Azcue M, Rashid M, Griffiths A, Pencharz P B
Division of Gastroenterology and Nutrition, Hospital for Sick Children, University of Toronto, Ontario, Canada.
Gut. 1997 Aug;41(2):203-8. doi: 10.1136/gut.41.2.203.
Malnutrition and growth retardation are common complications of Crohn's disease in children. The contribution of resting energy expenditure (REE) to malnutrition is unclear.
To characterise the REE and body composition in children with Crohn's disease and compare them with normal controls and patients with anorexia nervosa; to compare the effects of prednisolone and enteral nutrition on energy expenditure and body composition.
Twenty four children with Crohn's disease, 19 malnourished females with anorexia nervosa, and 22 healthy control subjects were studied.
In children with Crohn's disease measurements were done when the disease was acute and repeated at one and three months after treatment with either prednisolone or enteral nutrition. Resting energy expenditure was measured by indirect calorimetry and body composition by anthropometry, bioelectrical impedance analysis, total body potassium, H218O, and bromide space studies.
Body weight and ideal body weight were significantly lower in patients with Crohn's disease than in healthy controls. Lean tissue was depleted and there was an increase in extracellular water. Per unit of lean body mass, there was no difference between REE in patients with Crohn's disease and controls, whereas patients with anorexia nervosa had significantly reduced REE. With enteral nutrition all body compartments and REE increased significantly (p < 0.001). In a subgroup of age-matched men there was a significant increase in height after three months of enteral nutrition compared with prednisolone (p < 0.01). Those treated with steroids did not show a significant change in height but did show an increase in all body compartments. However, intracellular water as well as lean body mass accretion were significantly higher in the enteral nutrition group than in the prednisolone group.
Despite being malnourished, children with Crohn's disease fail to adapt their REE per unit of lean body mass. This might be a factor contributing to their malnutrition. Lean tissue accretion is higher in patients treated with enteral nutrition than in those treated with prednisolone.
营养不良和生长发育迟缓是儿童克罗恩病常见的并发症。静息能量消耗（REE）对营养不良的影响尚不清楚。
描述克罗恩病患儿的REE和身体组成，并与正常对照及神经性厌食症患者进行比较；比较泼尼松龙和肠内营养对能量消耗和身体组成的影响。
对24例克罗恩病患儿、19例营养不良的神经性厌食症女性患者和22例健康对照者进行了研究。
对克罗恩病患儿在疾病急性期进行测量，并在使用泼尼松龙或肠内营养治疗1个月和3个月后重复测量。通过间接测热法测量静息能量消耗，通过人体测量、生物电阻抗分析、全身钾、H218O和溴空间研究测量身体组成。
克罗恩病患者的体重和理想体重显著低于健康对照者。瘦组织减少，细胞外液增加。每单位瘦体重，克罗恩病患者和对照者的REE无差异，而神经性厌食症患者的REE显著降低。肠内营养后，所有身体成分和REE均显著增加（p<0.001）。在年龄匹配的男性亚组中，与泼尼松龙相比，肠内营养3个月后身高显著增加（p<0.01）。接受类固醇治疗的患者身高无显著变化，但所有身体成分均有增加。然而，肠内营养组的细胞内液以及瘦体重增加显著高于泼尼松龙组。
尽管营养不良，但克罗恩病患儿每单位瘦体重的REE未能适应。这可能是导致其营养不良的一个因素。接受肠内营养治疗的患者瘦组织增加高于接受泼尼松龙治疗的患者。
