title: Pulmonary function and nutritional morbidity in children and adolescents with congenital diaphragmatic hernia.
abstract: BACKGROUND
  Malnutrition is common among congenital diaphragmatic hernia (CDH) survivors and may result from elevated respiratory effort. We evaluated body mass index (BMI), measured resting energy expenditure (mREE) and pulmonary function test (PFT) results in children and adolescents with CDH to determine if there is a correlation.
  
  
  METHODS
  With ethics approval (REB# 1000035323), anthropometrics, indirect calorimetry (IC) results and PFTs were collected from patients 5-17years of age during CDH clinic visits between 2000 and 2016. Malnutrition was defined as BMI z-scores <-2.0; mREE (as percent predicted REE) was measured using IC; z-scores for forced expiratory volume in 1s (FEV1) and forced vital capacity (FVC) were normal if <-1.64.
  
  
  METHODS
  GraphPad Prism 6, San Diego, CA.
  
  
  CONCLUSIONS
  Of 118 patients who attended clinic, 33 had reproducible PFTs, anthropometrics and IC results. Mean BMI z-score was -0.89±1.47 and 24% of patients were malnourished; mean FVC z-score (-1.32±1.39) was within normal range, whereas mean z-scores for FEV1(-2.21±1.68) and FEV1/FVC ratio (-1.78±0.73) were below normal. A correlation was noted between BMI and PFTs (FEV1r=0.70, P<0.0001; FVC r=0.74 P<0.0001). Mean mREE was 112%±12% of expected and 67% of patients were hypermetabolic (mREE<110% predicted). IC results did not correlate with z-scores for either FEV1(r=0.10, P=0.57); or FVC (r=0.28, P=0.12).
  
  
  CONCLUSIONS
  These preliminary results suggest that a correlation is present between BMI and lung function in CDH children and adolescents, whereas lung function does not seem to correlate with mREE.
  
  
  METHODS
  II.
authors.affiliation: Department of Surgery, Division of Pediatric General and Thoracic Surgery, The Hospital for Sick Children, 555 University Ave, M5G 1X8, Toronto, ON, Canada.
authors.forename: Beth
authors.initials: B
authors.lastname: Haliburton
authors.affiliation: Department of Pediatrics, Division of Gastroenterology, Hepatology and Nutrition, The Hospital for Sick Children, 555 University Ave, M5G 1X8, Toronto, ON, Canada.
authors.forename: Marialena
authors.initials: M
authors.lastname: Mouzaki
authors.affiliation: Department of Surgery, Division of Pediatric General and Thoracic Surgery, The Hospital for Sick Children, 555 University Ave, M5G 1X8, Toronto, ON, Canada.
authors.forename: Monping
authors.initials: M
authors.lastname: Chiang
authors.affiliation: Department of Pediatrics, Division of Gastroenterology, Hepatology and Nutrition, The Hospital for Sick Children, 555 University Ave, M5G 1X8, Toronto, ON, Canada.
authors.forename: Vikki
authors.initials: V
authors.lastname: Scaini
authors.affiliation: Department of Pediatrics, Division of Gastroenterology, Hepatology and Nutrition, The Hospital for Sick Children, 555 University Ave, M5G 1X8, Toronto, ON, Canada.
authors.forename: Margaret
authors.initials: M
authors.lastname: Marcon
authors.affiliation: Department of Pediatrics, Division of Respiratory Medicine, The Hospital for Sick Children, 555 University Ave, M5G 1X8, Toronto, ON, Canada.
authors.forename: Wenming
authors.initials: W
authors.lastname: Duan
authors.affiliation: Department of Pediatrics, Division of Respiratory Medicine, The Hospital for Sick Children, 555 University Ave, M5G 1X8, Toronto, ON, Canada.
authors.forename: David
authors.initials: D
authors.lastname: Wilson
authors.affiliation: Department of Surgery, Division of Pediatric General and Thoracic Surgery, The Hospital for Sick Children, 555 University Ave, M5G 1X8, Toronto, ON, Canada.
authors.forename: Priscilla P L
authors.initials: PP
authors.lastname: Chiu
authors.affiliation: Department of Pediatrics, Division of Respiratory Medicine, The Hospital for Sick Children, 555 University Ave, M5G 1X8, Toronto, ON, Canada. Electronic address: theo.moraes@sickkids.ca.
authors.forename: Theo J
authors.initials: TJ
authors.lastname: Moraes
mesh_terms: D000293:Adolescent; D015992:Body Mass Index; D002648:Child; D002675:Child, Preschool; D004734:Energy Metabolism; D005260:Female; D005500:Follow-Up Studies; D005541:Forced Expiratory Volume; D065630:Hernias, Diaphragmatic, Congenital / Q000503:physiopathology* / Q000601:surgery; D006801:Humans; D008168:Lung / Q000503:physiopathology*; D008297:Male; D044342:Malnutrition / Q000175:diagnosis / Q000209:etiology*; D012189:Retrospective Studies; D014797:Vital Capacity
keywords: Congenital diaphragmatic hernia; Indirect calorimetry; Malnutrition; Nutritional morbidity; Pulmonary function test