title: Long-term nutritional consequences of bowel segment use for lower urinary tract reconstruction in pediatric patients.
abstract: OBJECTIVE
  To identify whether nutritional abnormalities, specifically vitamin B12 deficiency, folate deficiency, and low carotene levels, are long-term sequelae of the use of ileum and/or colon for lower urinary tract reconstruction in pediatric patients.
  
  
  METHODS
  Serum levels of vitamin B12, methyl malonic acid (MMA), carotene, and folate were measured 3 to 13 years (mean 6) after surgery in patients less than 18 years old at the time of operation.
  
  
  RESULTS
  Thirteen (44.8%) of 29 patients had abnormal nutritional serum levels, with 5 (38.5%) of 13 having more than one abnormal value. Vitamin B12 was low in 4 (14%) of 29 patients; MMA was abnormally high in 7 (26%) of 27; and both folate and carotene levels were low in 4 (14.8%) of 27. No patient with reconstruction with colon alone (n = 3) had abnormal values, and no patient had any clinical signs or symptoms of vitamin B12 deficiency or fat malabsorption.
  
  
  CONCLUSIONS
  Nutritional abnormalities can occur in patients after lower urinary tract reconstruction with ileum. No patient in this study had symptomatic abnormalities; however, long-term clinical effects may be significant. The implications of low folate levels in women of childbearing age must also be taken into consideration because of the potential association with congenital anomalies.
authors.affiliation: James Buchanan Brady Urological Institute, Department of Urology, Johns Hopkins Medical Institutions, Baltimore, Maryland 21287-2101, USA.
authors.forename: N B
authors.initials: NB
authors.lastname: Kalloo
authors.forename: R D
authors.initials: RD
authors.lastname: Jeffs
authors.forename: J P
authors.initials: JP
authors.lastname: Gearhart
mesh_terms: D000293:Adolescent; D017195:Adolescent Nutritional Physiological Phenomena / Q000502:physiology*; D002338:Carotenoids / Q000097:blood; D002432:Cecum / Q000601:surgery; D002648:Child; D002664:Child Nutritional Physiological Phenomena / Q000502:physiology*; D002675:Child, Preschool; D003106:Colon / Q000601:surgery; D005260:Female; D005492:Folic Acid / Q000097:blood; D005500:Follow-Up Studies; D006801:Humans; D007082:Ileum / Q000601:surgery; D007223:Infant; D008297:Male; D008764:Methylmalonic Acid / Q000097:blood; D013997:Time Factors; D014547:Urinary Diversion; D014805:Vitamin B 12 / Q000097:blood
chemical_list: D002338:Carotenoids; D008764:Methylmalonic Acid; D005492:Folic Acid; D014805:Vitamin B 12