Knops N, Wulffraat N, Lodder S, Houwen R, de Meer K
Department of Gastroenterology, Het Wilhelmina Kinderziekenhuis University Hospital for Children and Youth, Utrecht, The Netherlands.
J Rheumatol. 1999 Sep;26(9):2039-43.
Undernutrition is frequently encountered in children with juvenile rheumatoid arthritis (JRA). We assessed resting energy expenditure (REE) in relation to nutritional status and body composition in patients with JRA.
We selected 33 children (age 6 to 18 yrs) with JRA (13 oligoarticular, 10 polyarticular, 10 systemic JRA) and 17 controls matched for age and sex. Nutritional status was assessed for height, weight, and fat-free mass (FFM), and REE was measured with indirect calorimetry.
Nutritional status in the patients with systemic JRA was diminished compared to the controls for height (140 vs. 159 cm; p<0.01) and FFM (28 vs. 38 kg; p = 0.03). Oligo and polyarticular patients with JRA had normal height and FFM. No significant differences existed in crude REE among the groups. However, after correcting REE for body weight and FFM, the patients with systemic JRA, compared to controls, had 18% higher REE per kg body weight (159 vs. 134 kJ/kg/day; p<0.01) and 21% higher REE per kg FFM (196 vs. 162 kJ/kg/day; p<0.01). Oligo and polyarticular JRA patients had 8% increased values for REE per kg body weight or FFM, but these differences were not statistically significant.
Patients with systemic JRA show stunting, low FFM, and a significantly increased REE when nutritional status is taken into account. These data suggest that assessment of individual energy requirements should include correction for fat-free mass in the treatment of malnutrition in patients with systemic JRA.
青少年类风湿性关节炎（JRA）患儿中经常出现营养不良的情况。我们评估了JRA患者静息能量消耗（REE）与营养状况和身体组成的关系。
我们选取了33名6至18岁的JRA患儿（13名单关节型、10名多关节型、10名全身型JRA）以及17名年龄和性别相匹配的对照儿童。评估了身高、体重和去脂体重（FFM）的营养状况，并采用间接测热法测量REE。
与对照组相比，全身型JRA患者的身高（140 vs. 159 cm；p<0.01）和FFM（28 vs. 38 kg；p = 0.03）营养状况较差。单关节型和多关节型JRA患者的身高和FFM正常。各组间的粗REE无显著差异。然而，在根据体重和FFM校正REE后，与对照组相比，全身型JRA患者每千克体重的REE高18%（159 vs. 134 kJ/kg/天；p<0.01），每千克FFM的REE高21%（196 vs. 162 kJ/kg/天；p<0.01）。单关节型和多关节型JRA患者每千克体重或FFM的REE值增加8%，但这些差异无统计学意义。
考虑到营养状况时，全身型JRA患者表现出发育迟缓、FFM较低且REE显著增加。这些数据表明，在治疗全身型JRA患者的营养不良时，个体能量需求的评估应包括去脂体重的校正。
