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Pulmonary function and nutritional morbidity in children and adolescents with congenital diaphragmatic hernia
Beth Haliburton1, Marialena Mouzaki2, Monping Chiang1
1Department of Surgery, Division of Pediatric General and Thoracic Surgery, The Hospital for Sick Children, 555 University Ave, M5G 1X8, Toronto, ON, Canada.
Insights
Malnutrition is common in congenital diaphragmatic hernia (CDH) survivors. This study found a correlation between body mass index (BMI) and lung function in CDH patients, but not with resting energy expenditure.
Area of Science:
- Pediatric Surgery
- Pulmonology
- Nutritional Science
Background:
- Congenital diaphragmatic hernia (CDH) survivors often experience malnutrition, potentially due to increased respiratory effort.
- Evaluating nutritional status and pulmonary function is crucial for managing CDH patients.
Purpose of the Study:
- To investigate the correlation between body mass index (BMI), measured resting energy expenditure (mREE), and pulmonary function test (PFT) results in children and adolescents with CDH.
Main Methods:
- Anthropometrics, indirect calorimetry (IC) for mREE, and PFTs were collected from 33 CDH patients aged 5-17 years.
- Malnutrition defined as BMI z-scores <-2.0; PFT z-scores for FEV1 and FVC were assessed.
- Statistical analysis was performed using GraphPad Prism 6.
Main Results:
- 24% of CDH patients were malnourished (BMI z-score <-2.0).
- Mean FEV1 and FEV1/FVC ratio z-scores were below normal, indicating impaired lung function.
- Significant correlations were found between BMI and PFTs (FEV1 r=0.70, FVC r=0.74), but not between IC results and PFTs.
Conclusions:
- A correlation exists between BMI and lung function in pediatric CDH survivors.
- Lung function in CDH patients does not appear to correlate with measured resting energy expenditure.
Background:
Malnutrition is common among congenital diaphragmatic hernia (CDH) survivors and may result from elevated respiratory effort. We evaluated body mass index (BMI), measured resting energy expenditure (mREE) and pulmonary function test (PFT) results in children and adolescents with CDH to determine if there is a correlation.
Methods:
With ethics approval (REB# 1000035323), anthropometrics, indirect calorimetry (IC) results and PFTs were collected from patients 5-17years of age during CDH clinic visits between 2000 and 2016. Malnutrition was defined as BMI z-scores <-2.0; mREE (as percent predicted REE) was measured using IC; z-scores for forced expiratory volume in 1s (FEV1) and forced vital capacity (FVC) were normal if <-1.64.
Statistics:
GraphPad Prism 6, San Diego, CA.
Results & Discussion:
Of 118 patients who attended clinic, 33 had reproducible PFTs, anthropometrics and IC results. Mean BMI z-score was -0.89±1.47 and 24% of patients were malnourished; mean FVC z-score (-1.32±1.39) was within normal range, whereas mean z-scores for FEV1 (-2.21±1.68) and FEV1/FVC ratio (-1.78±0.73) were below normal. A correlation was noted between BMI and PFTs (FEV1 r=0.70, P<0.0001; FVC r=0.74 P<0.0001). Mean mREE was 112%±12% of expected and 67% of patients were hypermetabolic (mREE<110% predicted). IC results did not correlate with z-scores for either FEV1 (r=0.10, P=0.57); or FVC (r=0.28, P=0.12).
Conclusions:
These preliminary results suggest that a correlation is present between BMI and lung function in CDH children and adolescents, whereas lung function does not seem to correlate with mREE.
Level Of Evidence:
II.
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