title: Growth and bone health in pediatric intestinal failure patients receiving long-term parenteral nutrition.
abstract: BACKGROUND
  Children with chronic intestinal failure (IF) treated with long-term parenteral nutrition (PN) may present with low bone mineral density (BMD). The cause may reflect small body size or suboptimal bone mineralization.
  
  
  OBJECTIVE
  We assessed growth and bone health in children with severe IF.
  
  
  METHODS
  Height, weight, and fracture history were recorded. The lumbar spine bone mass was measured in 45 consecutive patients (24 male subjects) aged 5-17 y receiving PN for a median of 5 y. BMD and bone mineral apparent density (BMAD) [ie, adjusted-for-height SD scores (SDSs)] were calculated.
  
  
  RESULTS
  Diagnoses were short bowel syndrome in 12 patients (27%), intestinal enteropathy in 20 patients (44%), and motility disorder in 13 patients (29%). Mean (±SD) weight, height, and body mass index SDSs were -0.8 ± 1.3, -1.80 ± 1.5, and 0.4 ± 1.3, respectively. The height SDS was less than -2 in 23 children (50%). Patients with enteropathy or intestinal mucosal inflammation (associated with dysmotility or short bowel) were significantly shorter than patients without enteropathy (P = 0.007). The BMD SDS was -1.7 ± 1.6, and the BMAD SDS was -1.4 ± 1.5, independent of primary diagnosis or mucosal inflammation. Nineteen patients (42%) had low BMD (SDS less than -2.0), and 14 patients (31%) had low BMAD. In 25 patients studied at 1-2-y intervals, the BMD SDS fell significantly with time, whereas BMAD declined less, which suggested that a poor bone mineral accretion reflected poor growth. A total of 11 of 37 patients (24%) had nonpathologic fractures (P = 0.3 compared with the general population).
  
  
  CONCLUSIONS
  Approximately 50% of children were short, and one-third of children had low BMD and BMAD. Children with enteropathy or intestinal mucosal inflammation are at greatest risk of growth failure. Close nutritional monitoring and bespoke PN should maximize the potential for growth and bone mass.
authors.affiliation: Department of Paediatric and Adolescent Medicine, Medical University of Vienna, Vienna, Austria. judith.pichler@meduniwien.ac.at
authors.forename: Judith
authors.initials: J
authors.lastname: Pichler
authors.forename: Sirinuch
authors.initials: S
authors.lastname: Chomtho
authors.forename: Mary
authors.initials: M
authors.lastname: Fewtrell
authors.forename: Sarah
authors.initials: S
authors.lastname: Macdonald
authors.forename: Susan M
authors.initials: SM
authors.lastname: Hill
mesh_terms: D015502:Absorptiometry, Photon; D000293:Adolescent; D001823:Body Composition; D001827:Body Height; D015992:Body Mass Index; D001835:Body Weight; D015519:Bone Density; D001846:Bone Development; D001842:Bone and Bones / Q000378:metabolism*; D002113:Calcification, Physiologic; D002648:Child; D002675:Child, Preschool; D002908:Chronic Disease; D005260:Female; D050723:Fractures, Bone / Q000473:pathology; D006801:Humans; D007410:Intestinal Diseases / Q000628:therapy*; D007422:Intestines / Q000503:physiopathology*; D016014:Linear Models; D008137:Longitudinal Studies; D008297:Male; D015999:Multivariate Analysis; D015596:Nutrition Assessment; D010288:Parenteral Nutrition; D011239:Prednisolone / Q000008:administration & dosage; D012778:Short Bowel Syndrome / Q000628:therapy
chemical_list: D011239:Prednisolone