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Total body nitrogen in children with chronic renal failure and short stature
L A Baur1, J F Knight, B A Crawford
1James Fairfax Institute of Paediatric Clinical Nutrition, Children's Hospital, Camperdown, Sydney, NSW, Australia.
Insights
Children with chronic renal failure (CRF) and short stature have significantly lower body protein for their age. This protein depletion, potentially linked to energy deficiency, may contribute to growth failure in pediatric CRF.
Area of Science:
- Pediatric Nephrology
- Nutritional Biochemistry
- Growth and Development
Background:
- Chronic renal failure (CRF) in children is often associated with growth impairment.
- Assessing body composition, specifically protein status, is crucial for understanding growth failure in pediatric CRF.
Purpose of the Study:
- To directly measure and compare the body protein content of children with CRF and short stature to healthy controls.
- To investigate the relationship between body protein, anthropometric measurements, and nutritional intake in this population.
Main Methods:
- A study involving 17 children with CRF and short stature and 43 healthy children.
- Measurements included anthropometry, total body nitrogen (TBN) via neutron capture analysis, and dietary intake assessment.
- Serum albumin levels were also analyzed in the CRF group.
Main Results:
- CRF patients exhibited significantly lower total body nitrogen (TBN) compared to controls, indicating protein depletion relative to age.
- While TBN predicted from height was normal, TBN predicted from age was significantly reduced.
- Protein depletion correlated significantly with height and weight deficits, muscle area, and serum albumin levels.
Conclusions:
- Children with CRF and short stature are protein-depleted for their age, not necessarily for their height.
- Chronic energy deficiency may impair protein deposition, playing a role in the growth failure observed in pediatric CRF.
Objective:
To directly assess the body protein content of children with chronic renal failure (CRF) and short stature.
Setting:
A tertiary referral paediatric hospital.
Subjects:
There were: (i) 17 patients (10 male, nine pre-pubertal; mean age 12.90 +/- 3.20 years) with CRF and height standard deviation (SD) score < -2.00, and (ii) 43 normal children (18 male, 27 pre-pubertal; mean age 10.34 +/- 3.34 years).
Interventions:
CRF patients had the following measurements: anthropometry, total body nitrogen (TBN) by neutron capture analysis, 4 day weighed food record and serum albumin levels. Control subjects had TBN and anthropometric measurements only.
Results:
Although older than the controls, the CRF patients had significantly lower TBN values (645 +/- 265 vs 930 +/- 365 g, P < 0.01). Mean values for TBN and TBN/height (percentages of expected) in the CRF patients were significantly reduced to 54% and 63% respectively, when predicted from age. However, their TBN predicted from height was 100% of expected. %TBN (predicted from age) correlated significantly with height SD score (r = 0.79), weight SD score (r = 0.87), upper arm muscle area percentile (r = 0.62) and serum albumin (r = 0.62). Mean oral energy and protein intakes were 65% and 172% of recommended dietary intake respectively.
Conclusions:
Children with CRF and short stature are significantly protein-depleted for age although not for height. Chronic energy deficiency may contribute to impaired protein deposition which, in turn, may be important in the pathogenesis of growth failure in CRF.