{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,29]],"date-time":"2026-09-29T07:09:13Z","timestamp":1790665753369,"version":"4.1.0"},"reference-count":32,"publisher":"MDPI AG","issue":"2","license":[{"start":{"date-parts":[[2021,2,19]],"date-time":"2021-02-19T00:00:00Z","timestamp":1613692800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Nutrients"],"abstract":"<jats:p>Background: The use of oral nutritional supplements (ONS) is common practice in patients suffering from cystic fibrosis (CF). We aimed to describe the rate of ONS use to assess their contribution to dietary intake and to determine if they are associated with respiratory status, body composition, muscle strength, bone mineral density (BMD), bone remodeling biomarkers, and plasmatic levels of vitamins. Methods: Cross-sectional study. Patients were clinically stable adults recruited from the CF unit. A 4-day prospective dietary questionnaire was conducted; in addition to respiratory variables, body composition, and BMD (through densitometry, DXA), muscle strength (JAMAR dynamometer), fat-soluble vitamins, and bone remodeling biomarkers (vitamins A, D, and E; osteocalcin, OC; undercarboxylated osteocalcin, ucOC; degradation of the C-terminal telopeptides of type I collagen, CTX; and receptor activator of nuclear factor-kappaB ligand, RANKL) were also evaluated. Results: The study included 59 subjects with CF (57.6% female, mean age 29.3 \u00b1 9.4 years, and BMI 22.0 \u00b1 3.6 kg\/m2). In this study, 22% (13) patients were taking ONS and presented, compared with those not taking them, significantly more total and mild exacerbations and lower BMI; moreover, they showed a significantly higher total daily calorie intake in addition to a higher consumption of carbohydrates, proteins, and lipids per kg of body weight, omega-3 fatty acids, and vitamins A, D, and E. Vitamin E plasmatic levels were significantly higher in the group on ONS, as was the case with RANKL; finally, a lower rate of vitamin D deficiency was also found. Conclusions: ONS were used by patients with worse respiratory and nutritional statuses and their use was associated with a higher intake of macro- and micronutrients and with better plasmatic levels of fat-soluble vitamins.<\/jats:p>","DOI":"10.3390\/nu13020669","type":"journal-article","created":{"date-parts":[[2021,2,19]],"date-time":"2021-02-19T09:06:10Z","timestamp":1613725570000},"page":"669","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":18,"title":["Oral Nutritional Supplements in Adults with Cystic Fibrosis: Effects on Intake, Levels of Fat-Soluble Vitamins, and Bone Remodeling Biomarkers"],"prefix":"10.3390","volume":"13","author":[{"given":"Victoria","family":"Contreras-Bol\u00edvar","sequence":"first","affiliation":[{"name":"Servicio de Endocrinolog\u00eda y Nutrici\u00f3n, Hospital Regional Universitario de M\u00e1laga\/Universidad de M\u00e1laga, Instituto de Investigaci\u00f3n Biom\u00e9dica de M\u00e1laga (IBIMA), M\u00e1laga 29008, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Casilda","family":"Olveira","sequence":"additional","affiliation":[{"name":"Servicio de Neumolog\u00eda, Hospital Regional Universitario de M\u00e1laga\/Universidad de M\u00e1laga, Instituto de Investigaci\u00f3n Biom\u00e9dica de M\u00e1laga (IBIMA), M\u00e1laga 29008, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nuria","family":"Porras","sequence":"additional","affiliation":[{"name":"Servicio de Endocrinolog\u00eda y Nutrici\u00f3n, Hospital Regional Universitario de M\u00e1laga\/Universidad de M\u00e1laga, Instituto de Investigaci\u00f3n Biom\u00e9dica de M\u00e1laga (IBIMA), M\u00e1laga 29008, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jos\u00e9","family":"Abu\u00edn-Fern\u00e1ndez","sequence":"additional","affiliation":[{"name":"Servicio de Endocrinolog\u00eda y Nutrici\u00f3n, Hospital Regional Universitario de M\u00e1laga\/Universidad de M\u00e1laga, Instituto de Investigaci\u00f3n Biom\u00e9dica de M\u00e1laga (IBIMA), M\u00e1laga 29008, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mar\u00eda","family":"Garc\u00eda-Olivares","sequence":"additional","affiliation":[{"name":"Servicio de Endocrinolog\u00eda y Nutrici\u00f3n, Hospital Regional Universitario de M\u00e1laga\/Universidad de M\u00e1laga, Instituto de Investigaci\u00f3n Biom\u00e9dica de M\u00e1laga (IBIMA), M\u00e1laga 29008, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0739-2567","authenticated-orcid":false,"given":"Francisco","family":"S\u00e1nchez-Torralvo","sequence":"additional","affiliation":[{"name":"Servicio de Endocrinolog\u00eda y Nutrici\u00f3n, Hospital Regional Universitario de M\u00e1laga\/Universidad de M\u00e1laga, Instituto de Investigaci\u00f3n Biom\u00e9dica de M\u00e1laga (IBIMA), M\u00e1laga 29008, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9997-5048","authenticated-orcid":false,"given":"Mar\u00eda","family":"Gir\u00f3n","sequence":"additional","affiliation":[{"name":"Servicio de Neumolog\u00eda, Hospital Regional Universitario de M\u00e1laga\/Universidad de M\u00e1laga, Instituto de Investigaci\u00f3n Biom\u00e9dica de M\u00e1laga (IBIMA), M\u00e1laga 29008, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4548-2587","authenticated-orcid":false,"given":"Ignacio","family":"Ruiz-Garc\u00eda","sequence":"additional","affiliation":[{"name":"Servicio de Endocrinolog\u00eda y Nutrici\u00f3n, Hospital Regional Universitario de M\u00e1laga\/Universidad de M\u00e1laga, Instituto de Investigaci\u00f3n Biom\u00e9dica de M\u00e1laga (IBIMA), M\u00e1laga 29008, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7646-2899","authenticated-orcid":false,"given":"Gabriel","family":"Olveira","sequence":"additional","affiliation":[{"name":"Servicio de Endocrinolog\u00eda y Nutrici\u00f3n, Hospital Regional Universitario de M\u00e1laga\/Universidad de M\u00e1laga, Instituto de Investigaci\u00f3n Biom\u00e9dica de M\u00e1laga (IBIMA), M\u00e1laga 29008, Spain"},{"name":"Centro de Investigaci\u00f3n Biom\u00e9dica en Red-Diabetes y Enfermedades Metab\u00f3licas asociadas (CIBERDEM), Barcelona 08036, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2021,2,19]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"2519","DOI":"10.1016\/S0140-6736(16)00576-6","article-title":"Cystic fibrosis","volume":"388","author":"Elborn","year":"2016","journal-title":"Lancet"},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"676","DOI":"10.1177\/0884533613507086","article-title":"Malnutrition in cystic fibrosis: A review","volume":"28","author":"Culhane","year":"2013","journal-title":"Nutr. Clin. Pract."},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"153","DOI":"10.1016\/j.jcf.2018.02.006","article-title":"ECFS best practice guidelines: The 2018 revision","volume":"17","author":"Castellani","year":"2018","journal-title":"J. Cyst. Fibros."},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"557","DOI":"10.1016\/j.clnu.2016.03.004","article-title":"ESPEN-ESPGHAN-ECFS guidelines on nutrition care for infants, children, and adults with cystic fibrosis","volume":"3","author":"Turck","year":"2016","journal-title":"Clin. Nutr."},{"key":"ref_5","first-page":"71","article-title":"Nutrition, cystic fibrosis and the digestive tract","volume":"23","author":"Olveira","year":"2008","journal-title":"Nutr. Hosp."},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"715","DOI":"10.1002\/ncp.10251","article-title":"Association between Fat-Free Mass and Pulmonary Function in Patients with Cystic Fibrosis: A Narrative Review","volume":"34","author":"Gomes","year":"2019","journal-title":"Nutr. Clin. Pract."},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"73","DOI":"10.1016\/j.nut.2017.10.026","article-title":"Association between body composition and pulmonary function in children and","volume":"48","author":"Calella","year":"2018","journal-title":"Nutrition"},{"key":"ref_8","first-page":"CD000406","article-title":"Oral calorie supplements for cystic fibrosis","volume":"5","author":"Smyth","year":"2017","journal-title":"Cochrane Database Syst. Rev."},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"528","DOI":"10.1016\/j.clnu.2013.07.011","article-title":"Dietary intake in children and adolescents with cystic fibrosis","volume":"33","author":"Woestenenk","year":"2014","journal-title":"Clin. Nutr."},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"335","DOI":"10.1016\/j.clnu.2015.03.001","article-title":"Diagnostic criteria for malnutrition\u2014An ESPEN Consensus Statement","volume":"34","author":"Cederholm","year":"2015","journal-title":"Clin. Nutr."},{"key":"ref_11","first-page":"98","article-title":"Normative reference values for hand grip dynamometry in Spain. Association with lean mass","volume":"35","author":"Torralvo","year":"2018","journal-title":"Nutr. Hosp."},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"1704","DOI":"10.1016\/j.jada.2009.07.012","article-title":"Markers for the validation of reported dietary intake in adults with cystic fibrosis","volume":"109","author":"Olveira","year":"2009","journal-title":"J. Am. Diet. Assoc."},{"key":"ref_13","unstructured":"Jimenez, A. (2002). Tablas de Composici\u00f3n de Alimentos, Barcelona Novartis Consum Heal SA."},{"key":"ref_14","unstructured":"Mataix, J. (2003). Tablas de Composici\u00f3n de Alimentos Espa\u00f1oles, Granada Univ Granada."},{"key":"ref_15","unstructured":"(2021, January 02). Spanish Food Composition Database. Available online: https:\/\/www.bedca.net\/bdpub\/."},{"key":"ref_16","first-page":"245","article-title":"Fat, protein and caloric content of different fish, seafood and mollusks, Atlantic and Mediterranean habitually consumed in the south of Spain","volume":"11","author":"Soriguer","year":"1996","journal-title":"Nutr. Hosp."},{"key":"ref_17","unstructured":"U.S. Department of Agriculture, Agricultural Research Service (2020, November 22). FoodData Central, Available online: https:\/\/fdc.nal.usda.gov\/download-datasets.html."},{"key":"ref_18","first-page":"316","article-title":"SEPAR (Spanish Society of Pneumology and Thoracic Surgery) Guidelines. Guideline for diagnosis and treatment of respiratory involvements in cystic fibrosis","volume":"37","author":"Baranda","year":"2001","journal-title":"Arch. Bronconeumol."},{"key":"ref_19","first-page":"217","article-title":"Spirometric reference values from a Mediterranean population","volume":"22","author":"Roca","year":"1986","journal-title":"Bull. Eur. Physiopathol. Respir."},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"212","DOI":"10.1016\/j.jcf.2013.08.009","article-title":"Effects of nutritional status and dietetic interventions on survival in Cystic Fibrosis patients before and after lung transplantation","volume":"13","author":"Hollander","year":"2014","journal-title":"J. Cyst. Fibros."},{"key":"ref_21","first-page":"19","article-title":"Actualizaci\u00f3n en nutrici\u00f3n en la fibrosis quistica","volume":"1","author":"Olveira","year":"2019","journal-title":"Nutr. Clin. Med."},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"95","DOI":"10.1046\/j.1365-277X.1998.00091.x","article-title":"Oral nutritional supplements promote significant weight gain in cystic fibrosis patients","volume":"11","author":"Skypala","year":"2008","journal-title":"J. Hum. Nutr. Diet."},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"632","DOI":"10.1136\/bmj.38737.600880.AE","article-title":"Oral protein energy supplements for children with cystic fibrosis: CALICO multicentre randomised controlled trial","volume":"332","author":"Poustie","year":"2006","journal-title":"Bmj"},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"618","DOI":"10.1136\/bmj.332.7542.618","article-title":"Nutritional supplements in cystic fibrosis","volume":"332","author":"Kappler","year":"2006","journal-title":"Bmj."},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"562","DOI":"10.2146\/ajhp070447","article-title":"Dietary supplement use in pediatric patients with cystic fibrosis","volume":"65","author":"Murray","year":"2008","journal-title":"Am. J. Health Pharm."},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"39","DOI":"10.1016\/j.genhosppsych.2016.02.002","article-title":"Depression and anxiety symptoms in Spanish adult patients with cystic fibrosis: Associations with health-related quality of life","volume":"40","author":"Olveira","year":"2016","journal-title":"Gen. Hosp. Psychiatry"},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"50","DOI":"10.1002\/path.4753","article-title":"Overexpression of RANKL in osteoblasts: A possible mechanism of susceptibility to bone disease in cystic fibrosis","volume":"240","author":"Delion","year":"2016","journal-title":"J. Pathol."},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"1232S","DOI":"10.1093\/ajcn\/81.5.1232","article-title":"Osteoporosis: The role of micronutrients","volume":"81","author":"Nieves","year":"2005","journal-title":"Am. J. Clin. Nutr."},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"3959","DOI":"10.1080\/10408398.2016.1211616","article-title":"Effect of vitamin K in bone metabolism and vascular calcification: A review of mechanisms of action and evidences","volume":"57","author":"Villa","year":"2017","journal-title":"Crit. Rev. Food Sci. Nutr."},{"key":"ref_30","first-page":"1028","article-title":"Phylloquinone (Vitamin K1): Occurrence, Biosynthesis and Functions","volume":"17","author":"Basset","year":"2016","journal-title":"Mini Rev. Med. Chem."},{"key":"ref_31","first-page":"48","article-title":"Vitamin K in cystic fibrosis","volume":"97","author":"Conway","year":"2004","journal-title":"J. R. Soc. Med."},{"key":"ref_32","doi-asserted-by":"crossref","first-page":"1325","DOI":"10.1542\/peds.2004-1242","article-title":"Vitamin K status among children with cystic fibrosis and its relationship to bone mineral density and bone turnover","volume":"115","author":"Conway","year":"2005","journal-title":"Pediatrics"}],"container-title":["Nutrients"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2072-6643\/13\/2\/669\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,11]],"date-time":"2025-10-11T05:26:07Z","timestamp":1760160367000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2072-6643\/13\/2\/669"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2021,2,19]]},"references-count":32,"journal-issue":{"issue":"2","published-online":{"date-parts":[[2021,2]]}},"alternative-id":["nu13020669"],"URL":"https:\/\/doi.org\/10.3390\/nu13020669","relation":{},"ISSN":["2072-6643"],"issn-type":[{"value":"2072-6643","type":"electronic"}],"subject":[],"published":{"date-parts":[[2021,2,19]]}}}