Multiple Micronutrient Deficiencies among Patients with Intestinal Failure during and after Transition to Enteral Nutrition

Abstract

Objective To determine the prevalence of specific micronutrient (iron, zinc, magnesium, phosphorus, selenium, copper, folate, vitamins A, D, E and B12) deficiencies in children with intestinal failure (IF), and identify risk factors associated with developing these deficiencies. Study design A retrospective review of prospectively collected data from 178 children with IF managed by the intestinal rehabilitation program at Cincinnati Children’s Hospital Medical Center, Ohio, USA between August1st 2007 and July 31st 2012. Transition to full enteral nutrition (FEN) was defined as the period during which the patient received between 20%–100% of estimated required nutrition enterally. FEN was defined as the patient tolerating all of the estimated required nutrition (100%) enterally for > 2 weeks. Results Necrotizing enterocolitis (NEC) was the most common cause of IF (27.5 %). Iron was the most common micronutrient deficiency identified during (83.9%) and after (61%) successful transition to FEN with significant reduction in the percentage of patients with iron deficiency between the two periods (P=0.003). Predictors of micronutrient deficiency after successful transition to FEN include birth weight (P=0.03), weight percentiles (P=0.02), height percentiles (P=0.04) and PN duration (P=0.013). After multivariate adjustments, only PN duration remained statistically significant (P=0.03). Conclusions Micronutrient deficiencies persist in patients with IF during and after transition to enteral nutrition. These data support the need for routine monitoring and supplementation of these patients especially those on prolonged PN.

Selenium deficiency in children and adolescents nourished by parenteral nutrition and/or selenium-deficient enteral formula

“…Ubesie et al reported that among 178 children with intestinal failure, 14.3% exhibited selenium deficiency during the transitional period from PN to EN [6]. Kodama et al reported a literature of review of 21 patients with selenium deficiency caused by EDs or low residue diets in Japan (Table 6) [9].…”

“…Some nutritional products such as EDs, protein-hydrolysed formulae and liquid EN products available in Japan lack selenium or contain reduced doses (Table 7). Therefore, we need to be cautious about selenium depletion in patients [6]. Bates et al described the mean and 2.5 percentile of plasma selenium concentration in a representative sample of British children aged 4-18 years as 0.87 mol/L (6.87 g/dL) and 0.61 mol/L (4.82 g/dL), respectively [7].…”

“…were analyzed. Based on previous reports, we determined 4.0 g/dL as the lower cut-off limit of serum selenium in this study [6][7][8].…”

Half-elemental Nutrition Mixtures for Enteral Nutrition of Children in Critical Conditions: Features of Usage and Economic Efficiency

“…Кишечная недостаточность при энтеропатиях Кишечная недостаточность при энтеропатиях различ-ного генеза приводит к мальабсорбции как макро-, так и микроэлементов (Fe, Zn, Cu, Mg, Se, фосфора, фолиевой кислоты, Ca, витаминов A, Е, D, а также группы В) со слож-ными механизмами нарушения всасывания каждого из них [20,[26][27][28][29][30].…”

“…Дефицит цинка при энтеропатиях часто сопрово-ждается задержкой роста и иммунными изменениями Дефицит витамина В проявляется неврологическими расстройствами. Энтеральное питание, обогащенное по-вышенными дозами микронутриентов и витаминов, улуч-шает нутритивный статус детей с синдромом кишечной недостаточности [30,31].…”