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Anthropometric evaluation of children with chronic liver disease
1Department of Pediatrics, University of Colorado School of Medicine, Denver 80262.
Insights
Malnutrition is common in children with chronic liver disease (CLD). Triceps skinfold thickness better reflects acute malnutrition than weight-for-height, which can be skewed by organomegaly.
Area of Science:
- Pediatrics
- Hepatology
- Nutritional Science
Background:
- Childhood chronic liver disease (CLD) is associated with significant health challenges.
- Malnutrition, encompassing both stunting and wasting, is a prevalent complication in pediatric CLD.
- Accurate assessment of nutritional status is crucial for managing these children.
Purpose of the Study:
- To define the types and age-specific patterns of malnutrition in children with CLD.
- To evaluate the efficacy of various anthropometric indices in identifying malnutrition in this population.
Main Methods:
- A cohort of 56 children (1 month to 10 years) with CLD underwent anthropometric assessments during clinical stability.
- Measurements included height, weight, weight-for-height, triceps skinfold (TSF) thickness, mid-arm circumference, mid-arm muscle area, and head circumference.
- Z scores were calculated for each parameter to compare with reference standards.
Main Results:
- Children with CLD commonly exhibit both chronic (stunting) and acute (wasting) malnutrition.
- Height-for-age Z scores were consistently depressed across different CLD types.
- Triceps skinfold thickness Z scores were significantly lower than weight-for-height Z scores, indicating underestimation of acute malnutrition by weight-for-height, likely due to organomegaly.
Conclusions:
- Malnutrition is a significant and common issue in children with chronic liver disease.
- Triceps skinfold thickness is a more sensitive indicator of acute malnutrition (wasting) than weight-for-height in children with CLD.
- Head circumference is a useful indicator of malnutrition in children under 24 months of age.
Abstract:
To characterize type and age distribution of malnutrition and to determine the usefulness of anthropometric indices in children with chronic liver disease (CLD), 56 children (aged 1 mo-10 y) with CLD underwent anthropometric evaluation when they were clinically stable. Mean-height Z score was depressed, whereas mean-weight Z score was closer to normal and mean-weight/height Z score was normal in patients with extrahepatic biliary atresia, idiopathic neonatal hepatitis, and other liver disorders. Patients with arteriohepatic dysplasia showed more severe depression of all three variables. In all patients, triceps skinfold (TSF) thickness Z scores were significantly more depressed than were weight/height Z scores. Depressions of midarm-circumference and midarm-muscle-area Z scores were intermediate. Mean-head-circumference Z score was depressed in children aged less than 24 mo. We conclude that acute (wasting) and chronic (stunting) malnutrition are common in childhood CLD and that weight/height values underestimate the degree of acute malnutrition compared with TSF thickness, most likely because of the inflated patient weight caused by organomegaly.