Bone mineral density and vitamin D in paediatric intestinal failure patients receiving home parenteral nutrition. (October 2020)

• Record Type: Journal Article
• Authors: Kvammen, Janne Anita; Thomassen, Rut Anne; Kjeserud, Christina Nicolaisen; Sæland, Camilla; Godang, Kristin; Bollerslev, Jens; Thorsby, Per Medbøe; Juliusson, Petur Benedikt; Bentsen, Beint Sigmund; Henriksen, Christine
• Is Part Of: Clinical nutrition ESPEN. Volume 39(2020)
• Page Start: 234
• Page End: 241
• Publication Date: 2020-10
• Subjects: Bone mineral density -- Children -- Growth -- Home parenteral nutrition -- Intestinal failure -- Vitamin D; BMD Bone mineral density -- BMDz Bone mineral density z-score -- BMI Body mass index -- BMIz Body mass index for age z-score -- ESPGHAN European Society of Paediatric Gastroenterology, Hepatology and Nutrition -- Htz Height for age z-score -- HPN Home parenteral nutrition -- IF Intestinal failure -- NNR Nordic Nutrition Recommendations 2012 -- OUH Oslo University Hospital -- PN Parenteral nutrition -- RI Recommended intake -- TPN Total parenteral nutrition -- UiO University of Oslo -- Wtz Weight for age z-score; Nutritionally induced diseases -- Periodicals; Metabolism -- Disorders -- Periodicals; 616.39005
• DOI: 10.1016/j.clnesp.2020.06.006
• Languages: English
• ISSNs: 2405-4577

Abstract

Summary: Background & aims: 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. Methods: 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)2 D). Physical activity was reported by a questionnaire. Results: 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 (17 μg/d vs 5.3 μg/d, P < 0.001). Both groups were sufficient in 25(OH)D (IF patients 71 nmol/L vs healthy 81 nmol/L). Nevertheless, IF patients had significantly lower 1, 25(OH)2 D than healthy children (71 pmol/L vs 138 pmol/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). Conclusions: 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)2 D 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. Trial identification number: Clinical Trials AEV2017/1. 2016/391/REK sør-øst B Revision number: CLNESP-D-20-00022.