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Micronutrients in paediatric Intestinal Failure Patients receiving home parenteral nutrition
Rut Anne Thomassen1, Janne Anita Kvammen1, Camilla Sæland2
1Oslo University Hospital, Department of Paediatric Medicine, Oslo, Norway.
Insights
Children with intestinal failure (IF) on home parenteral nutrition (HPN) show insufficient iodine and iron status. Their iodine levels were low despite high parenteral supply, suggesting current recommendations may be inadequate.
Area of Science:
- Pediatric Nutrition
- Clinical Micronutrient Research
- Gastroenterology
Background:
- Children with intestinal failure (IF) require parenteral nutrition (PN) for growth.
- Assessing micronutrient status in these children is crucial for optimal health outcomes.
- Home parenteral nutrition (HPN) is a common management strategy for pediatric IF.
Purpose of the Study:
- To evaluate the micronutrient status, specifically iodine and iron, in pediatric patients with IF receiving HPN.
- To compare the micronutrient status of IF patients with that of healthy children.
- To investigate potential correlations between nutrient intake and status in IF patients.
Main Methods:
- An observational, cross-sectional study involving 19 children with IF and 50 healthy controls.
- Dietary and parenteral intake were recorded; blood and urine samples were analyzed for vitamin, mineral, and hematological parameters.
- Iodine status was assessed via urinary iodine concentration (UIC), and iron status through hematological analysis.
Main Results:
- Paediatric IF patients exhibited insufficient iodine and iron status compared to healthy children.
- Median UIC in IF patients was 89 μg/L, indicating insufficient iodine status despite high parenteral iodine supply.
- The prevalence of anemia was significantly higher in IF patients (40%) than in controls (10%).
Conclusions:
- Pediatric IF patients on HPN demonstrate inadequate iodine and iron status.
- Current European Society for Paediatric Gastroenterology, Hepatology and Nutrition (ESPGHAN) recommendations for parenteral iodine may be insufficient.
- Micronutrient monitoring and potentially adjusted intake recommendations are vital for children with IF receiving PN.
Background & Aims:
Children with intestinal failure (IF) receive parental nutrition to ensure adequate growth and development. The aim of this study was to assess micronutrient status in paediatric IF patients receiving home parenteral nutrition (HPN) in comparison to a group of healthy children.
Methods:
An observational cross-sectional study was performed at Oslo University Hospital and at the Department of Nutrition, University of Oslo from January to September 2017. All children with IF, aged two to 18 years, were invited to participate. A reference group of healthy children was recruited through social media advertisement. Dietary intake was assessed by a four-day food record, and enteral and parenteral provision was recorded. Blood samples were analysed for vitamins, minerals and haematology to assess iron status. Two spot urine samples from each subject were analysed for iodine concentration (UIC) and creatinine.
Results:
Nineteen children with IF and 50 healthy children were included. The mean age of the participants was 10.0 years. IF-patients received a median of 76% of their estimated energy requirements from parenteral nutrition (PN). Recommended intake (RI) for iodine from the diet was reached by 16% of IF patients and 28% of healthy children. In the IF group there was a significant positive correlation between UIC and the percentage of iodine intake from oral diet and enteral nutrition support (r = 0.57, p = 0.03). Although the IF patients had a median parenteral iodine supply of more than twice the ESPGHAN recommendation, the median UIC was 89 μg/L indicating insufficient iodine status. This may suggest that the ESPGHAN recommendation for iodine in paediatric parenteral nutrition is too low. The healthy children had sufficient iodine status according to the median UIC (133 μg/L). IF patients had significantly lower total provision of iron compared to the healthy children, 4,9 vs 8,4 mg/day (p = 0.01) with 21% of IF patients and 28% of healthy children reaching RI for iron. The prevalence of anaemia was higher in IF patients than in the healthy children (40 vs.10%, p = 0.016).
Conclusion:
The study indicates an insufficient iodine and iron status among paediatric IF patients. Iodine status was associated with enteral provision and patients had insufficient status even if they received the ESPGHAN recommendation of iodine.
Trial Identification Number:
Clinical Trials AEV2017/1. 2016/391/REK sør-øst B.
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