Clinical Indices and Body Composition Changes After Feeding Children By Gastrostomy

Abstract

LEARNING OUTCOME: To define the outcome of adequate weight gain reflecting fat and lean mass for children with neurological disabilities fed by gastrostomy.This study addressed a commonly held impression that an outcome of gastrostomy feeding is to make children fat, particularly those with neurological impairments. A repeated measure study identified body composition and clinical correlates longitudinally in 12 underweight children who had laporoscopic surgery for gastrostomy placement and fundoplication. The baseline was the surgery date, with assessments every three months. The subjects were four to eight years, diagnosed with spastic quadriplegia, and were non-ambulatory. Eleven were diagnosed with failure-to-thrive. Four had interfering conditions effecting recumbent length, such as hip dislocation surgical correction or scoliosis. The usual post-surgical services were provided with nutritional assessments that included weight, triceps skinfolds fat mass, arm circumference, head circumference, recumbent length, and Dual Electron X-ray Absorptiometry (DEXA). The subjects gained an average of 3.8 kg over 9 months. Increase in both lean (r=0.914) and fat (r=0.834) compartments were significantly correlated to weight (p<001), and paralleled correction of failure to thrive as defined by increase in z-score for weight for age. The study did not suggest a period for detecting a significant changes; 3,6 or 9 months were all improved over baseline on a continuum of growth. Triceps skinfolds fat mass significantly correlated with fat mass (r=0.782) but not with fat-free mass (r=0.574). None of the children had triceps fat mass greater than mid-range, even with rapid weight gain. Percent body fat was not a good clinical indicator; weight and triceps skinfolds fat mass were significant outcome measures compared to DEXA. The use of DEXA measurements gave confirmatory but not additional information to the clinical correlates. For these subjects added weight after gastrostomy feeding was initiated was not only fat, but significant lean body mass, in spite of severe neuromuscular disabilities.