Abstract
Patients with intestinal failure (IF) are dependent on long-term home parenteral nutrition (HPN) to ensure growth and development. The primary aim of the present study was to assess bone mineral density (BMD) and vitamin D status in paediatric IF patients on HPN and a group of healthy children aged 2-18 years. Secondary aims were to assess growth, body composition, nutrient provision and physical activity. 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. Dual energy x-ray absorptiometry (DXA; Lunar Prodigy in IF patients and Lunar iDXA in healthy subjects) was performed to assess BMD and body composition. BMD z-score (BMDz) was calculated for total body and lumbar spine L2-L4 based on the integrated reference population in the software. Weight and height were measured for growth assessment. Nutrient provision was assessed by a 4-day food record. Blood samples were analysed for 25-hydroxy-vitamin D (25(OH)D) and 1,25-dihydroxyvitamin D (1,25(OH)2D). Physical activity was reported by a questionnaire. Nineteen IF patients and 50 healthy children were included. The mean age of participants was 10.0 years. The aetiology of IF patients was paediatric intestinal pseudo-obstruction (58%), short bowel syndrome (26%), and intestinal enteropathy (16%). Lower median BMDz for total body (-0.4 vs 1.1, P<0.001) and lumbar spine L2-L4 (-0.9 vs 0.2, P=0.01) were found in the IF group compared with the healthy children. Vitamin D provision was significantly higher in IF patients (17μg/d vs 5.3μg/d, P<0.001). Both groups were sufficient in 25(OH)D (IF patients 71nmol/L vs healthy 81nmol/L). Nevertheless, IF patients had significantly lower 1,25(OH)2D than healthy children (71pmol/L vs 138pmol/L, P<0.001). The IF group was significantly shorter (height for age z-score-1,5 vs 0,1, P=0.001) and lighter (weight for age z-score-1,0 vs 0,1, P=0.009) compared with the healthy subjects. BMIz did not differ; however, body fat percentage was significantly higher in IF patients compared with healthy children (34% vs 25%, P=0.02). A lower frequency of physical activity was found in the IF group compared with the healthy group (P=0.001). Paediatric IF patients on HPN had lower BMD, impaired growth, and higher body fat percentage in comparison with the healthy children. Despite a higher total supply of vitamin D in the IF group, the levels of 25(OH)D did not differ. Nevertheless, a significantly lower level of 1,25(OH)2D was found in IF patients. The results raise questions regarding differences between oral and parenteral vitamin D provision and whether intestinal function is important for the metabolism of vitamin D. Clinical Trials AEV2017/1. 2016/391/REK sør-øst B REVISION NUMBER: CLNESP-D-20-00022.
Highlights
Intestinal failure (IF) is a consequence of a reduced mass or function of the gut
Protein, and fat provision per kilogram were not significantly different, but carbohydrates were higher in IF patients compared with healthy children (9.3 g/kg vs 5.9 g/kg, P 1⁄4 0.005; Table 3)
Total vitamin D provision was significantly higher in IF patients compared with healthy children (17 mg/d vs 5.3 mg/d, P < 0.001; Table 3)
Summary
Intestinal failure (IF) is a consequence of a reduced mass or function of the gut. Long-term home parenteral nutrition (HPN) is required to supply enough fluid, energy, macronutrients, and micronutrients. Metabolic bone disease in association with long-term parenteral nutrition (PN) was first described in paediatric patients in 2010 [4]. Poor nutritional status, including vitamin D deficiency, growth failure, and high fat mass, have been found in IF patients [4,8e13]. This can be related to suboptimal PN, malabsorption, and faecal loss of energy, proteins, fluids, and electrolytes. Patients with intestinal failure (IF) are dependent on long-term home parenteral nutrition (HPN) to ensure growth and development. The primary aim of the present study was to assess bone mineral density (BMD) and vitamin D status in paediatric IF patients on HPN and a group of healthy children aged 2e18 years. Secondary aims were to assess growth, body composition, nutrient provision and physical activity. Vitamin D provision was significantly higher in IF patients
Sign-in/Register to view highlights & summary Sign-in/Register to access full text options 
Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a callDisclaimer: All third-party content on this website/platform is and will remain the property of their respective owners and is provided on "as is" basis without any warranties, express or implied. Use of third-party content does not indicate any affiliation, sponsorship with or endorsement by them. Any references to third-party content is to identify the corresponding services and shall be considered fair use under The CopyrightLaw.
