Hepatology, Gastroenterology and Pediatric Nutrition Unit, Femme Mere Enfant Hospital, Hospices Civils de Lyon, University Claude Bernard Lyon 1, Lyon, France.
Radiology Department, Hopital Femme Mere Enfant, Hospices Civils de Lyon, Lyon, France.
JPEN J Parenter Enteral Nutr. 2018 Mar;42(3):613-622. doi: 10.1177/0148607117701399. Epub 2017 Dec 15.
Metabolic bone disease is common in children receiving home parenteral nutrition (HPN) for intestinal failure (IF). Long-term evolution of bone mass in pediatric IF is poorly documented. The aims of this study were (1) to determine the prevalence of low bone mass (LBM) in children receiving HPN for IF, (2) to evaluate the evolution of total bone mineral content (TBMC) during HPN with dual-energy x-ray absorptiometry (DXA), and (3) to identify related factors.
All children referred in our HPN center from 2004 to 2014 were eligible. Inclusion criteria were HPN dependence due to noninflammatory IF, at least 2 TBMC assessments, and HPN duration of at least 2 years at last DXA. TBMC was expressed in z score for ideal weight for height (WFH). LBM was defined by a TBMC WFH z score ≤-2 standard deviations (SD).
A total of 175 DXAs for 31 children were performed, mean of 5.6 ± 2.9 assessments per child. The median time between first and last DXA recorded was 6.2 years (0.7-16.6). At the first DXA, 14 children (45%) had a LBM. TBMC increased by +0.1 ± 0.04 SD per year of HPN (P = .012). The risk of LBM decreased with an odds ratio of 0.9 per year of HPN (95% confidence interval, 0.92-0.99; P = .018). Lean mass z score and calcium parenteral intakes were related to the TBMC improvement.
LBM is common in pediatric IF, but bone status could improve during HPN in these children.
代谢性骨病在接受家庭肠外营养（HPN）治疗的肠道衰竭（IF）儿童中很常见。儿科 IF 患者骨量的长期变化记录甚少。本研究的目的是：（1）确定接受 HPN 治疗 IF 的儿童中低骨量（LBM）的发生率；（2）用双能 X 线吸收法（DXA）评估 HPN 期间总骨矿物质含量（TBMC）的演变；（3）确定相关因素。
2004 年至 2014 年在我们的 HPN 中心就诊的所有儿童均符合条件。纳入标准为：非炎症性 IF 导致的 HPN 依赖，至少有 2 次 TBMC 评估，且最后一次 DXA 时 HPN 持续时间至少 2 年。TBMC 用身高理想体重（WFH）的 z 分数表示。LBM 通过 TBMC WFH z 分数≤-2 标准差（SD）定义。
共对 31 名儿童的 175 次 DXA 进行了分析，每个儿童平均进行了 5.6 ± 2.9 次评估。首次和最后一次 DXA 之间记录的中位数时间为 6.2 年（0.7-16.6）。首次 DXA 时，14 名儿童（45%）有 LBM。HPN 每年增加 TBMC 增加+0.1 ± 0.04 SD（P =.012）。LBM 的风险随着 HPN 每年减少 0.9 的几率比而降低（95%置信区间，0.92-0.99；P =.018）。瘦体重 z 评分和钙的肠外摄入量与 TBMC 改善有关。
LBM 在儿科 IF 中很常见，但在这些儿童中 HPN 期间骨量可能会改善。
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