Santoro Jonathan D, Nespor Colleen, Poole Robert L, Kerner John A
Stanford University School of Medicine, Department of Pediatrics, Palo Alto California
Lucile Packard Children's Hospital Stanford, Pharmacy Department, Palo Alto, California.
Nutr Clin Pract. 2016 Apr;31(2):245-9. doi: 10.1177/0884533615611846. Epub 2015 Oct 27.
Patients dependent on parenteral nutrition (PN) are among a group at risk of developing iodine deficiency. Supplementation with iodine in this population has been debated in a number of studies, resulting in variable clinical practices. The Committee on Clinical Practice Issues of the American Society for Clinical Nutrition recommends a dose of 1 mcg/kg/d of parenteral iodine for patients receiving PN. At our institution, PN trace elements do not include iodine, although this is not the case internationally. Our study sought to assess iodine levels and thyroid function in a cohort of PN-dependent pediatric patients.
A retrospective analysis studied 32 pediatric patients with a variety of medical diagnoses who received PN as a primary means of nutrition for 6 months or longer. Patients received variable proportions of their total caloric intake as PN, which ranged from 14%-100%. Iodine and thyroid function levels were obtained by serum sampling.
No patient in our cohort of 32 demonstrated thyroid dysfunction or developed iodine deficiency. The length of time on PN and the percentage of total nutrition intake as PN were not associated with iodine levels (P < .89 and P < .73, respectively). There were no significant associations between age (P < .342), clinical diagnosis (P < .46), or sex (P < .43) on iodine status. There were no incidences of abnormal iodine levels in our cohort. Our study suggests that pediatric patients older than 6 months receiving PN may not benefit from iodine supplementation, but further investigation is needed.
依赖肠外营养(PN)的患者属于有碘缺乏风险的群体。该人群补充碘的问题在多项研究中存在争议,导致临床实践各不相同。美国临床营养学会临床实践问题委员会建议,接受PN的患者肠外碘剂量为1微克/千克/天。在我们机构,PN微量元素中不包括碘,不过国际上并非如此。我们的研究旨在评估一组依赖PN的儿科患者的碘水平和甲状腺功能。
一项回顾性分析研究了32例患有各种医学诊断疾病的儿科患者,他们将PN作为主要营养方式达6个月或更长时间。患者通过PN摄入的总热量比例各不相同,范围为14% - 100%。通过血清采样获取碘和甲状腺功能水平。
我们这组32例患者中,没有患者出现甲状腺功能障碍或碘缺乏。PN使用时间以及PN占总营养摄入量的百分比与碘水平无关(P分别< 0.89和P < 0.73)。年龄(P < 0.342)、临床诊断(P < 0.46)或性别(P < 0.43)与碘状态之间均无显著关联。我们这组中没有碘水平异常的情况发生。我们的研究表明,6个月以上接受PN的儿科患者可能无法从碘补充中获益,但仍需进一步研究。