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Resting energy expenditure and nutritional status in children with juvenile rheumatoid arthritis
N Knops1, N Wulffraat, S Lodder
1Department of Gastroenterology, Het Wilhelmina Kinderziekenhuis University Hospital for Children and Youth, Utrecht, The Netherlands.
Insights
Children with systemic juvenile rheumatoid arthritis (JRA) experience stunting and low fat-free mass (FFM). Their resting energy expenditure (REE) is significantly increased, highlighting the need for FFM-corrected energy assessments in managing malnutrition.
Area of Science:
- Pediatric Rheumatology
- Nutritional Science
- Metabolic Research
Background:
- Undernutrition is a common issue in children diagnosed with juvenile rheumatoid arthritis (JRA).
- Assessing energy expenditure is crucial for understanding nutritional status in pediatric chronic inflammatory conditions.
Purpose of the Study:
- To evaluate resting energy expenditure (REE) in relation to nutritional status and body composition in children with JRA.
- To compare REE between different subtypes of JRA (oligoarticular, polyarticular, systemic) and healthy controls.
Main Methods:
- Indirect calorimetry was used to measure REE in 33 children with JRA and 17 age- and sex-matched controls.
- Nutritional status was assessed via height, weight, and fat-free mass (FFM).
Main Results:
- Systemic JRA patients exhibited diminished height and FFM compared to controls.
- While crude REE showed no significant differences, systemic JRA patients had significantly higher REE per kg body weight (18%) and per kg FFM (21%) after adjustments.
- Oligo- and polyarticular JRA patients showed non-significant increases in adjusted REE.
Conclusions:
- Systemic JRA is associated with stunting, reduced FFM, and elevated REE when adjusted for nutritional status.
- Individual energy requirements in systemic JRA patients necessitate correction for FFM to effectively treat malnutrition.
Objective:
Undernutrition is frequently encountered in children with juvenile rheumatoid arthritis (JRA). We assessed resting energy expenditure (REE) in relation to nutritional status and body composition in patients with JRA.
Methods:
We selected 33 children (age 6 to 18 yrs) with JRA (13 oligoarticular, 10 polyarticular, 10 systemic JRA) and 17 controls matched for age and sex. Nutritional status was assessed for height, weight, and fat-free mass (FFM), and REE was measured with indirect calorimetry.
Results:
Nutritional status in the patients with systemic JRA was diminished compared to the controls for height (140 vs. 159 cm; p<0.01) and FFM (28 vs. 38 kg; p = 0.03). Oligo and polyarticular patients with JRA had normal height and FFM. No significant differences existed in crude REE among the groups. However, after correcting REE for body weight and FFM, the patients with systemic JRA, compared to controls, had 18% higher REE per kg body weight (159 vs. 134 kJ/kg/day; p<0.01) and 21% higher REE per kg FFM (196 vs. 162 kJ/kg/day; p<0.01). Oligo and polyarticular JRA patients had 8% increased values for REE per kg body weight or FFM, but these differences were not statistically significant.
Conclusion:
Patients with systemic JRA show stunting, low FFM, and a significantly increased REE when nutritional status is taken into account. These data suggest that assessment of individual energy requirements should include correction for fat-free mass in the treatment of malnutrition in patients with systemic JRA.