Pediatric Gastroenterology, Hepatology, and Nutrition, David Geffen School of Medicine at UCLA, Los Angeles, California, USA.
Children's National Health System, Washington, DC, USA.
JPEN J Parenter Enteral Nutr. 2018 Feb;42(2):427-435. doi: 10.1177/0148607117690528. Epub 2017 Dec 13.
Home parenteral nutrition (PN) is a lifesaving therapy for children with intestinal failure (IF). Our aims were to describe the prevalence of micronutrient deficiencies (vitamin D, zinc, copper, iron, selenium) in a diverse population of children with IF receiving PN and to identify and characterize risk factors associated with micronutrient deficiencies, including hematologic abnormalities.
Data were collected on 60 eligible patients through retrospective chart review between May 2012 and February 2015. Descriptive statistics included frequencies, medians, interquartile ranges (IQRs), and odds ratios (ORs). Statistical analyses included χ , Fisher's exact, t tests, and logistic, univariate, and multivariate regressions.
Patients were primarily young (median age, 3.3 years; IQR, 0.7-8.4), Latino (62%), and male (56%), with short bowel syndrome (70%). Of 60 study patients, 88% had ≥1 deficiency and 90% were anemic for age. Of 51 patients who had all 5 markers checked, 59% had multiple deficiencies (defined as ≥3). Multivariate analysis shows multiple deficiencies were associated with nonwhite race (OR, 9.4; P = .012) and higher body mass index z score (OR, 2.2; P = .016). Children with severe anemia (hemoglobin <8.5 g/dL) made up 50% of the cohort. Nonwhite race (OR, 6.6; P = .037) and zinc deficiency (OR, 11; P = .003) were multivariate predictors of severe anemia.
Micronutrient deficiency and anemia are overwhelmingly prevalent in children with IF using chronic PN. This emphasizes the importance of universal surveillance and supplementation to potentially improve quality of life and developmental outcomes. Future research should investigate how racial disparities might contribute to nutrition outcomes for children using chronic PN.
家庭肠外营养（PN）是患有肠衰竭（IF）的儿童的救命疗法。我们的目的是描述接受 PN 的不同 IF 儿童中微量营养素缺乏症（维生素 D、锌、铜、铁、硒）的流行情况，并确定和描述与微量营养素缺乏症相关的风险因素，包括血液学异常。
通过回顾性图表审查，于 2012 年 5 月至 2015 年 2 月期间收集了 60 名符合条件的患者的数据。描述性统计数据包括频率、中位数、四分位距（IQR）和比值比（OR）。统计分析包括 χ 、Fisher 精确检验、t 检验和逻辑、单变量和多变量回归。
患者主要为年轻（中位年龄 3.3 岁；IQR 为 0.7-8.4）、拉丁裔（62%）和男性（56%），短肠综合征（70%）。在 60 名研究患者中，88%有≥1 种缺乏症，90%按年龄贫血。在接受所有 5 项标志物检查的 51 名患者中，59%有多种缺乏症（定义为≥3 种）。多变量分析表明，多种缺乏症与非白色种族（OR，9.4；P =.012）和较高的体重指数 z 分数（OR，2.2；P =.016）相关。严重贫血（血红蛋白<8.5 g/dL）的患儿占队列的 50%。非白色种族（OR，6.6；P =.037）和锌缺乏症（OR，11；P =.003）是严重贫血的多变量预测因素。
接受慢性 PN 的 IF 儿童中，微量营养素缺乏症和贫血非常普遍。这强调了普遍监测和补充的重要性，可能会改善生活质量和发育结果。未来的研究应调查种族差异如何可能影响接受慢性 PN 的儿童的营养结果。
