Effect of Antioxidant Supplements on Oxidative Stress, Disease Severity and Bacterial Infection in Cystic Fibrosis Children

Background: Cystic fibrosis (CF) is a multisystem disease, which is characterized by impaired secretion of the exocrine glands and affects many organs, especially the digestive and respiratory systems leading to the continuous development of respiratory infections, which are associated with poor clinical outcomes. Children with CF experience on-going oxidative stress and inflammation, which contribute to disease severity and worsening lung function. Antioxidant supplementation may enhance benefits in those patients by directly counteract-ing the process of oxidative stress. Aim of Study: The study evaluated the effect of antioxi-dants supplementation on the level of oxidative stress, as meas-ured by 3-Nitrotyrosine and its implications on bacterial colo-nization and disease severity among CF children. Patients and Methods: This randomized controlled clini-cal trial study was conducted at CF Clinic, Children’s Hospital, Ain Shams University after approval of Ethical Research Com-mittee at Ain Shams University Hospitals from March 2024 till September 2024. Sixty patients assigned randomly into 2 groups: Study group and control group. Patients in both groups received Mediterranean diet (MD) and the study group received antioxidant oral preparation in addition to MD for 6 months. All participants were subjected to the following initially and after 6 months of intervention: Medical history, clinical assessment stressing on clinical severity assessment using the CF-ABLE score, laboratory investigations (sputum culture and serum 3-nitrotyrosine level as a marker of oxidative stress) anddietary adherence was evaluated using 24-hour dietary recall and the KIDMED score. Results: The study group, who received MD and antioxi-dant supplementation, showed a significant reduction in 3-ni-trotyrosine levels compared to the control group (p-value = 0.003), indicating decreased oxidative stress. Surprisingly, CF-ABLE scores showed greater improvement in the control group (p=0.035) compared to the study group. Both groups exhibited similar trends in sputum culture results, indicating that addi-tional antioxidant supplementation did not provide significant added benefits in bacterial infection control. Conclusion: MD alone may provide significant benefits in reducing oxidative stress while also supporting better lung function and disease stabilityin children with CF. Nevertheless, further larger scale studies are recommended to highlight any additional benefits of antioxidant supplementation.