Nutrition and immunological status in long-term follow up of children with short bowel syndrome.
BACKGROUND
Little is known about the long-term evolution, nutrition status, growth, and eventual deficiencies of patients with short bowel syndrome (SBS) adapted to oral feeding after parenteral nutrition (PN). Because there are not absolute criteria for weaning from parenteral or enteral nutrition to oral feeding, new nutrient deficiencies may develop. Subtle nutrition deficits could induce subclinical immune deficiencies; therefore, we studied long-term growth, nutrition status, and the state of the immune system in 10 patients with SBS after weaning PN for at least 2 years.


METHODS
Ten children with SBS (3-12 years old; mean, 7.4 years) who had not received PN for at least 2 years were studied. Anthropometric measurements, hemoglobin values, and indicators of iron, zinc, copper, folate and vitamin B(12) nutrition status were evaluated, along with immunoglobulins, lymphocyte subpopulations, and polymorphonuclear candidicidal activity.


RESULTS
Weight-for-height was normal in 8 children; height-for-age was low in 5 children whose SBS was established early in life. Fat body mass was also low in 5 subjects. Four children presented macrocytosis, 2 with anemia. Low serum levels of vitamin B(12) (1 child), folates (4 children), and ferritin (2 children) were observed. Diminished candidicidal activity (4 children) was the only remarkable immunological abnormality.


CONCLUSIONS
Many biologic and growth deficiencies are frequently seen in patients with SBS, even in children adapted to enteral feeding. This finding and the existence of previously unreported decreased candidicidal activity in some patients with SBS deserve long-term clinical and biologic follow up.
González
Horacio F
HF
Instituto de Desarrollo e Investigaciones Pediátricas, Hospital de Niños Sor María Ludovica, Calle 16 No 1069 1900, La Plata, Argentina. institutoinvestigaciones@hotmail.com
Pérez
Néstor B
NB
Malpeli
Agustina
A
Martínez
María I
MI
Del Buono
Beatriz
B
Viteri
Fernando E
FE
D001835:Body Weight / Q000502:physiology; D002648:Child; D002657:Child Development; D015362:Child Nutrition Disorders / Q000097:blood / Q000453:epidemiology* / Q000209:etiology; D002675:Child, Preschool; D004435:Eating; D005260:Female; D005500:Follow-Up Studies; D006304:Health Status; D006305:Health Status Indicators; D006801:Humans; D008297:Male; D009751:Nutritional Requirements; D009752:Nutritional Status; D010288:Parenteral Nutrition; D012778:Short Bowel Syndrome / Q000150:complications* / Q000276:immunology* / Q000628:therapy; D016896:Treatment Outcome; D014886:Weaning