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Muscle Strength, Agility, and Body Composition in Children With Intestinal Failure on Parenteral Nutrition
Stephanie So1,2,3, Catherine Patterson1,2,3, Zachary Betts4
1From the Department of Rehabilitation Services, The Hospital for Sick Children, Toronto, ON, Canada.
Insights
Children with intestinal failure (IF) on parenteral nutrition (PN) show reduced muscle strength and agility. Body composition is also altered, highlighting the need for comprehensive interventions to improve outcomes.
Area of Science:
- Pediatric Gastroenterology
- Pediatric Physical Therapy
- Pediatric Nutrition
Background:
- Long-term parenteral nutrition (PN) is increasingly used for children with intestinal failure (IF).
- The impact of IF and PN on pediatric motor function and body composition requires further investigation.
Purpose of the Study:
- To assess muscle strength, speed, agility, and body composition in children with IF on PN.
- To identify clinical factors predicting motor and body composition impairments in this population.
Main Methods:
- A cross-sectional study involving children aged 5-18 years with IF on PN.
- Evaluations included the Bruininks-Oseretsky Test of Motor Proficiency-2 (BOT-2), grip strength, and dual-energy x-ray absorptiometry (DXA) for body composition.
- Clinical data were collected via chart abstraction and compared to age/sex-matched controls.
Main Results:
- Children with IF demonstrated significantly lower strength and agility (P < 0.001) and grip strength (P = 0.001) compared to controls.
- 43% of children with IF scored >1 SD below the mean on BOT-2, and 62% had grip strength >1 SD below the mean.
- Lower fat-free mass (FFM)% and higher fat mass (FM)% were observed, with decreased FFM% correlating with poorer motor scores (P = 0.044).
Conclusions:
- Children with IF on PN are at significant risk for impaired muscle strength, agility, and altered body composition.
- Factors such as prematurity, height, hospitalizations, sepsis, and small bowel length influence these impairments.
- Continuous medical, nutritional, and rehabilitation interventions are crucial for optimizing outcomes in children with IF.
Objectives:
With increasing number of children with intestinal failure (IF) on long-term parenteral nutrition (PN), this study assesses the impact of IF on muscle strength, speed, and agility and body composition (BC), identifying clinical factors that may predict impairment.
Methods:
Cross-sectional study in children 5-18 years with IF on PN. Assessments included Bruininks-Oseretsky Test of Motor Proficiency-2 strength and agility subtest (BOT-2), and grip strength. BC data from dual-energy x-ray absorptiometry (DXA) measurements and clinical variables were collected by chart abstraction. Data were compared to age and sex matched controls and population norms.
Results:
Twenty-one children with IF (14 males), median age 8.33 (IQR: 6.96-11.04) years and 33 controls (20 males), 8.25 (6.67-10.79) years were included. Strength and agility ( P < 0.001) and grip strength ( P = 0.001) differed between groups. Nine of 21 (43%) of children with IF scored >1 standard deviation (SD) below mean on BOT-2 and 13 of 21 (62%) had grip strength >1 SD below mean. DXA measurements showed 10 of 18 (56%) of children had lower fat-free mass (FFM)% and higher fat mass (FM)% than reference norms. Decreased FFM% was associated with lower BOT-2 scores ( r = 0.479; P = 0.044) and grip strength scores >1 SD below mean ( P = 0.047). Additional clinical factors significantly impacting strength and agility included prematurity, height, hospitalizations, sepsis, and small bowel length.
Conclusions:
Children with IF are at risk of decreased muscle strength and agility, along with altered BC. Ongoing medical, nutritional, and rehabilitation intervention is vital to optimize outcomes.
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