Professor of Nutritional Sciences and Pediatrics
Director, Dietetics Program
B.S. 1987, Taipei Medical College (Taiwan)
Ph.D. 1994, University of Wisconsin – Madison
M.S. 2002, University of Wisconsin – Madison (Biostatistics)
Understanding how nutrition affects the onset and progression of pediatric chronic diseases, including cystic fibrosis, asthma and obesity.
Cystic fibrosis (CF) is a genetic disease that affects more than 30,000 Americans. Malnutrition and lung disease reduce survival of cystic fibrosis patients; 20% of deaths occur before 20 years of age and half die before mid 30’s. CF is caused by mutations in the cystic fibrosis transmembrane regulator (CFTR) gene, resulting in defective chloride transport and production of viscid secretions of low water content in exocrine glands. Major clinical manisfestions of CF include malnutrition, growth faltering, nutrient deficiencies, airway obstruction and recurrent respiratory infections, leading to pulmonary failure.
The ultimate goal of my CF research is to develop evidence-based clinical practice guidelines for improving the quality of screening, diagnosis, care and outcomes of patients with CF. This goal is being achieved through conducting epidemiological and clinical studies. Current areas of research include: 1) validation of malnutrition indicators and development of risk models predictive of CF genotype, phenotype and clinical outcomes, 2) evaluation of the effectiveness of the Wisconsin Statewide CF Newborn Screening Program, and 3) investigation of the potential benefits and risks of breastfeeding on clinical outcomes of infants with CF. Addressing the breastfeeding question is particularly urgent as the entire US implemented newborn screening for CF in 2010, however, optimal feeding for infants with CF is unclear. A prospective multi-center observational study, Feeding Infants Right… from the STart (FIRST), was initiated in 2012 to answer this question. For more information about the FIRST study, see our page or that of UW Health.
Diet as a risk factor for asthma was first hypothesized in1980s based on two observations: 1) the rising prevalence of asthma coincided with a change in typical American diets characteristic of decreased consumption of fruits/vegetables and increased intake of high-calorie, high-fat foods, and 2) asthma is more common in obese individuals, and vice versa. Our Diet-Asthma-Obesity Study was initiated in 2004 to examine the temporal relationships among diet, asthma and obesity during the first decade of life. This study utilizes the COAST cohort, a prospective birth cohort established in Wisconsin in 1998 to identify the origins of childhood. Current studies include: 1) validation of dietary assessment instruments for children age 5-7 years, 2) identification of early life predictors of obesity and asthma.
1. Lai HC, FitzSimmons SC, Allen DB, Kosorok MR, Rosenstein BJ, Campbell P and Farrell PM. Persistent growth impairment in children with cystic fibrosis following treatment of alternate-day prednisone. New Engl J Med. 2000;342: 851-859.
2. Lai HJ, Cheng Y, Cho H, Kosorok MR, Farrell PM. Association between initial disease presentation, lung disease outcomes and survival in patients with cystic fibrosis. Am J Epidemiol 2004;159:537-546.
3. Shoff SM, Ahn H, Davis LA, Lai HJ. Temporal associations between energy intake, plasma linoleic acid and growth improvement in response to treatment initiation after diagnosis of cystic fibrosis. Pediatrics 2006;117:391-400.
4. Lai HJ and Shoff SM. Classification of malnutrition in cystic fibrosis: implications on evaluating and benchmarking clinical practices. Am J Clin Nutr 2008;88:161-166.
5. Lai HJ, Shoff SM, Farrell PM, and the Wisconsin CF Neonatal Screening Group. Recovery of birth weight z-score within two years of diagnosis is positively associated with pulmonary status at age six years in children with cystic fibrosis. Pediatrics 2009;123:714-722.
6. Yan J, Cheng Y, Fine JP, Lai HJ. Uncovering symptom progression history from disease registry data with application to young cystic fibrosis patients. Biometrics 2010;66:594-602.
7. Zhang Z, Lai HJ, Roberg KA, Gangnon RE, Evans MD, Anderson EL, Pappas TE, Dasilva DF, Tisler CJ, Salazar LP, Gern JE, Lemanske RF Jr. Early childhood weight status in relation to asthma development in high-risk children. J Allergy Clin Immunol 2010;126;1157-1162.
8. Jadin, S, Wu GS, Zhang Z, Shoff SM, Tippets BM, Farrell PM, Miller T, Rock MJ, Levy H, Lai HJ. Growth and pulmonary outcomes during the first two years of life of breastfed and formula-fed infants diagnosed through the Wisconsin routine cystic fibrosis newborn screening program. Am J Clin Nutr 2011; 93:1037-1047.