thick mucus generated by CF clogs the ducts (tubes) leading in and out of the pancreas, liver, and intestines.
In the pancreas, the mucus created by CF prevents the release of enzymes into the small intestines. These enzymes are needed to break down foods and turn them into usable proteins, fats and carbohydrates. Proteins are needed for growth, tissue repair, and healing. Fats are calorie-rich and full of fat-soluble vitamins that the body needs for growth and to stay healthy. When a body does not process nutrients properly, the condition is called malabsorption.
About 80-90% people with cystic fibrosis (CF) have pancreatic insufficiency, which causes malabsorption.1
In addition to malabsorption, people with cystic fibrosis often burn more calories due to the extra energy it takes to breathe and fight infections. In fact, people with CF need up to twice the daily recommended calories compared to other people of the same age and weight.1-3
All this results in malnutrition, slow growth in childhood, and difficulty gaining weight or keeping weight on throughout adulthood. Other symptoms of malabsorption include greasy, bulky stools, stomachache, and excessive gas.1-4
Diagnosing low weight gain
In infants, a test known as a fecal elastase is used to measure pancreatic function and how well the body is absorbing nutrients.
In babies who were not diagnosed during newborn screening, failure to thrive, trouble gaining weight, malnutrition, and malabsorption may indicate cystic fibrosis if the infant also shows other common symptoms - such as lung infections. These babies are usually given a genetic test to look for CF.
In children and adults with CF, regular BMI (body mass index) charts are used to indicate whether growth, height, and weight are on target.
Treatment for malabsorption caused by cystic fibrosis
Many techniques and treatments can help a child or adult with CF eat enough to grow or maintain a healthy weight.
Pancreatic enzyme replacements (PERT)
First, pancreatic enzyme replacements (PERT) help the person with CF process their foods more efficiently so they can absorb the nutrients in the food they eat. This allows them to retain more energy from the foods they consume. The amount of enzymes a person with CF takes changes as they age.
Next, people with CF are also usually encouraged to eat as much as they’d like of high-calorie, high-fat foods, along with plenty of nutritious fruits and vegetables. People with CF also often need to take extra fat-soluble vitamins A, D, E and K.1-4
Eating fatigue is a common complaint for people with CF. Even if a person with cystic fibrosis feels hungry and eats large amounts of food, it may still not be enough to combat malabsorption.
GI symptoms that may impact growth and development
Other gastrointestinal symptoms that people with cystic fibrosis develop include:
- CF-related diabetes
- Rectal prolapse
- Liver disease
- Colon cancer