目的:最佳生长障碍和缺乏适当的体重增加是炎症性肠病(IBD)儿童的主要营养问题。因此,本研究旨在评估非常早发性IBD(VEO-IBD)患者在个体营养干预前后的营养和生长状况.
方法:这项前瞻性队列研究通过进行全面的临床检查并评估人体测量和生化指标,评估了30例VEO-IBD患儿的营养状况。后者包括血清白蛋白的初步评估,前白蛋白,矿物,和25-羟维生素D.为每位患者设计了为期24个月的营养策略.完成研究的患者在6个月后重新评估,并在2年后计算其生长速率。
结果:使用世界卫生组织z评分对营养不良严重程度的初步评估显示,36.7%,43.3%,和26.7%的研究组体重不足,发育不良,和浪费,分别。在研究人群中,克罗恩病的患病率最高。几乎所有患者都有微量营养素缺乏(即,铁,钙,锌,镁,和维生素D)和低于正常的营养标志物血清水平(即,前白蛋白和白蛋白)。干预后六个月,人体测量和生化参数显著改善(p<0.05);然而,计算出的增长率在两年后显示出相当大的下降。
结论:早期发现VEO-IBD患者的营养损害仍然是一个重大挑战。因此,必须对这些患者进行营养支持和持续监测,以确保其营养状况得到改善并达到可接受的生长速度。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.
OBJECTIVE: 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.
METHODS: 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.
RESULTS: 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.
CONCLUSIONS: 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.