Normal anthropometry does not equal normal body composition in pediatric intestinal failure

Yanchis, Dianna; Belza, Christina; Harrison, Debra; Wong-Sterling, Sylvia; Kean, Penni; So, Stephanie; Patterson, Catherine; Wales, Paul W.; Avitzur, Yaron; Courtney‐Martin, Glenda

doi:10.1002/jpen.2265

Cited by 7 publications

(22 citation statements)

References 45 publications

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“…26 Children with intestinal failure receiving parenteral nutrition have been reported to have reduced physical activity 27,28 and lower lean mass despite similar body weight compared with their peers. 21,[28][29][30] Additional research in this area is needed to optimize the bone health of children with intestinal failure.…”

Section: Bmd Results By Age Group Are Shown In Tablementioning

confidence: 99%

“…Unfortunately, we did not have information on bone loading physical activity or lean body mass, both of which are positively associated with BMD in children 26 . Children with intestinal failure receiving parenteral nutrition have been reported to have reduced physical activity 27,28 and lower lean mass despite similar body weight compared with their peers 21,28–30 . Additional research in this area is needed to optimize the bone health of children with intestinal failure.…”

Section: Discussionmentioning

confidence: 99%

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Age‐related trajectory of bone density in children with intestinal failure: A longitudinal retrospective cohort study

Ali

Cole

Hornung

et al. 2023

J Parenter Enteral Nutr

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BackgroundLongitudinal changes in bone health in children with intestinal failure (IF) are unclear. We aimed to better understand the trajectory of bone mineral status over time in children with IF and identify clinical factors that influence the trajectory.MethodsClinical records of patients attending the Intestinal Rehabilitation Center of Cincinnati Children's Hospital Medical Center between 2012 and 2021 were reviewed. Children diagnosed with IF before age 3 years with at least two lumbar spine dual‐energy x‐ray absorptiometry scans were included. We abstracted information on medical history, parenteral nutrition, bone density, and growth. We calculated bone density z scores with and without adjustment for height z scores.ResultsThirty‐four children with IF met inclusion criteria. Children were shorter than average with a mean height z score of −1.5 ± 1.3. The mean bone density z score was −1.5 ± 1.3 with 25 of the cohort having a z score < −2.0. After height adjustment, the mean bone density z score was −0.42 ± 1.4 with 11% below −2.0. Most dual‐energy x‐ray absorptiometry scans (60%) had a feeding tube artifact. Bone density z scores increased slightly with age and lower parenteral nutrition dependency and were higher in scans without an artifact. Etiologies of IF, line infections, prematurity, and vitamin D status were not associated with height‐adjusted bone density z scores.ConclusionChildren with IF were shorter than expected for age. Deficits in bone mineral status were less common when adjusting for short stature. Etiologies of IF, prematurity, and vitamin D deficiency were not associated with bone density.

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Section: Bmd Results By Age Group Are Shown In Tablementioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Age‐related trajectory of bone density in children with intestinal failure: A longitudinal retrospective cohort study

Ali

Cole

Hornung

et al. 2023

J Parenter Enteral Nutr

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“…Despite normal anthropometry, body composition may be abnormal in SBS children (25). In infants with IF requiring PN after intestinal surgery, poor body weight gain was associated with poor fat mass gain, while fat free mass was adequate (26).…”

Section: Aim Of Treatmentmentioning

confidence: 99%

“…However, studies in older children have reported increased adiposity and reduced lean body mass SBS resulting in an apparently correct BMI in children with a higher fat mass (25,27,28). Dual X-ray absorptiometry (DXA), routinely used in SBS children since they are at risk of low mineral bone density (see below), may be an adequate method to assess body composition (25,29), however other routine methods avoiding X-ray radiation may be considered.…”

Section: Nutritional Statusmentioning

confidence: 99%

Nutrition and Intestinal Rehabilitation of Children With Short Bowel Syndrome: A Position Paper of the ESPGHAN Committee on Nutrition. Part 2: Long-Term Follow-Up on Home Parenteral Nutrition

Norsa,

Goulet,

Alberti

et al. 2023

Journal of Pediatric Gastroenterology &Amp; Nutrition

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Short bowel syndrome (SBS) is the leading cause of intestinal failure (IF) in children. The preferred treatment for IF is parenteral nutrition which may be required until adulthood. The aim of this position paper is to review the available evidence on managing SBS and to provide practical guidance to clinicians dealing with this condition. All members of the Nutrition Committee of the European Society for Paediatric Gastroenterology Hepatology and Nutrition (ESPGHAN) contributed to this position paper. Some renowned experts in the field joined the team to guide with their expertise. A systematic literature search was performed from 2005 to May 2021 using PubMed, MEDLINE, and Cochrane Database of Systematic Reviews. In the absence of evidence, recommendations reflect the expert opinion of the authors. Literature on SBS mainly consists of retrospective single-center experience, thus most of the current papers and recommendations are based on expert opinion. All recommendations were voted on by the expert panel and reached >90% agreement. This second part of the position paper is dedicated to the long-term management of children with SBS-IF. The paper mainly focuses on how to achieve intestinal rehabilitation, treatment of complications, and on possible surgical and medical management to increase intestinal absorption.

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“…Studies have shown that children with IF and dependence on PN may have abnormal body composition (BC) with lower levels of lean or fat-free mass (FFM) and higher levels of fat mass (FM) (7)(8)(9). In addition, they may be at risk for disease or nutrition-related sarcopenia, defined as reduced muscle strength accompanied by loss of skeletal muscle mass and/or and low physical performance (10).…”

mentioning

confidence: 99%

Muscle Strength, Agility, and Body Composition in Children With Intestinal Failure on Parenteral Nutrition

Patterson

Betts

et al. 2022

Journal of Pediatric Gastroenterology &Amp; Nutrition

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Objectives: With increasing number of children with intestinal failure (IF) on long-term parenteral nutrition (PN), this study assesses the impact of IF on muscle strength, speed, and agility and body composition (BC), identifying clinical factors that may predict impairment. Methods: Cross-sectional study in children 5-18 years with IF on PN. Assessments included Bruininks-Oseretsky Test of Motor Proficiency-2 strength and agility subtest (BOT-2), and grip strength. BC data from dualenergy x-ray absorptiometry (DXA) measurements and clinical variables were collected by chart abstraction. Data were compared to age and sex matched controls and population norms.Results: Twenty-one children with IF (14 males), median age 8.33 (IQR: 6.96-11.04) years and 33 controls (20 males), 8.25 (6.67-10.79) years were included. Strength and agility (P < 0.001) and grip strength (P = 0.001) differed between groups. Nine of 21 (43%) of children with IF scored >1 standard deviation (SD) below mean on BOT-2 and 13 of 21 (62%) had grip strength >1 SD below mean. DXA measurements showed 10 of 18 (56%) of children had lower fat-free mass (FFM)% and higher fat mass (FM)% than reference norms. Decreased FFM% was associated with lower BOT-2 scores (r = 0.479; P = 0.044) and grip strength scores >1 SD below mean (P = 0.047). Additional clinical factors significantly impacting strength and agility included prematurity, height, hospitalizations, sepsis, and small bowel length. Conclusions: Children with IF are at risk of decreased muscle strength and agility, along with altered BC. Ongoing medical, nutritional, and rehabilitation intervention is vital to optimize outcomes.

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Normal anthropometry does not equal normal body composition in pediatric intestinal failure

Cited by 7 publications

References 45 publications

Age‐related trajectory of bone density in children with intestinal failure: A longitudinal retrospective cohort study

Age‐related trajectory of bone density in children with intestinal failure: A longitudinal retrospective cohort study

Nutrition and Intestinal Rehabilitation of Children With Short Bowel Syndrome: A Position Paper of the ESPGHAN Committee on Nutrition. Part 2: Long-Term Follow-Up on Home Parenteral Nutrition

Muscle Strength, Agility, and Body Composition in Children With Intestinal Failure on Parenteral Nutrition

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