Bone mineral density and vitamin D in paediatric intestinal failure patients receiving home parenteral nutrition

Abstract

Background & aims: Patients with intestinal failure (IF) are dependent on long-term home parenteral nutrition (HPN) to ensure growth and development. The primary aim of the present study was to assess bone mineral density (BMD) and vitamin D status in paediatric IF patients on HPN and a group of healthy children aged 2e18 years. Secondary aims were to assess growth, body composition, nutrient provision and physical activity. Methods: An observational cross-sectional study was performed at Oslo University Hospital and at the Department of Nutrition, University of Oslo, from January to September 2017. Dual energy x-ray absorptiometry (DXA; Lunar Prodigy in IF patients and Lunar iDXA in healthy subjects) was performed to assess BMD and body composition. BMD z-score (BMDz) was calculated for total body and lumbar spine L2-L4 based on the integrated reference population in the software. Weight and height were measured for growth assessment. Nutrient provision was assessed by a 4-day food record. Blood samples were analysed for 25-hydroxy-vitamin D (25(OH)D) and 1,25-dihydroxyvitamin D (1,25(OH) 2 D). Physical activity was reported by a questionnaire. Results: Nineteen IF patients and 50 healthy children were included. The mean age of participants was 10.0 years. The aetiology of IF patients was paediatric intestinal pseudo-obstruction (58%), short bowel syndrome (26%), and intestinal enteropathy (16%). Lower median BMDz for total body (À0.4 vs 1.1, P < 0.001) and lumbar spine L2-L4 (À0.9 vs 0.2, P ¼ 0.01) were found in the IF group compared with the healthy children. Vitamin D provision was significantly higher in IF patients (17 mg/d vs 5.3 mg/d, P < 0.001). Both groups were sufficient in 25(OH)D (IF patients 71 nmol/L vs healthy 81 nmol/L). Nevertheless, IF patients had significantly lower 1,25(OH) 2 D than healthy children (71 pmol/L vs 138 pmol/L, P < 0.001). The IF group was significantly shorter (height for age z-score À1,5 vs 0,1, P ¼ 0.001) and lighter (weight for age z-score À1,0 vs 0,1, P ¼ 0.009) compared with the healthy subjects.

Metabolic Bone Disease in Children with Intestinal Failure and Long-Term Parenteral Nutrition: A Systematic Review

“…One further article was included by reference snowballing. Twenty studies were included in the final review [ 16 , 17 , 18 , 19 , 20 , 21 , 22 , 23 , 24 , 25 , 26 , 27 , 28 , 29 , 30 , 31 , 32 , 33 , 34 ] ( Figure 1 ).…”

“…All studies were observational, and six included a control group (case-control studies) [ 18 , 19 , 20 , 24 , 25 , 34 ]. All except one were single-center studies: 7 from U.S. centers [ 16 , 18 , 19 , 22 , 26 , 27 , 28 ], 1 from Canada [ 25 ], and 11 from Europe [ 17 , 20 , 21 , 23 , 24 , 29 , 30 , 31 , 32 , 33 , 34 ], and 1 study reported data from 2 U.S. centers [ 24 ]. The 20 studies included patients from 15 different cohorts (6 studies from 3 cohorts [ 17 , 21 , 29 , 30 , 33 , 34 ]) and 3 studies from one cohort [ 19 , 22 , 24 ]).…”

“…All except one were single-center studies: 7 from U.S. centers [ 16 , 18 , 19 , 22 , 26 , 27 , 28 ], 1 from Canada [ 25 ], and 11 from Europe [ 17 , 20 , 21 , 23 , 24 , 29 , 30 , 31 , 32 , 33 , 34 ], and 1 study reported data from 2 U.S. centers [ 24 ]. The 20 studies included patients from 15 different cohorts (6 studies from 3 cohorts [ 17 , 21 , 29 , 30 , 33 , 34 ]) and 3 studies from one cohort [ 19 , 22 , 24 ]). Eight studies (40%) reported longitudinal data [ 16 , 17 , 20 , 24 , 26 , 28 , 29 , 30 ].…”

“…Case-control studies compared data from 77 IF children with 131 (age- and gender-matched) controls [ 18 , 19 , 20 , 24 , 25 , 34 ]. Sixteen studies reported data from children [ 16 , 17 , 18 , 19 , 20 , 23 , 24 , 25 , 28 , 29 , 30 , 31 , 32 , 33 , 34 ], and two studies included children and young adults [ 21 , 22 ], while two studies did not specify the age of participants [ 26 , 27 ] although it was clearly indicated that data were collected from children with IF.…”

“…There was considerable variation among definitions of intestinal failure and PN dependence, with minimum length of PN (to define the “IF condition”) ranging from 1 to 6 months. Eight studies exclusively included subjects on PN at the time of bone assessment [ 16 , 17 , 24 , 25 , 30 , 31 , 32 , 33 ], three studies focused on subjects after PN discontinuation (PN duration ranging from 1 to 78 months) [ 18 , 19 , 21 ], and nine studies included IF patients independently from being on PN [ 20 , 22 , 23 , 24 , 26 , 27 , 28 , 29 , 34 ]. In the eight studies reporting longitudinal data, median follow-up varied from 1 to 6.2 years [ 16 , 17 , 20 , 24 , 26 , 28 , 29 , 30 ].…”