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Body composition in paediatric intestinal failure patients receiving long-term parenteral nutrition
Judith Pichler1, Sirinuch Chomtho, Mary Fewtrell
1Department of Paediatric and Adolescent Medicine, Medical University Vienna, , Vienna, Austria.
Insights
Children with intestinal failure (IF) on parenteral nutrition (PN) often have low lean mass and high fat mass. Monitoring body composition (BC) and adjusting PN can improve growth and long-term health outcomes.
Area of Science:
- Pediatric Gastroenterology
- Nutritional Science
- Body Composition Analysis
Background:
- Parenteral nutrition (PN) has improved outcomes for children with intestinal failure (IF).
- The impact of PN and IF on pediatric body composition (BC) remains largely uncharacterized.
- Understanding BC is crucial for optimizing growth and health in these vulnerable children.
Purpose of the Study:
- To review body composition (BC) in children treated with PN, including those weaned off.
- To compare the BC of PN-treated children with reference data.
- To identify factors influencing BC in children with IF.
Main Methods:
- Dual-energy X-ray absorptiometry (DXA) was used to measure regional fat mass (FM) and lean mass (LM).
- Children with intestinal enteropathy, short bowel syndrome (SBS), and intestinal dysmotility were included.
- Body composition indices were compared based on intestinal inflammation, steroid use, and PN dependency.
Main Results:
- Children were shorter and lighter but had a higher BMI SDS compared to reference data.
- Low limb lean mass index (LMI SDS) was observed across all groups.
- Children with short bowel syndrome (SBS) had low fat mass index (FMI SDS).
- Intestinal inflammation and total PN dependency were associated with higher BMI SDS and fat mass.
Conclusions:
- Children with IF on long-term PN exhibit altered body composition, notably low limb lean mass and, in some cases, high fat mass.
- Body composition monitoring and tailored PN adjustments are recommended for children with IF.
- Optimizing PN can support linear growth and improve long-term health in children with intestinal failure.
Objective:
Outcome of children with intestinal failure (IF) has improved on treatment with parenteral nutrition (PN). The effects of PN and IF on body composition (BC) are unknown. The aim was to review BC in PN-treated children and those weaned off and to compare with reference data.
Design:
Children on long-term/home PN underwent measurement of regional fat mass (FM) and lean mass (LM) using dual energy X-ray absorptiometry. Underlying diseases were intestinal enteropathy, n=15, short bowel syndrome (SBS), n=8 and intestinal dysmotility, n=11. PN duration was median 10 years. Fat Mass Index (FMI) and Lean Mass Index (LMI) were compared in children with and without intestinal inflammation, steroid treatment and according to PN dependency.
Results:
34 children aged 5-20 years were studied. They were short, mean height SD score (SDS) -1.8 (p<0.001) and light (mean weight SDS -0.86, p<0.001) with high body mass index (BMI) SDS: mean 0.4 (p=0.04) and low Limb LMI SDS -0.9 (p<0.001). Children with SBS had low FMI SDS -0.8 (p=0.01). BC did not significantly differ between diagnostic groups or with steroid treatment. Patients with intestinal inflammation (n=20) had higher BMI SDS than those without, p=0.007. Totally, PN-dependent children, n=11 had higher BMI SDS, p=0.004, total body FMI SDS, p=0.008 and trunk FMI SDS, p=0.001 compared with patients partially dependent and off PN.
Conclusions:
Significantly low limb LM was seen in all patient groups with high FM in children on total PN. Children with IF requiring PN treatment >27 days may benefit from BC monitoring and PN adjustment according to results in order to maximise linear growth and health in later life.
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