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Published on: October 21, 2017
Nutritional evaluation of children with chronic cholestatic disease
Francislaine Veiga da Silva1, Priscila Menezes Ferri2, Thaís Costa Nascentes Queiroz3
1Group of Pediatric Hepatology and Gastroenterology, Hospital das Clínicas, Universidade Federal de Minas Gerais (UFMG), Belo Horizonte, MG, Brazil; Pediatric Gastroenterology Group, School of Medicine, Hospital das Clínicas, Universidade Federal de Minas Gerais (UFMG), Belo Horizonte, MG, Brazil.
Insights
Nutritional status in children with persistent cholestasis is best assessed using triceps skinfold thickness (TST), arm circumference (AC), and arm muscle circumference (AMC). These indices better reflect depletion than weight-for-age or body mass index (BMI) in liver disease.
Area of Science:
- Pediatrics
- Hepatology
- Nutritional Science
Background:
- Persistent cholestasis in children can lead to malnutrition.
- Accurate assessment of nutritional status is crucial for managing pediatric liver diseases.
Purpose of the Study:
- To evaluate the nutritional status of children with persistent cholestasis.
- To compare anthropometric indices in children with and without liver cirrhosis and jaundice.
Main Methods:
- Included children with persistent cholestasis (elevated direct bilirubin or GGT).
- Measured weight (W), height (H), arm circumference (AC), triceps skinfold thickness (TST), arm muscle circumference (AMC), and body mass index (BMI).
Main Results:
- 33% and 30.8% of children had low weight-for-age and height-for-age, respectively.
- Triceps skinfold thickness (TST) showed depletion in 64% of patients.
- Arm circumference (AC) and arm muscle circumference (AMC) indicated depletion in 43.8% and 71.1% of patients, respectively.
Conclusions:
- Weight-based indices may overestimate nutritional status in liver disease due to fluid retention.
- Triceps skinfold thickness (TST), arm circumference (AC), and arm muscle circumference (AMC) are superior indicators of nutritional depletion in cholestatic children.
- These specific anthropometric measures should be integrated into the routine management of pediatric liver diseases and cholestasis.
Objective:
To evaluate the nutritional status of children with persistent cholestasis and to compare the anthropometric indices between children with and without liver cirrhosis and children with and without jaundice.
Methods:
Children with persistent cholestasis, i.e. increased direct bilirrubin or changes in the canalicular enzyme gamma-glutamyl transferase (GGT), were included. The anthropometric measures were weight (W), height or length (H), arm circumference (AC), triceps skinfold thickness (TST), arm muscle circumference (AMC), and body mass index (BMI).
Results:
Ninety-one children with cholestasis, with current median age of 12 months, were evaluated. W/age (A) and H/A indices below -2 Z-scores were observed in 33% and 30.8% of patients, respectively. Concerning the W/H index and BMI, only 12% and 16% of patients, respectively, were below -2 Z-scores. Regarding AC, 43.8% of 89 evaluated patients had some depletion. Observing the TST, 64% of patients had depletion, and 71.1% of the 45 evaluated patients had some degree of depletion regarding the ACM index.
Conclusion:
Evaluation using weight in patients with chronic liver diseases may overestimate the nutritional status due to visceromegaly, subclinical edema, or ascites. Indices that correlate weight and height, such as W/H and BMI, may also not show depletion because of the chronic condition in which there are depletion of both weight and height. TST, AC, and ACM are parameters that better estimate nutritional status and should be part of the management of patients with liver diseases and cholestasis.
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