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Reduced strength is associated with abnormal body composition in children with a history of intestinal failure
Dianna Yanchis1,2, Stephanie So1,2,3, Catherine Patterson1,2,3
1Research Institute, The Hospital for Sick Children, Toronto, Ontario, Canada.
Insights
Children with intestinal failure (IF) exhibit reduced muscle strength compared to norms. Strength is linked to body composition, with lower fat-free mass correlating with decreased strength, particularly in males.
Area of Science:
- Pediatric Gastroenterology
- Pediatric Endocrinology
- Pediatric Physical Therapy
Background:
- Limited data exists on the relationship between body composition and muscle strength in pediatric patients with intestinal failure (IF).
- This study addresses the knowledge gap by assessing strength and its correlation with body composition in children with IF.
Purpose of the Study:
- To evaluate muscle and functional strength in children with IF against established norms.
- To investigate the association between body composition metrics and strength parameters in this cohort.
Main Methods:
- Thirty-one children (aged 4-18 years) with IF were assessed for functional strength using the Bruininks-Oseretsky Test of Motor Proficiency-2 (BOT-2) and muscle strength via handgrip strength (HGS) and knee dynamometry.
- Body composition was determined using dual-energy X-ray absorptiometry (DXA).
- Statistical analyses included t-tests for group comparisons and linear regression to explore body composition-strength relationships.
Main Results:
- Children with IF demonstrated significantly lower HGS, knee flexion, and extension strength compared to published norms (p < 0.05 for all).
- A substantial percentage of participants scored below average in all strength measures (80.6% for HGS, 71.0% for knee flexion, 74.2% for extension).
- Functional strength positively correlated with fat-free mass and inversely with fat mass (r² = 0.36, p = 0.002), with this relationship being stronger in males (r² = 0.62, p < 0.001).
Conclusions:
- Pediatric patients with intestinal failure exhibit generalized weakness compared to healthy controls, irrespective of nutritional support method (enteral nutrition or parenteral nutrition).
- Reduced fat-free mass is a key factor associated with decreased strength in children with IF.
- The stronger association between body composition and strength in males warrants further investigation into underlying physiological mechanisms.
Objective:
Data on the relationship between body composition and strength in children with intestinal failure (IF) is lacking. The objectives were to (1) assess strength in children with IF compared to published norms; (2) examine the relationship between body composition and strength.
Methods:
Children aged 4-18 years with IF, excluding those with significant developmental delay or mobility challenges, were included. Functional strength was assessed using the Bruininks-Oseretsky Test of Motor Proficiency-2 (BOT-2) and muscle strength was measured with a dynamometer for handgrip strength (HGS) and knee flexion/extension. Body composition was assessed using dual-energy X-ray absorptiometry. Two-sample t-test compared strength in IF patients to published norms, and the relationship between body composition and strength was analyzed using linear regression.
Results:
Thirty-one children (71% male, mean age 9.9 years) were included. Twelve (39%) received parenteral nutrition (PN). Children with IF had significantly lower HGS (p = 0.004), knee flexion (p = 0.002), and extension (p < 0.001) compared to published norms. Specifically, 80.6% scored below the mean for HGS, 71.0% for knee flexion, and 74.2% for extension. BOT-2 revealed 26.9% had scores less than -1 SD. No significant differences in strength were found between those on enteral nutrition or PN. A significant positive relationship between functional strength and increased fat-free mass, and decreased fat mass was found (r2 = 0.36, p = 0.002), with male sex strengthening the relationship (r2 = 0.62, p < 0.001).
Conclusion:
Children with IF, both on enteral nutrition and PN, are weaker than healthy literature controls. Decreased strength was associated with lower fat-free mass. This relationship was stronger in males than in females, highlighting the need to further investigate the mechanisms behind body composition and strength in this population.
Trial Registration:
ClinicalTrials.gov identifier: NCT04610918.
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