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The goal of the study is to examine multiple markers of anthropometrics, body composition, sarcopenia and frailty and compare them to dual energy X-ray absorptiometry (DXA) output, which is considered the current clinical gold-standard tool to measure body composition. The result of this study will provide detailed data regarding the nutrition and body composition within this Cystic Fibrosis population and also provide a baseline evaluation for use of these biomarkers in the future studies including evaluation of nutritional intervention. Further, the study will also include psychosocial and other patient-reported outcomes and medical contributors to understand their contributions to the nutritional failure in the adult advanced lung disease population. Finally, the study will evaluate both established and emerging nutritional and body composition parameters and link them to clinical outcomes in adults with CF across the spectrum of pulmonary function.
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| Label | Type | Description | Intervention Names |
|---|---|---|---|
| Cohort 1 | Forced expiratory volume in 1 second (FEV1) <70% predicted during the 12 months prior to enrollment (>50% of measurements, eliminating periods of exacerbation). If no stable spirometry data are available in the 12 months prior to enrollment, from the prior 24 months will be used. |
| |
| Cohort 2 | FEV1 ≥70% predicted during the 12 months prior to enrollment (>50% of measurements, eliminating periods of exacerbation). |
| Name | Type | Description | Arm Group Labels | Other Names |
|---|---|---|---|---|
| BMI and lean mass index from DXA | Diagnostic Test | Estimate and compare correlation between lean mass index from DXA and BMI |
|
| Measure | Description | Time Frame |
|---|---|---|
| Correlation between DXA lean mass index and BMI | Estimate and compare correlation between lean mass index from DXA (kg/m2) and BMI (kg/m2) | Baseline and 1 year |
| Correlation between DXA lean mass index and mid-arm muscle circumference | Estimate and compare correlation between lean mass index from DXA (kg/m2) and mid-arm muscle circumference (cm) | Baseline and 1 year |
| Correlation between DXA lean mass index and hand-grip strength | Estimate and compare correlation between lean mass index from DXA (kg/m2) and hand-grip strength (kg) | Baseline and 1 year |
| Correlation between DXA lean mass index and the 6-minute walk distance traveled | Estimate and compare correlation between lean mass index from DXA (kg/m2) and 6-minute walk (distance traveled in six minutes) | Baseline and 1 year |
| Correlation between DXA lean mass index and the 1-minute sit-to-stand number of repetitions | Estimate and compare correlation between lean mass index from DXA (kg/m2) and 1-minute sit-to-stand (number of sit-to-stand repetitions in one minute) | Baseline and 1 year |
| Correlation between DXA lean mass index and Short Physical Performance Battery frailty score | Estimate and compare correlation between lean mass index from DXA (kg/m2) and Short Physical Performance Battery frailty score (total points) | Baseline and 1 year |
| Measure | Description | Time Frame |
|---|---|---|
| Characterize lean mass index from DXA cross-sectionally and longitudinally | Characterize lean mass index from DXA cross-sectionally (at enrollment) and longitudinally (post-enrollment changes) based on descriptive statistics and evaluate variance | Baseline and 1 year |
| Characterize BMI cross-sectionally and longitudinally |
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Inclusion Criteria:
Exclusion Criteria:
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The study population will include adults 18 and older with a confirmed diagnostic of cystic fibrosis, identified genotypes (when available), no prior solid organ transplant, and not pregnant or planning on becoming pregnant during the 1st year of the study. Participants receiving a lung transplantation while enrolled in the study will not need to be withdrawn.
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| Name | Affiliation | Role |
|---|---|---|
| Adam Stein | Northwestern University | Principal Investigator |
| Jessica Alvarez | Emory University | Principal Investigator |
| Melissa Putman | Massachusetts General Hospital | Principal Investigator |
| Facility | Status | City | State | ZIP | Country | Contacts |
|---|---|---|---|---|---|---|
| University of Arizona | Tucson | Arizona | 85724 | United States | ||
| University of Arkansas for Medical Sciences (UAMS) |
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Serum, plasma, urine and stool samples will be collected.
| Anthropometric Measurements | Diagnostic Test | Skinfold will be assessed with calipers. Circumference will be measured with a tape measure. |
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| Hand-grip strength | Diagnostic Test | A small, handheld dynamometer will be used to measure grip strength, a measure of function, on each hand. |
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| Six-minute walk Test | Diagnostic Test | This will be another functional assessment of fitness. Participants will be asked to walk at their normal pace for 6 minutes.The total distance walked in that time will be measured. |
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| Sit-to-Stand Test | Diagnostic Test | This will be used as a functional assessment of fitness and lower extremity strength. Participants will start seated on a chair and be asked to complete as many sit-to-stand repetitions without using their arms for one minute. |
|
| Short physical performance battery (SPPB) | Diagnostic Test | This is an assessment of frailty. The test is completed in approximately 8 minutes. The test consists of 3 assessments: 1) Balance tests where the participant stands and tries to balance with their feet in various positions for 10 seconds each without assistance (side-by-side, heel-to-side, and heel-to-toe); 2) Two 4-meter gait speed tests; and 3) Chair-stand tests (single chair stand, 5 chair stands). |
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| BIA Sub-study | Diagnostic Test | A minimum of 50 individuals will be enrolled. Body composition will be assessed at each study visit using study bioelectrical impendence analysis (BIA). |
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| Accelerometry to assess physical activity | Diagnostic Test | Participants will be provided with a wrist-worn accelerometer/heart rate monitor at the baseline study visit and asked to wear it continuously for at least 3-10 days (two weekdays, one weekend day). Approximately every 3 months, the participant will be asked to again wear the accelerometer. Participants will be able to keep their accelerometers. |
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| Gastrointestinal (GI) and nutrition questionnaires: | Other | Subjects will complete surveys regarding gastrointestinal (GI) symptoms, including the Patient Assessment of Constipation (PAC-SYM) Score, Patient Assessment of Gastrointestinal Symptoms (PACGI-SYM) Score, the Bristol Stool Chart, and the scored Patient-Generated Subjective Global Assessment (PG-SGA). |
|
| Psychosocial questionnaire: PHQ-8 | Other | This is an 8-item scale that measures depressive symptoms over the past two weeks. |
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| Psychosocial questionnaire: GAD-7 | Other | This is a 7-items scale that measures anxiety symptoms over the past two weeks, from not at all to nearly every day. |
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| Psychosocial questionnaire: The Treatment Self-Regulation Questionnaire (TSRQ) | Other | This is a 15-item scale that assesses the degree to which participants' motivation is autonomous or self-regulated. |
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| Psychosocial questionnaire: CF Fatalism Scale | Other | The CF Fatalism Scale measures the belief in a lack of personal power or control over one's future and has 13 items. |
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| Psychosocial questionnaire: Body Esteem Scale for Adolescents and Adults (BESAA) | Other | The Body Esteem Scale for Adolescents and Adults (BESAA) is 23-item measurement of self-evaluations of one's body or appearance. |
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| 12-month Questionnaire | Other | A short questionnaire designed to explore participants' perspectives of the acceptability and feasibility of nutritional assessments used in STRONG-CF will be given to all study participants at the end of the study. |
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| Oral glucose tolerance testing (OGTT) | Other | For subjects without previously diagnosed CFRD, an OGTT will be performed at baseline and 12-months with samples analyzed at the central lab. |
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| Continuous glucose monitoring (CGM) | Device | Subjects will wear a Dexcom G6Pro sensor in blinded mode for three 10-day periods to collect comprehensive glucose data. |
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| Chest CT scans (When available within the past 6 months in medical records) | Diagnostic Test | Standard of Care chest CT images will be drawn from the medical record, as available, from enrolled participants. FEV1 measurements prior to chest CT scans will be recorded to account for possible illness occurring at the time of scanning. Quantitative assessment of the pectoralis muscle area will be performed on the first single axial image above the aortic arch. Any additional standard of care chest CT's that are performed while the participant is enrolled in the study will also be collected and have a quantitative assessment of the pectoralis muscle performed. |
|
| Hologic Dual X-Ray Absorptiometry (DXA) | Diagnostic Test | DXA measurements for whole body, total hip and lumbar spine will be acquired using the Hologic DXA and standard positioning as noted in the DXA Manual of Operations. DXA will be used to estimate total and regional body composition, which will include body fat and lean body mass. This will be used as the gold standard from which to validate BIA and MAMC. |
|
| Ultrasound Sub-study of assessment of appendage muscles using ultrasound | Diagnostic Test | A minimum of 50 individuals will be enrolled. At each study visit, participants will undergo ultrasound muscle measurements (cross-sectional area and muscle thickness) of the biceps and quadriceps on each (left and right) side of the body (4 total areas). These measurements will be obtained in triplicate for each patient. |
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| Psychosocial questionnaire: Hunger Vital Sign questionnaire | Diagnostic Test | Screening tool for identifying households at risk of food insecurity and poor health outcomes linked to food insecurity with 3-items over the last 12 months. |
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| Respiratory symptom questionnaire: CRISS | Other | Chronic Respiratory Infection Symptom Score (CRISS) is an 8-item respiratory symptom questionnaire covering the last 24-hours. |
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| Spirometry | Diagnostic Test | Spirometry will be performed in accordance with the current American Thoracic Society recommendations for the performance and interpretation of tests. |
|
| Psychosocial questionnaire: Additional Health Questionnaire | Other | Single question over the last 3 months/90 days about cannabis use for GI problems and appetite. The clinical sites will not see the responses to this question. It will be completed by the participant online either during the study visit or at home. |
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| CF Management Questionnaire | Other | Assessment of prior 12-month management of cystic fibrosis, including treatments, medication intake and hospitalizations. This questionnaire will only be completed at 24- and 36- month visits. |
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| Food Frequency Questionnaire | Other | Assessment of prior 12-month nutritional intake being completed at Baseline (no later than 6-month visit) and 12-month visit. |
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Characterize lean mass index from BMI cross-sectionally (at enrollment) and longitudinally (post-enrollment changes) based on descriptive statistics and evaluate variance |
| Baseline and 1 year |
| Characterize mid-arm measurement circumference cross-sectionally and longitudinally | Characterize lean mass index from mid-arm circumference measurements cross-sectionally (at enrollment) and longitudinally (post-enrollment changes) based on descriptive statistics and evaluate variance | Baseline and 1 year |
| Characterize hand-grip strength cross-sectionally and longitudinally | Characterize hand-grip strength cross-sectionally (at enrollment) and longitudinally (post-enrollment changes) based on descriptive statistics and evaluate variance | Baseline and 1 year |
| Characterize 1 minute sit-to-stand repetitions cross-sectionally and longitudinally | Characterize the 1 minute sit-to-stand repetitions cross-sectionally (at enrollment) and longitudinally (post-enrollment changes) based on descriptive statistics and evaluate variance | Baseline and 1 year |
| Characterize mid-arm 6-minute walk test distance traveled cross-sectionally and longitudinally | Characterize the 6-minute walk test distance traveled cross-sectionally (at enrollment) and longitudinally (post-enrollment changes) based on descriptive statistics and evaluate variance | Baseline and 1 year |
| Characterize the Short Physical Performance Battery frailty score cross-sectionally and longitudinally | Characterize the Short Physical Performance Battery frailty score cross-sectionally (at enrollment) and longitudinally (post-enrollment changes) based on descriptive statistics and evaluate variance | Baseline and 1 year |
| Compare lean mass index from DXA between participants with FEV1 <70% to matched participants with FEV1 ≥70% | Compare lean mass index from DXA between participants with FEV1 <70% to matched participants with FEV1 ≥70%. | Baseline and 1 year |
| Compare BMI between participants with FEV1 <70% to matched participants with FEV1 ≥70% | Compare BMI between participants with FEV1 <70% to matched participants with FEV1 ≥70%. | Baseline and 1 year |
| Compare lean mass index from mid-arm muscle circumference between participants with FEV1 <70% to matched participants with FEV1 ≥70% | Compare lean mass index from mid-arm muscle circumference between participants with FEV1 <70% to matched participants with FEV1 ≥70%. | Baseline and 1 year |
| Compare hand-grip strength between participants with FEV1 <70% to matched participants with FEV1 ≥70% | Compare hand-grip strength between participants with FEV1 <70% to matched participants with FEV1 ≥70%. | Baseline and 1 year |
| Compare the 1-minute sit-to-stand repetitions between participants with FEV1 <70% to matched participants with FEV1 ≥70% | Compare the 1-minute sit-to-stand repetitions between participants with FEV1 <70% to matched participants with FEV1 ≥70%. | Baseline and 1 year |
| Compare the 6-minute walk test distance between participants with FEV1 <70% to matched participants with FEV1 ≥70% | Compare the 6-minute walk test distance between participants with FEV1 <70% to matched participants with FEV1 ≥70%. | Baseline and 1 year |
| Compare the Short Physical Performance Battery frailty score between participants with FEV1 <70% to matched participants with FEV1 ≥70% | Compare the Short Physical Performance Battery frailty score between participants with FEV1 <70% to matched participants with FEV1 ≥70%. | Baseline and 1 year |
| Evaluate mean glucose in participants with FEV1 <70% and matched participants with FEV1 ≥70% | Evaluate mean glucose from continuous glucose measurement data in participants with FEV1 <70% and matched participants with FEV1 ≥70% | Baseline and 1 year |
| Evaluate % time above 140 mg/dL in participants with FEV1 <70% and matched participants with FEV1 ≥70% | Evaluate % time above 140 mg/dL from continuous glucose measurement data in participants with FEV1 <70% and matched participants with FEV1 ≥70% | Baseline and 1 year |
| Evaluate % time above 180 mg/dL in participants with FEV1 <70% and matched participants with FEV1 ≥70% | Evaluate % time above 180 mg/dL from continuous glucose measurement data in participants with FEV1 <70% and matched participants with FEV1 ≥70% | Baseline and 1 year |
| Evaluate peak glucose in participants with FEV1 <70% and matched participants with FEV1 ≥70% | Evaluate peak glucose from continuous glucose measurement data in participants with FEV1 <70% and matched participants with FEV1 ≥70% | Baseline and 1 year |
| Evaluate % time below 70 mg/dL in participants with FEV1 <70% and matched participants with FEV1 ≥70% | Evaluate % time below 70 mg/dL from continuous glucose measurement data in participants with FEV1 <70% and matched participants with FEV1 ≥70% | Baseline and 1 year |
| Evaluate % time below 54 mg/dL in participants with FEV1 <70% and matched participants with FEV1 ≥70% | Evaluate % time below 54 mg/dL from continuous glucose measurement data in participants with FEV1 <70% and matched participants with FEV1 ≥70% | Baseline and 1 year |
| Evaluate the standard deviation in CGM glucose data in participants with FEV1 <70% and matched participants with FEV1 ≥70% | Evaluate the standard deviation in CGM glucose data in participants with FEV1 <70% and matched participants with FEV1 ≥70% | Baseline and 1 year |
| Evaluate the coefficient of variation in CGM glucose data in participants with FEV1 <70% and matched participants with FEV1 ≥70% participants | Evaluate the coefficient of variation in CGM glucose data in participants with FEV1 <70% and matched participants with FEV1 ≥70% participants | Baseline and 1 year |
| Little Rock |
| Arkansas |
| 72205 |
| United States |
| Emory | Atlanta | Georgia | 30324 | United States |
| Northwestern University | Chicago | Illinois | 60611 | United States |
| University of Iowa | Iowa City | Iowa | 52242 | United States |
| University of Kentucky | Lexington | Kentucky | 40508 | United States |
| Tulane University | New Orleans | Louisiana | 70112 | United States |
| John Hopkins University | Baltimore | Maryland | 21287 | United States |
| Massachusetts General Hospital (MGH) | Boston | Massachusetts | 02114 | United States |
| Boston Children's Hospital and Brigham and Women's CF Center | Boston | Massachusetts | 02120 | United States |
| University of Minnesota | Minneapolis | Minnesota | 55455 | United States |
| Washington University School of Medicine (St. Louis) | St Louis | Missouri | 63110 | United States |
| Rutgers Health | New Brunswick | New Jersey | 08901 | United States |
| New York Medical College (NYMC) | Hawthorne | New York | 10532 | United States |
| Northwell LIJ Adult Cystic Fibrosis Center | New Hyde Park | New York | 11040 | United States |
| University of Cincinnati | Cincinnati | Ohio | 45220 | United States |
| University Hospitals | Cleveland | Ohio | 44106 | United States |
| University of Oklahoma Sciences Center | Oklahoma City | Oklahoma | 73104 | United States |
| Oregon Health and Science University | Portland | Oregon | 97239 | United States |
| University of Pittsburgh Medical Center | Pittsburgh | Pennsylvania | 15224 | United States |
| Medical University of South Carolina | Charleston | South Carolina | 29425 | United States |
| Baylor University | Houston | Texas | 77030 | United States |
| University of Virginia Cystic Fibrosis Center | Charlottesville | Virginia | 22908 | United States |
| ID | Term |
|---|---|
| D003550 | Cystic Fibrosis |
| ID | Term |
|---|---|
| D010182 | Pancreatic Diseases |
| D004066 | Digestive System Diseases |
| D008171 | Lung Diseases |
| D012140 | Respiratory Tract Diseases |
| D030342 | Genetic Diseases, Inborn |
| D009358 | Congenital, Hereditary, and Neonatal Diseases and Abnormalities |
| D007232 | Infant, Newborn, Diseases |
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| ID | Term |
|---|---|
| D015992 | Body Mass Index |
| D018737 | Hand Strength |
| D000070857 | Walk Test |
| D011795 | Surveys and Questionnaires |
| D000095583 | Continuous Glucose Monitoring |
| D013147 | Spirometry |
| ID | Term |
|---|---|
| D001837 | Body Weights and Measures |
| D001824 | Body Constitution |
| D010808 | Physical Examination |
| D019937 | Diagnostic Techniques and Procedures |
| D003933 | Diagnosis |
| D000886 | Anthropometry |
| D008919 | Investigative Techniques |
| D010829 | Physiological Phenomena |
| D001699 | Biometry |
| D015991 | Epidemiologic Measurements |
| D011634 | Public Health |
| D004778 | Environment and Public Health |
| D053580 | Muscle Strength |
| D009142 | Musculoskeletal Physiological Phenomena |
| D055687 | Musculoskeletal and Neural Physiological Phenomena |
| D005080 | Exercise Test |
| D006334 | Heart Function Tests |
| D003935 | Diagnostic Techniques, Cardiovascular |
| D003625 | Data Collection |
| D004812 | Epidemiologic Methods |
| D017531 | Health Care Evaluation Mechanisms |
| D011787 | Quality of Health Care |
| D017530 | Health Care Quality, Access, and Evaluation |
| D001774 | Blood Chemical Analysis |
| D019963 | Clinical Chemistry Tests |
| D019411 | Clinical Laboratory Techniques |
| D003940 | Diagnostic Techniques, Endocrine |
| D008991 | Monitoring, Physiologic |
| D012129 | Respiratory Function Tests |
| D003948 | Diagnostic Techniques, Respiratory System |
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