El Koofy Nehal M, Moawad Eman Mohamed Ibraheim, Yassin Noha A, Almohammady Mohammad N, Ibrahim Gehan S, El Mougy Fatma A, El Ayadi Ahmed A, Tarek Sara
Pediatric Department, Faculty of Medicine Cairo University, Cairo, Egypt.
Clinical and Chemical Pathology Department, Faculty of Medicine, Cairo University, Cairo, Egypt.
Arab J Gastroenterol. 2022 Nov;23(4):270-276. doi: 10.1016/j.ajg.2022.06.004. Epub 2022 Jul 30.
Failure of optimal growth and lack of appropriate weight gain are major nutritional problems in children with inflammatory bowel disease (IBD). Therefore, this study was designed to assess the nutritional and growth status of patients with very-early-onset IBD (VEO-IBD) before and after individual-based nutritional interventions.
This prospective cohort study assessed the nutritional status of 30 pediatric patients with VEO-IBD by performing comprehensive clinical examinations and evaluating anthropometric and biochemical parameters. The latter included the initial evaluation of serum albumin, prealbumin, minerals, and 25-hydroxyvitamin D. A 24-month nutritional strategy was designed for each patient. Patients who completed the study were reassessed after 6 months and their growth rate was calculated 2 years later.
The initial assessment of malnutrition severity using the World Health Organization's z-score revealed that 36.7%, 43.3%, and 26.7% of the study group were underweight, stunted, and wasted, respectively. Among the study population, Crohn's disease has the highest prevalence. Almost all patients had micronutrient deficiencies (i.e., iron, calcium, zinc, magnesium, and vitamin D) and subnormal serum levels of nutritional markers (i.e., prealbumin and albumin). Six months after the intervention, a significant improvement in anthropometric and biochemical parameters was detected (p < 0.05); nevertheless, the calculated growth rate revealed a considerable decrease after 2 years.
The early detection of nutritional impairment in patients with VEO-IBD remains a major challenge. Therefore, nutritional support and constant monitoring of these patients are necessary to ensure the improvement in their nutritional status and achieve an acceptable growth rate. Furthermore, we found that prealbumin could be a good discriminative tool for screening malnutrition in such patients.
生长未达最佳状态以及体重增加不足是炎症性肠病（IBD）患儿的主要营养问题。因此，本研究旨在评估极早发型IBD（VEO-IBD）患者在个体化营养干预前后的营养及生长状况。
这项前瞻性队列研究通过全面的临床检查以及评估人体测量和生化参数，对30例VEO-IBD儿科患者的营养状况进行了评估。后者包括血清白蛋白、前白蛋白、矿物质和25-羟基维生素D的初始评估。为每位患者制定了一项为期24个月的营养策略。完成研究的患者在6个月后重新进行评估，并在2年后计算其生长速率。
使用世界卫生组织的z评分对营养不良严重程度进行的初始评估显示，研究组中分别有36.7%、43.3%和26.7%的患者体重不足、发育迟缓及消瘦。在研究人群中，克罗恩病的患病率最高。几乎所有患者都存在微量营养素缺乏（即铁、钙、锌、镁和维生素D）以及营养标志物（即前白蛋白和白蛋白）的血清水平低于正常。干预6个月后，人体测量和生化参数有显著改善（p<0.05）；然而，计算得出的生长速率显示2年后有相当程度的下降。
VEO-IBD患者营养损害的早期检测仍然是一项重大挑战。因此，对这些患者进行营养支持和持续监测对于确保其营养状况改善并实现可接受的生长速率是必要的。此外，我们发现前白蛋白可能是筛查此类患者营养不良的良好鉴别工具。
