Nutritional Considerations in Pediatric Chronic Disease

Abstract

1. Wednesday Marie A. Sevilla, MD, MPH, CNSC* 1. *Division of Pediatric Gastroenterology, Hepatology and Nutrition, Children’s Hospital of Pittsburgh, University of Pittsburgh Medical Center, Pittsburgh, PA * BMI: : body mass index CF: : cystic fibrosis CHD: : congenital heart disease CKD: : chronic kidney disease DRI: : daily required intake ESLD: : end-stage liver disease GH: : growth hormone GI: : gastrointestinal IBD: : inflammatory bowel disease MCT: : medium-chain triglycerides 1. Clinicians should be knowledgeable of the multiple factors that affect nutritional status and cause growth failure in children with chronic disease. 2. Clinicians should be knowledgeable of the basic elements of nutritional assessment in children who need nutritional support for growth failure. 3. Clinicians should be aware of the effects of limited dietary intake on nutritional status and growth. After completing the article, readers should be able to: 1. Determine the pathophysiological factors in childhood chronic disease that lead to growth failure. 2. Describe components of clinical evaluation and basic anthropometric measurements that are used to monitor nutritional status in children with chronic disease. 3. Recognize the effects of a restricted diet on nutritional intake adequacy. Growth failure, defined as the inability to reach expected growth potential based on standard anthropometric measurements for age regarding weight and height, is common in chronic childhood disease. Growth failure in chronic childhood disease is multifactorial. Nutritional outcome is affected by baseline nutritional status, disease state, and, rarely, an inherent genetic abnormality. (1) A sign of growth failure is stunting, defined as length or stature below the minimum cutoff for age, usually the fifth percentile. (2) It represents systemic dysfunction during an important phase of physical development and is the hallmark of chronic malnutrition. Related to this is the definition of short stature—a height measurement 2 standard deviations (SD) scores below the mean for age and sex. Wasting, on the other hand, is an indicator of acute malnutrition and is defined as weight-for-height or -length 2 SD scores or more below the mean for age and sex. It usually signals more recent weight loss. (2) The measurement of height and …