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Inflammation and micronutrient deficiency as major risk factors for anemia in children with intestinal failure: A
Heitor P Leite1,2, Eduardo F Hatanaka1,2, Giovana S Galati Sabio1
1Center for Intestinal Rehabilitation, Hospital Samaritano de São Paulo, São Paulo, Brazil.
Insights
Anemia affects one-third of children with intestinal failure (IF), but its frequency decreases with home parenteral nutrition. Hemoglobin levels are linked to inflammation and micronutrient levels in these patients.
Area of Science:
- Pediatric Gastroenterology
- Hematology
- Clinical Nutrition
Background:
- Limited longitudinal data exist on anemia in children with intestinal failure (IF).
- Previous studies primarily relied on single-time-point data collection.
- Understanding anemia dynamics during home parenteral nutrition is crucial.
Purpose of the Study:
- To determine the frequency of anemia in children with IF receiving home parenteral nutrition.
- To identify factors associated with hemoglobin levels throughout their treatment course.
Main Methods:
- A longitudinal cohort study was conducted at a pediatric intestinal rehabilitation center.
- Hemoglobin levels and anemia prevalence were tracked over time.
- Associations with age, parenteral nutrition duration, chronic disease, and serum micronutrients (CRP, iron, copper, selenium, vitamins A, B12, folic acid) were analyzed.
Main Results:
- 32% of 25 pediatric patients with IF experienced anemia.
- Mean hemoglobin levels showed a non-significant trend toward improvement during follow-up.
- Elevated C-reactive protein (>1 mg/dL) correlated with decreased hemoglobin (-0.57 g/dL), while increased vitamin A was linked to higher hemoglobin (+0.93 g/dL).
Conclusions:
- Anemia is prevalent in nearly one-third of children with IF, with frequency declining during follow-up.
- Hemoglobin levels in these children are significantly influenced by inflammatory markers and serum micronutrient status.
- These findings highlight the importance of monitoring inflammation and micronutrients in managing anemia in pediatric IF.
Background:
Most data on anemia in children with intestinal failure (IF) have been obtained from studies in which the data were collected at a single point in time. We aimed to identify the frequency of anemia and factors associated with hemoglobin levels in children with IF during their course of home parenteral nutrition.
Methods:
We performed a longitudinal cohort study of patients with IF followed up at a pediatric intestinal rehabilitation center. Outcome variables were hemoglobin levels and prevalence of anemia during the follow-up period. The exposure variables were age, duration of parenteral nutrition, chronic disease, and serum concentrations of C-reactive protein, iron, copper, selenium, vitamins A, D, B12 , and folic acid.
Results:
Twenty-five children with a median time of receiving parenteral nutrition of 40.7 months were included. A median (and interquartile range) of 40.7 (25.2-58) hemoglobin measurements were performed per patient. Mean (SD) hemoglobin was 10.7 (1.8) g/dL at baseline and 11.6 (0.9) g/dL in the last observation (paired t test, P = 0.07); 32% of patients had mean hemoglobin values below the lower limit for age. In a multivariable predictive model, having C-reactive protein >1 mg/dL was associated with a decrease of 0.57 g/dL in hemoglobin (95% CI, -0.90 to -0.24, P = 0.01), and an increase of 1 mg/L in vitamin A concentration was associated with the increase of 0.93 g/dL in Hb level (95% CI, 0.24-1.61; P = 0.008).
Conclusion:
Anemia affects almost one-third of children with IF and its frequency decreases during the follow-up period. Hemoglobin levels are associated with inflammatory response and serum micronutrient concentrations.
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