Objective
Diet modification may improve body composition and respiratory parameters in children with respiratory insufficiency. Our objective was to examine the effect of an individualized diet intervention on changes in weight, lean body mass (LBM), minute ventilation (MV) and carbon dioxide production (VCO2) in children on home mechanical ventilator support.
Design
Prospective, open-labeled interventional study.
Setting
Study subjects' homes
Patients
Children, ages 1 month to 17 years, dependent on at least 12 hours per day of transtracheal mechanical ventilator support.
Intervention
Twelve weeks of an individualized diet modified to deliver energy at 90-110% of measured energy expenditure (MEE) and protein intake per age-based guidelines.
Measurements & Main Results
During a multidisciplinary home visit we obtained baseline values of height and weight, LBM% by bioelectrical impedance analysis, actual energy and protein intake by food record, and MEE by indirect calorimetry. An individualized diet was then prescribed to optimize energy and protein intake. After 12 weeks on this interventional diet we evaluated changes in weight, height, LBM%, MV and VCO2. Sixteen subjects, mean age 9.3y (SD 4.9), 8 male, completed the study. For the diet intervention, a majority of subjects required a change in energy and protein prescription. The mean percentage of energy delivered as carbohydrate was significantly decreased, 51.7% at baseline vs. 48.2% at follow-up, p=0.009. Mean height and weight increased on the modified diet. Mean LBM% increased from 58.3% to 61.8%. MV was significantly lower (0.18 L/min/kg vs. 0.15 L/min/kg, p=0.04) and we observed a trend towards lower VCO2 (5.4 ml/min*kg vs. 5.3 ml/min*kg, p=0.06) after 12 weeks on the interventional diet.
Conclusions
Individualized diet modification is feasible and associated with a significant decrease in minute ventilation, a trend towards significant reduction in carbon dioxide production, and improved body composition in children on long-term mechanical ventilation. Optimization of respiratory parameters and LBM by diet modification may benefit children with respiratory insufficiency in the intensive care unit.