Impact of Individualized Diet Intervention on Body Composition and Respiratory Variables in Children With Respiratory Insufficiency

Abstract

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.

Update on pediatric gastroparesis: A review of the published literature and recommendations for future research

“…Critically ill patients may also be at risk for precipitating delayed gastric emptying, increasing the risk for respiratory decompensation such as aspiration, pneumonia, decreased efficacy of enteral medications, and unsuccessful enteral nutrition . Additionally, intracranial trauma can cause temporary gastroparesis .…”

“…Critically ill patients may also be at risk for precipitating delayed gastric emptying, increasing the risk for respiratory decompensation such as aspiration, pneumonia, decreased efficacy of enteral medications, and unsuccessful enteral nutrition. [30][31][32] Additionally, intracranial trauma can cause temporary gastroparesis. 32 Prematurity and acute respiratory distress in infants may also lead to delayed gastric emptying, thus prolonging the initiation of enteral feeds.…”

Body Composition in Children with Chronic Illness: Accuracy of Bedside Assessment Techniques

“…Accurate assessment of body composition is important in children with chronic illness, as it has been associated with poor clinical outcomes. 4, 5, 2728, 29 Characterization of weight as FFM and FM allows assessment of response to nutritional interventions aimed at decreasing FFM loss and improving clinical outcomes. 5, 6 …”

Measuring body composition in children: research and practice

“…In children with cerebral palsy, more severe impairments (Gross Motor Function Classification levels III–V) have been demonstrated to be associated with increased body fat and lower lean body mass. While the optimal body composition parameters for infants and children with specific disease states are unknown, targeting lean mass through dietary interventions has been demonstrated to improve short-term outcomes in other settings such as children dependent on long-term ventilation,32 and in adults, there is a strong inverse relationship between predicted lean body mass and mortality from respiratory disease 33…”