(237) The Impact of Ethnicity and Social Determinants of Health on Weight Gain in Adults with Cystic Fibrosis After 12 Months of Treatment with Elexacaftor-Tezacaftor-Ivacaftor
Assistant Professor University of Texas Health San Antonio, United States
Background: Exacaftor/tezacaftor/ivacaftor (ETI) therapy is associated with vast improvements in lung function and nutrition in cystic fibrosis (CF). Although, overnutrition is emerging as a concern, resulting in overweight/obesity. Hispanics are at greater risk of developing overweight/obesity and its related complications including high blood pressure and diabetes when compared to non-Hispanic whites (NHW). Social determinants of health (SDOH) also contribute to obesity-related disparities. We investigated the impact of ethnicity and SDOH on changes in body mass index (BMI) and obesity-related complications after initiation of ETI treatment in CF.
Methods: We performed a retrospective chart review of adult patients treated with ETI for at least 12 months at the University of Texas Health San Antonio CF Center. Self-reported ethnicity (Hispanic vs NHW) and SDOH including insurance, income, and education were extracted from the medical record. Genotype, pancreatic status (insufficient [PI] vs sufficient [PS]), diagnosis of CF-related diabetes and CF-liver disease, and family history of type 2 diabetes (famHxT2D) were also extracted. Changes in mean BMI, body weight (BW), systolic blood pressure (SBP), diastolic blood pressure (DBP), A1c, liver profile (AST, ALT, GGT), Vitamin D, and FEV1 were calculated as the difference between data obtained prior to (baseline) and at least 12 months post-initiation of ETI therapy. Data was analyzed using chi squared tests, paired t-tests, and independent t-tests. Data is presented as number (%) and mean ± SD.
Results: Of the 46 eligible patients, 21 (46%) were Hispanic and 25 (54%) were NHW. At baseline, Hispanic patients were more likely to have government insurance (52% vs 24%, p< 0.05), lower income ($63K±26.5K vs $86K±23K, p< 0.05), lower DBP (70±9 vs 75±21mmHg, p< 0.05), and higher GGT (35±36 vs 16±11U/L, p< 0.05). Overweight/obesity was present in 7 (33%) Hispanics and 8 (32%) NHW. In Hispanics, the mean change in BMI (+1.6±2.1kg/m2, p< 0.05), SBP (+8±14, p< 0.05), and FEV1 (+8.6±8.8%, p< 0.001) increased after ETI. Similarly, NHW experienced an increase in BMI (+1.4±1.9 kg/m2, p=0.001), SBP (+7±12.5mmHg, p< 0.05), DBP (+4.5±7.1mmHg, p< 0.05), and FEV1 (+7.6±7.3%, p< 0.001), but also experienced an increase in BW (+3.3±4.7kg, p< 0.05) and Vit D (+7.7±12.6ng/dL, p< 0.05). Additionally, the A1c (-0.2±0.5, p< 0.05) and ALT (-6±14, p< 0.05) decreased in NHW. The mean change for all variables were comparable among the 2 ethnicity groups except Vit D that worsened in Hispanics and improved in NHW (p< 0.05). Regardless of ethnicity, patients with famHxT2D experienced an increase in SBP (+10±11, p< 0.05) and DBP (+6±7, p< 0.05). No differences in mean changes of any variables were noted among SDOH groups. Overweight/obesity was appreciated in 10 (48%) Hispanics and 11 (44%) NHW at the end of the observational period.
Conclusions: In this single-center retrospective study, both Hispanics and NHW experienced increases in BMI and blood pressure after at least 12 months of treatment with ETI. Interestingly, patients with a famHxT2D also experienced increases in blood pressure. Larger prospective studies performed in ethnically diverse CF cohorts are necessary to monitor for development of obesity and its related complications. This research is imperative to guide nutritional recommendations for patients receiving ETI therapy.
Acknowledgements: This work was supported by the National Center for Advancing Translational Sciences, National Institute of Health (KL2 TR002646).
