Abstract
Children with intestinal failure (IF) receive parental nutrition to ensure adequate growth and development. The aim of this study was to assess micronutrient status in paediatric IF patients receiving home parenteral nutrition (HPN) in comparison to a group of healthy children. 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. All children with IF, aged two to 18 years, were invited to participate. A reference group of healthy children was recruited through social media advertisement. Dietary intake was assessed by a four-day food record, and enteral and parenteral provision was recorded. Blood samples were analysed for vitamins, minerals and haematology to assess iron status. Two spot urine samples from each subject were analysed for iodine concentration (UIC) and creatinine. Nineteen children with IF and 50 healthy children were included. The mean age of the participants was 10.0 years. IF-patients received a median of 76% of their estimated energy requirements from parenteral nutrition (PN). Recommended intake (RI) for iodine from the diet was reached by 16% of IF patients and 28% of healthy children. In the IF group there was a significant positive correlation between UIC and the percentage of iodine intake from oral diet and enteral nutrition support (r=0.57, p=0.03). Although the IF patients had a median parenteral iodine supply of more than twice the ESPGHAN recommendation, the median UIC was 89μg/L indicating insufficient iodine status. This may suggest that the ESPGHAN recommendation for iodine in paediatric parenteral nutrition is too low. The healthy children had sufficient iodine status according to the median UIC (133μg/L). IF patients had significantly lower total provision of iron compared to the healthy children, 4,9 vs 8,4mg/day (p=0.01) with 21% of IF patients and 28% of healthy children reaching RI for iron. The prevalence of anaemia was higher in IF patients than in the healthy children (40 vs.10%, p=0.016). The study indicates an insufficient iodine and iron status among paediatric IF patients. Iodine status was associated with enteral provision and patients had insufficient status even if they received the ESPGHAN recommendation of iodine. Clinical Trials AEV2017/1. 2016/391/REK sør-øst B.
Highlights
Intestinal failure (IF) is defined as a critical reduction of functional gut mass below the minimum needed for the absorption of nutrients and fluids necessary to maintain health and growth [1,2]
Several studies have focused on the micronutrient status during and after weaning of parenteral nutrition (PN) [7,15,21,22] Only a few studies have focused on the micronutrient status in children with chronic IF dependent on long-term PN, and data on micronutrient provision is often incomplete or lacking [22,23]
We found no clear correlation between the underlying cause of IF and the type of nutritional support, except for Total parenteral nutrition (TPN) which was provided to paediatric intestinal pseudo obstruction (PIPO) patients only
Summary
Intestinal failure (IF) is defined as a critical reduction of functional gut mass below the minimum needed for the absorption of nutrients and fluids necessary to maintain health and growth [1,2]. Growth failure and negative energy- and protein balances have previously been reported among paediatric HPN patients [10,11]. The aim of the present study was to assess micronutrient provision and status in a group of paediatric IF patients on home parenteral nutrition in comparison to a group of healthy children. Children with intestinal failure (IF) receive parental nutrition to ensure adequate growth and development. The aim of this study was to assess micronutrient status in paediatric IF patients receiving home parenteral nutrition (HPN) in comparison to a group of healthy children. IF-patients received a median of 76% of their estimated energy requirements from parenteral nutrition (PN). Recommended intake (RI) for iodine from the diet was reached by 16% of IF patients and 28% of healthy children. The IF patients had a median parenteral iodine supply of more than twice the ESPGHAN (http://creativecommons.org/licenses/by/4.0/)
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