Risk of Metabolic Bone Disease is Increased Both during and after Weaning off Parenteral Nutrition in Pediatric Intestinal Failure
Risk of Metabolic Bone Disease is Increased Both during and after Weaning off Parenteral Nutrition in Pediatric Intestinal Failure
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DOI：
10.1159/000350616
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发表时间：
2013-01-01
影响因子：
3.2
通讯作者：
Pakarinen, Mikko P.
中科院分区：
文献类型：
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作者：
Mutanen, Annika;Makitie, Outi;Pakarinen, Mikko P.
目的：评价小儿肠衰竭（IF）患者的骨健康状况。方法：对41例IF患者（年龄9.9岁）进行骨矿物质密度（BMD）、骨生化、营养状况和生长评估。11例患者在69个月后仍维持肠外营养（PN）。30例患者在服用PN 30个月后（平均）提前9.0年停用PN。结果：大多数患者腰椎或股骨BMD Z-score为80 nmol/l。青春期前，身高（-1.4 ~ -0.8,1 ~ 12岁）和体重z分数（-1.3 ~ -0.5,1 ~ 16岁）均低于正常平均值（p < 0.05）。小肠长度与S-25-OHD水平相关（r = 0.489, p = 0.013）。在多变量模型中，戒掉PN后的时间（β = -0.597, p = 0.001）、PN持续时间（β = -0.466, p = 0.006）和钙摄入（β = -0.331, p = 0.035）预测腰椎骨密度下降。结论：在儿童IF中，维生素D不足、继发性甲状旁腺功能亢进和骨密度降低是常见的。在停用PN期间和之后，应密切监测骨密度、维生素D、钙和营养状况，以确保有足够的维生素D和矿物质替代，以实现正常生长和骨量的实现。巴塞尔S. Karger股份有限公司版权所有
Aim: To assess bone health in pediatric intestinal failure (IF). Methods: A population-based cohort of 41 IF patients (age 9.9 years) underwent evaluation of bone mineral density (BMD), bone biochemistry, nutritional status and growth. Eleven patients remained on parenteral nutrition (PN) after 69 months. Thirty had weaned off PN 9.0 years earlier (mean), i.e. after 30 months on PN. Results: The majority of patients had lumbar spine or femoral BMD Z-score 80 nmol/l. Until puberty, height (-1.4 to -0.8, age 1-12) and weight Z-scores (-1.3 to -0.5, age 1-16) were below the normal mean (p < 0.05). Small bowel length associated with S-25-OHD levels (r = 0.489, p = 0.013). In a multivariate model, time after weaning off PN (beta = -0.597, p = 0.001), duration of PN (beta = -0.466, p = 0.006) and calcium intake (beta = -0.331, p = 0.035) predicted decreased lumbar spine BMD. Conclusions: In pediatric IF, vitamin D insufficiency, secondary hyperparathyroidism and decreased BMD are common. BMD, vitamin D, calcium and nutritional status should be closely monitored during and after weaning off PN to ensure sufficient vitamin D and mineral substitution for normal growth and bone mass attainment. Copyright (C) 2013 S. Karger AG, Basel