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Published on: March 14, 2017
Energy expenditure and intake in children with sickle cell disease during acute illness
E B Fung1, B M Malinauskas, D A Kawchak
1Department of Pediatrics, University of Pennsylvania School of Medicine and Divisions of Gastroenterology & Nutrition and Hematology, Children's Hospital of Philadelphia, PA 19104, USA.
Insights
Children with sickle cell disease experience an energy deficit due to poor food intake, not increased energy expenditure. Nutrition support is crucial during illness and recovery.
Area of Science:
- Pediatric Hematology
- Nutritional Science
- Clinical Research
Background:
- Sickle cell disease (SCD) in children often involves pain and infections, potentially leading to negative energy balance.
- Understanding energy dynamics is critical for managing growth and health in pediatric SCD patients.
Purpose of the Study:
- To investigate energy expenditure and intake in children with sickle cell disease-SS genotype during acute illness and recovery.
- To determine if increased energy expenditure or decreased energy intake contributes to nutritional deficits in pediatric SCD.
Main Methods:
- Two groups of African-American children (younger <6 years, older >=6 years) with SCD-SS were studied during hospitalization and at one-month follow-up.
- Body composition, dietary intake, and energy expenditure (via indirect calorimetry) were assessed in both groups.
Main Results:
- Energy expenditure did not significantly differ between admission and follow-up, even after adjusting for covariates.
- Energy intake was significantly lower at admission compared to the follow-up period in both age groups.
- No significant excess energy expenditure was found in children with sickle cell disease during acute illness.
Conclusions:
- Children with sickle cell disease do not exhibit increased energy expenditure during acute illness but face an energy deficit primarily due to reduced caloric intake.
- These findings highlight the need for targeted nutrition care protocols to ensure adequate energy intake during hospitalization and recovery for pediatric SCD patients.
- The study supports the development of nutritional interventions to mitigate energy deficits in children with sickle cell disease.
Background:
Children with sickle cell disease have frequent bouts of pain and infection which may increase energy expenditure, decrease energy intake and lead to a subsequent energy deficit.
Methods:
Two groups of African-American children with sickle cell disease-SS genotype were enrolled in this study upon hospital admission for a sickle cell disease related illness: a younger (<6 years, n=14, 7 M) and older group (> or =6 years, n=17, 8 M). Body composition and dietary intake were assessed, and sleeping (younger) or resting energy expenditure (older) were measured by indirect calorimetry at admission and one month later at steady state.
Results:
Energy expenditure was not different between the two timepoints for younger children, but was slightly elevated at steady state (+50 kcal/d, P=0.049) in the older group. After controlling for gender, changes in fat-free mass and dietary intake, the significance disappeared. Energy intake in both groups was significantly depressed at admission compared to follow-up (P<0.01).
Conclusions:
These children and adolescents did not expend excess energy during their acute illness, however, an energy deficit was observed secondary to poor energy intake. Since 20% of patients with sickle cell disease have multiple hospitalizations per year, these results provide justification for the development and evaluation of nutrition care protocols to maintain adequate caloric intake during hospitalization and recovery.
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