Evaluation of growth and nutritional status in children and adolescents with extrahepatic portal vein obstruction and portal hypertension

Priscila Francisco Marques,Marcela Linden Ferreira,Gabriel Hessel,Maria Angela Bellomo Brandão,Roberta Vacari Alcantara,Elizete Aparecida Lomazi

doi:10.1590/1678-98652017000400005

Priscila Francisco Marques, Marcela Linden Ferreira + Show 4 more

Open Access

https://doi.org/10.1590/1678-98652017000400005

Copy DOI

Abstract

ABSTRACT Objective: This study aims to evaluate dietary intake, nutritional status, and growth rate in children and adolescents with extrahepatic portal vein obstruction and portal hypertension. Methods: Outpatients aged 1-18 years, diagnosed with extrahepatic portal vein obstruction and portal hypertension, who had no associated diseases, and who had not been subjected to a venous shunt were included in this study. Two evaluations were carried out in this study: an initial (evaluation 1) and a final evaluation (evaluation 2), with a three-month minimum interval between them. In each evaluation, dietary intake was analyzed comparing the results with recommended energy intake using the Harris & Benedict equation and participants’ anthropometric data, such as weight, height, mid-arm muscle circumference, weight-for-age, height-for-age, and body mass index-for-age, based on the World Health Organization 2006 standards. Results: A total of 22 patients participated in this study. There was a significant improvement in weight, height, body mass index, and mid-arm muscle circumference measurements (p<0.001; p<0.001; p<0.017; p=0.0018 respectively) and in the relationship between dietary intake and energy recommended energy intake, according to the Harris & Benedict equation (p=0.0001) from the first and second evaluation. Conclusion: Extrahepatic portal vein obstruction and portal hypertension were not shown to be factors predisposing to malnourishment.

Highlights

Extrahepatic Portal Vein Obstruction (EHPVO) is the main cause of portal vein obstruction and can occur due to presence of hepatocellular carcinoma or due to compression caused by extra-hepatic malignant tumors
Extrahepatic portal vein obstruction and portal hypertension were not shown to be factors predisposing to malnourishment
Another theory associated with a reduction in growth rate in patients with EHPVO is the reduction of the liver blood flow due to the formation of portalsystemic collateral vessels leading to deprivation of hepatotrophic hormones interfering with the overall growth of these children [4,7,9,10]

Summary

Introduction

Extrahepatic Portal Vein Obstruction (EHPVO) is the main cause of portal vein obstruction and can occur due to presence of hepatocellular carcinoma or due to compression caused by extra-hepatic malignant tumors. Some authors have indicated that children with EHPVO may have growth retardation [6,7,8] They have argued that malnutrition results from chronic anemia due to bleeding and hypersplenism, intestinal venous congestion with concurrent malabsorption, and visceromegaly, which affects food acceptance. Another theory associated with a reduction in growth rate in patients with EHPVO is the reduction of the liver blood flow due to the formation of portalsystemic collateral vessels leading to deprivation of hepatotrophic hormones interfering with the overall growth of these children [4,7,9,10]. The occurrence of growth retardation remains controversial; some studies suggest that pediatric care and appropriate treatment of complications of esophagogastric varices can ensure proper growth in these children [3,11]

Methods

Discussion

Conclusion