Related Experiment Videos
Nutrition and growth in relation to severity of renal disease in children
L J Norman1, J E Coleman, I A Macdonald
1Department of Nutrition and Dietetics, Nottingham City Hospital, NHS Trust, Hucknall Road, Nottingham, NG5 1PB, UK. lnorman@ncht.org.uk
Insights
Children with chronic renal insufficiency (CRI) show early declines in nutritional status and growth. Joint medical and dietetic interventions are crucial for managing these nutritional disturbances in pediatric CRI patients.
Area of Science:
- Pediatric Nephrology
- Clinical Nutrition
- Growth and Development
Background:
- Chronic renal insufficiency (CRI) in children significantly impacts nutritional status and growth.
- Early identification and management of nutritional deficits are essential for improving outcomes in pediatric patients with CRI.
Purpose of the Study:
- To compare nutritional status and growth in children with varying degrees of CRI.
- To establish the need for integrated medical and dietetic guidelines in pediatric CRI management.
Main Methods:
- Cross-sectional study involving 95 children (>2 years) with CRI, categorized by glomerular filtration rate (GFR).
- Assessment included anthropometry (weight, height, BMI), laboratory tests, and 3-day dietary records.
- Nutritional intake was compared against the Estimated Average Requirement (EAR).
Main Results:
- Anthropometric indices (weight, height, BMI) significantly deteriorated with worsening GFR.
- Total energy intake decreased as renal function declined, particularly in severe CRI.
- Elevated serum parathyroid hormone (PTH) and phosphate levels were observed in moderate to severe CRI.
Conclusions:
- Nutritional disturbances, bone biochemistry abnormalities, and impaired growth are evident early in pediatric CRI.
- Joint medical and dietetic interventions are recommended for children with mild, moderate, and severe CRI.
Abstract:
Practical joint medical/dietetic guidelines are required for children with chronic renal insufficiency (CRI). Nutritional status and growth were compared in 95 children (59 male) > 2 years age with CRI, grouped following [51Cr]-labelled EDTA glomerular filtration rate (GFR, ml/min/1.73 m2) estimations into 'normal' kidney function [GFR > 75 (mean 104 (SD 18.9), n = 35], mild (GFR 51-75, n = 23), moderate (GFR 25-50, n = 19) and severe CRI (GFR < 25, n = 18). Anthropometry [weight (wt.), height (ht.), and body mass index (BMI)], laboratory investigations and a 3-day dietary record were obtained. All anthropometric indices deteriorated with worsening renal function, from mean SD scores for wt., ht. and BMI in 'normal' children of 0.32 (SD 1.2), 0.4 (SD 1.0) and 0.1 (SD 1.3), respectively, to values of -1.28 (SD 1.1; P < 0.001), -1.52 (SD 1.1; P < 0.001) and -0.42 (SD 1.1; NS) in severe CRI. Mean total energy intake decreased from 103% (SD 17) estimated average requirement (EAR) in 'normal' children to 85% EAR (SD 27; P = 0.004) in severe CRI. Mean serum PTH concentrations (normal laboratory range 12-72 ng/l) were higher in moderate [67 ng/l (SD 58), P < 0.001] and severe CRI [164 ng/l (SD 164), P < 0.001] and mean serum phosphate concentrations were higher in severe CRI (1.54 mmol/l (SD 0.17), P = 0.009) compared to 'normal'. Disturbances in nutritional intakes, bone biochemistry and growth occur early in CRI and suggest the need for joint medical/dietetic intervention in children with mild and moderate CRI, in addition to those with more severe CRI.