From the Department of Rehabilitation Services, The Hospital for Sick Children, Toronto, ON, Canada.
the Transplant and Regenerative Medicine Centre, The Hospital for Sick Children, Toronto, ON, Canada.
J Pediatr Gastroenterol Nutr. 2022 Oct 1;75(4):438-443. doi: 10.1097/MPG.0000000000003553. Epub 2022 Jul 13.
With increasing number of children with intestinal failure (IF) on long-term parenteral nutrition (PN), this study assesses the impact of IF on muscle strength, speed, and agility and body composition (BC), identifying clinical factors that may predict impairment.
Cross-sectional study in children 5-18 years with IF on PN. Assessments included Bruininks-Oseretsky Test of Motor Proficiency-2 strength and agility subtest (BOT-2), and grip strength. BC data from dual-energy x-ray absorptiometry (DXA) measurements and clinical variables were collected by chart abstraction. Data were compared to age and sex matched controls and population norms.
Twenty-one children with IF (14 males), median age 8.33 (IQR: 6.96-11.04) years and 33 controls (20 males), 8.25 (6.67-10.79) years were included. Strength and agility ( P < 0.001) and grip strength ( P = 0.001) differed between groups. Nine of 21 (43%) of children with IF scored >1 standard deviation (SD) below mean on BOT-2 and 13 of 21 (62%) had grip strength >1 SD below mean. DXA measurements showed 10 of 18 (56%) of children had lower fat-free mass (FFM)% and higher fat mass (FM)% than reference norms. Decreased FFM% was associated with lower BOT-2 scores ( r = 0.479; P = 0.044) and grip strength scores >1 SD below mean ( P = 0.047). Additional clinical factors significantly impacting strength and agility included prematurity, height, hospitalizations, sepsis, and small bowel length.
Children with IF are at risk of decreased muscle strength and agility, along with altered BC. Ongoing medical, nutritional, and rehabilitation intervention is vital to optimize outcomes.
随着越来越多的肠衰竭（IF）儿童需要长期肠外营养（PN），本研究评估 IF 对肌肉力量、速度和敏捷性以及身体成分（BC）的影响，确定可能导致损伤的临床因素。
对接受 PN 的 5-18 岁 IF 儿童进行横断面研究。评估包括布鲁因克斯-奥塞尔斯基运动能力测试-2 力量和敏捷子测试（BOT-2）和握力。通过图表提取收集双能 X 射线吸收法（DXA）测量的 BC 数据和临床变量。将数据与年龄和性别匹配的对照组和人群正常值进行比较。
共纳入 21 名 IF 儿童（14 名男性），中位年龄 8.33（IQR：6.96-11.04）岁和 33 名对照组（20 名男性），8.25（6.67-10.79）岁。两组间力量和敏捷性（P < 0.001）和握力（P = 0.001）存在差异。21 名 IF 儿童中有 9 名（43%）的 BOT-2 评分低于平均值 1 个标准差，21 名中有 13 名（62%）的握力低于平均值 1 个标准差。DXA 测量显示，18 名儿童中有 10 名（56%）的去脂体重（FFM）%低于参考正常值，脂肪量（FM）%较高。FFM%下降与 BOT-2 评分降低（r = 0.479；P = 0.044）和握力评分低于平均值 1 个标准差（P = 0.047）相关。其他显著影响力量和敏捷性的临床因素包括早产、身高、住院、败血症和小肠长度。
IF 儿童存在肌肉力量和敏捷性下降以及 BC 改变的风险。持续的医疗、营养和康复干预对于优化结局至关重要。
