Body Composition Using Air Displacement Plethysmography in Children With Intestinal Failure Receiving Long‐Term Home Parenteral Nutrition

Abstract

Background Children with intestinal failure (IF) are at risk of growth failure, but little information about body composition is available. Our aim was to assess body composition using air displacement plethysmography (ADP) and relate it to clinical and growth parameters. Methods In this prospective descriptive observational 2‐center cohort study, children aged 2–18 years receiving home parenteral nutrition (PN) for ≥6 months underwent ADP measurement. Fat mass index (FMI) and fat‐free mass index (FFMI) standard deviation scores (SDSs) were calculated to normalize for small body size. Results Twenty‐one out of 22 children, median age 7.4 years, underwent successful ADP measurement after a median PN duration of 5.5 years. They were significantly lighter (median weight for age SDS −0.71, P = 0.004) and shorter (median height for age SDS −1.55, P < 0.001) than the normal population mean; 52% were growing below target height range. They had low FFMI (median SDS −1.53, P < 0.001) and high FMI (median SDS 0.80, P = 0.002). Weight for height and body mass index (BMI) were significantly associated with FFMI and BMI with FMI, but children with the same weight and height showed different body composition. In 13 patients with 1‐year follow‐up, growth and body composition did not change significantly. Conclusion Children with IF receiving long‐term PN show lower FFM and higher FM than healthy children. Additionally, children with similar routine growth parameters showed different body composition. Further studies should evaluate the effect of a patient‐tailored approach including physical activity and nutrition advice based on body composition.

The Role of a Nutrition Support Team in the Management of Intestinal Failure Patients

“…Next to weight and height, it is also recommended to assess and monitor body composition (with for example air-displacement plethysmography) and muscle function (with for example handgrip strength). In a recent study in pediatric IF patients receiving long-term PN, Neelis et al reported that these children had higher fat mass and lower fat-free mass (i.e., muscle, water, bone, and internal organs), compared with healthy peers [16]. In another study, involving adult IF patients, it was shown that 73% had sarcopenia (i.e., loss of muscle mass and function) [17].…”

“…This nutrition assessment should incorporate aspects influencing intake, absorption, and expenditure, such as sex and age, the anatomy of the intestine (i.e., remaining bowel length, enterostomies, presence of ileocecal valve), and weight, height, and body composition. For visual representation see Figure 1, a more detailed description of the individual components is provided in Table 2 [14][15][16][17][18][19][20][21][22][23][24][25]. The assessment should be repeated regularly to evaluate the effectiveness of a nutrition intervention and to prevent patients from becoming dehydrated and undernourished with associated electrolyte abnormalities and weight loss.…”

Glutathione Supplementation of Parenteral Nutrition Prevents Oxidative Stress and Sustains Protein Synthesis in Guinea Pig Model

“…Another possibility is that this lack of growth in PN animals could be explained, at least in part, by a partial inability to de novo synthesize proteins. Low glutathione levels in the blood of premature infants [9] and children with chronic PN [23], combined with data indicating a shorter height in children on chronic PN [23,27] support the hypothesis of a non-optimal availability of energy and/or cysteine leading to suboptimal protein synthesis. Energy is an important factor for this synthesis.…”

“…Since the affinity of cysteinyl-tRNA synthetase for cysteine (Km = 1–20 µM [24]) is about 30 times greater than that of γ-glutamylcysteine ligase (Km = 200–350 µM [25,26]), the first enzyme for the synthesis of GSH, cysteine in PN seems to be used preferably for protein synthesis, especially in growing individuals. However, unlike preterm newborns who receive short-term PN for a limited time, studies reported that infants receiving long-term parenteral nutrition had a lighter weight [27] and a smaller height [23,27] than the population of the same age. We hypothesize, that PN does not provide enough cysteine to support glutathione and protein synthesis.…”

Early weight gain trajectories and body composition in infancy in infants born very preterm

“…This validated method estimates fat mass as percentage of total body weight (%FM), absolute fat mass (FM) and lean mass (LM) by direct measurements of body volume and mass 29,30 . To correct body composition variables for small body size (such as expected in our study group), FM index (FMI; FM (kg) / length (m) 2 ) and LM index (LMI; lean mass (kg) / length (m) 2 ) were calculated by dividing the FM and LM by squared length 31 . Age and sex corrected Z‐scores for body composition parameters were calculated based on average values from a large group of term born infants measured at our research center within the same time period 32 .…”