0 5 10 15 20 25 30

Other food assistance

Medicaid liquid supplement

Free or reduced price school lunch

Food banks

WIC

SSI

Food stamps

Percent of participants accessing resources (n=18)

CF Adults CF Parents

Type of Assistance

Evaluation of Food Insecurity in Adults and Children with Cystic FibrosisPerry Brown1, MD; Dixie Durham1, MHS; Rick Tivis3, MPH; Shannon Stamper1, RD;

Cleary Waldren1, MHS; Sarah Toevs2, PhD; Barbara Gordon3, RDN, LD, Tiffany Robb2, BS. 1 St. Luke’s Health System, 2Boise State University, 3Idaho State University

Dixie Durham, MHS, CCRC, RRT-NPSSt. Luke’s ResearchEmail: durhamd@slhs.orgPhone: (208) – 381 - 7334

Contact1. Gundersen C, Engelhard EE, Crumbaugh AS, Seligman HK. Brief assessment of food insecurity identifies high-risk US adults. Public Health Nutrition. 2017; 20:1367-71.2. Sawicki GS, Sellers DE, Robinson WM. High treatment burden in adults with cystic fibrosis: challenges to disease self-management. Journal of Cystic Fibrosis. 2009; 8:91-6.3. Hurley MN, McKeever TM, Prayle AP, Fogarty AW, Smyth AR. Rate of improvement of CF life expectancy exceeds that of general population - Observational death registration study. Journal of Cystic Fibrosis. 2014; 13:410-5.4. Borowitz D, Baker RD, Stallings V. Consensus Report on Nutrition for Pediatric Patients With Cystic Fibrosis. Journal of Pediatric Gastroenterology & Nutrition. 2002; 35:246-59.5. Stallings V, Stark L, Robinson K, Feranchak A, Quinton H. Evidence-based practice recommendations for nutrition-related management of children and adults with cystic fibrosis and pancreatic insufficiency: Results of a systematic review. Journal of

American Dietetic Association. 2008; 108:832-9.6. Stark LJ. Can nutrition counselling be more behavioural? Lessons learned from dietary management of cystic fibrosis. Proceedings of the Nutrition Society. 2003; 62:793-9.7. Coleman-Jensen A, Nord M, Andrews M, Carlson S. Household food security in the United States in 2011: United States Department of Agriculture2012 Contract No.: 141. 8. Bank IF. Food Insecurity in Idaho. 2015..

References

The percentage of individuals reporting food insecurity among the study population was more than two-times greater than the state rate of 15%.8 Parents of children with CF and adults with CF reported rates of food insecurity of 33% and 43%, respectively. Resources used by those accessing food assistance (n=18) are reported in Figure 1. Approximately 40% of participants indicated they would not access resources for food assistance if they met income requirements for such programs.

No significant correlations were found between self-reported food insecurity and lung function or body mass index (p>.05). There was also no significant association found between BMI/BMI percentile and FEV1 (p > 0.05; r = 0.24), or only BMI percentile and FEV1

(p >.05; r = 0.16).

Introduction

Participants:n= 87 participants receiving care at the St. Luke’s Cystic Fibrosis

Center of Idaho (44 patients and 43 parents)

Inclusion Criteria:Adult with CF or Parent of a child with CF

Data Collection:Patient Information: Research Electronic Data Capture (REDCap)

used to manage patient metricsSurvey: Mountain West Cystic Fibrosis Consortium Questionnaire

(MWCFC-Q)

Primary Food Insecurity Screening Questions:In the last 12 months, we worried whether (my/our) food would

run out before (I/we) got money to buy more.In the last 12 months, the food that (I/we) bought just didn’t last

and (I/we) didn’t have money to get more.1

Methods

Food insecurity is highly prevalent among Idahoans with CF, placing this population at risk to poor health outcomes. This finding is a call to action to providers who interact with individuals and families with CF. Providers must be aware of and equipped to offer patient-centered guidance related to food assistance resources.

This community-based study highlights the need for continued research on food access and insecurity in this patient population. The findings also indicate a need for providers and CF advocacy organizations to expand their efforts related to food insecurity.

Areas of future research and advocacy:• Identify food insecurity challenges specific to the CF population• Inform policy makers of gaps in access to resources such as

insurance coverage for nutritional supplements/formulas and medically necessary food purchases

• Increase awareness and knowledge among providers who interact with individuals with CF of food assistance resources

• Expand support for current food assistance programs

Discussion

Advances in the care and treatment of CF have led to improved mortality rates; therefore, more patients with CF are living into adulthood.2,3 Among other treatments, medical nutrition therapy is often required in the management of CF. Previous studies have found that social, behavioral, and physical factors influence the ability of patients with CF to follow dietary recommendations.4,5,6

A socio-economic factor that has not been adequately investigated with regards to dietary compliance among this population is food insecurity.

USDA Defines Food Insecurity as “a household-level economic and social condition of limited or uncertain access to adequate food.” 7

At the time of this study the national average for food insecurity among the general population was 13.7%; the rate in Idaho was 14.7%.8

The aim of this study, conducted by St Luke’s Cystic Fibrosis Center of Idaho between August 2013 and March 2015, was to explore the prevalence of food insecurity among CF patients residing in Idaho. Associations between food insecurity and health outcomes (lung function and body mass index) was also examined.

Results

Table 1. Participant Demographic and Health Status

Adult with CF

(18-50+ years)

Parent of Child with CF

(<1 to 17 years)

Male 21 7

Female 23 36

High School Graduate or less 15 10

Some College 17 16

College Graduate or more 12 17

Number receiving food assistance 12 29

Child with CF

(<1 to 17 years)

Malnourished: <10th percentile NA 2

Underweight: <50th percentile NA 20

Normal/healthy weight NA 9

Overweight/obese: ≥ 95th percentile NA 2

Underweight: < 18.5 kg/m2 4 NA

Normal/healthy weight 31 NA

Overweight: 25-29.9 kg/m2 7 NA

Obese: > 30 kg/m2 2 NA

Normal: FEV1 > 90 6 10

Mild obstruction: FEV1 70-90 10 10

Moderate obstruction: FEV1 40-70 23 4

Severe obstruction: FEV1 < 40 4 0

Testing not done (< 6 years old) NA 19

*Applicable data was collected on parents who completed surveys for their children

NA = Not applicable

Gender

Education

Supplemental Food Programs

Body Mass Index

Forced Expiratory Volume in One Second (FEV1)

Food insecurity is prevalent among Idahoans with Cystic Fibrosis (CF) with rates over two-times greater than those of the general population in the state. Not having access to adequate or consistent food supplies can impact a patient’s ability to adhere to dietary modifications and overall treatment protocols for CF. While no significant correlations were found between self-reported food insecurity and lung function or body mass index, the incidence of food insecurity underlines the importance of asking patients/parents about this important social determinant of health. The authors endorse the use of a two-question validated screening tool to identify patients and families at risk to food insecurity. 1

A reluctance among patients/parents to utilize food assistance programs was also identified in this study. Further investigation into this issue and how to sensitively encourage patients and families to leverage the resources offered by these programs is needed. It is imperative that providers (physicians, social workers, dietitians, and nurses) who interact with individuals with CF be aware of available food assistance resources and are prepared to provide patient-centered support and referral.

Conclusions

Figure 1. Food Assistance Programs Accessed by Participants