Body composition and energy expenditure in a population of children and adolescents with myelomeningocele

Abstract

Introduction.Myelomeningocele is a congenital defect that occurs when the neural tube fails to close completely. It causes body composition alterations and a high prevalence of obesity. It is difficult to detect the most adequate indicator for a nutritional diagnosis due to the impossibility of recording accurate anthropometric measurements. Objective. To describe body composition, resting energy expenditure and metabolic disorders in a population of patients with myelomeningocele managed at "Hospital Garrahan" by comparing obese patients with myelomeningocele and a control population with multifactorial obesity. Population and methods. An anthropometry, an impedance analysis, skinfold equations, arm circumference equations, indirect calorimetry, and biochemical determinations were done to all patients with myelomeningocele between June 2013 and April 2014, once the informed consent had been signed. Results. 131 patients aged 0.7-18.6 years were assessed; they were classified according to their body mass index Z-score into low weight (15%), normal weight (42%), overweight (12%), and obese (31%). A high correlation (r: 20.74) was observed between the fat mass % measured by impedance analysis versus that estimated using skinfolds. Patients with a high fat mass % had a higher body mass index Z-score than those with a normal fat mass % (1.07 versus -0.27, p: 0.0001) although both values were within normal parameters. A lower resting energy expenditure was observed among obese patients with myelomeningocele than predicted and in comparison with multifactorial obese controls. Conclusions. A high percentage of overweight/ obesity was found in the population with myelomeningocele. Skinfold equations would be more adequate to detect obesity. Obese patients with myelomeningocele had a lower resting energy expenditure than predicted and in comparison with controls. Energy indication should be customized.

Resting Energy Expenditure and Body Composition in Children and Adolescents With Genetic, Hypothalamic, Medication-Induced or Multifactorial Severe Obesity

“…As an example, our hypothalamic obesity group included two patients with meningomyelocele, both of which had a decreased REE% of 79.7% and 84.3%. This is in line with a recent study in 31 children with obesity with meningomyelocele where an average REE of 82% of predicted values was found ( 63 ). Importantly, a head-to-head comparison of these studies is hampered by the use of different methods to assess body composition (bioimpedance analysis [BIA] ( 25 , 63 ) or dual energy x-ray absorptiometry [DXA] ( 24 , 26 , 56 )) and different indirect calorimetry systems.…”

Describing Energy Expenditure in Children with a Chronic Disease: A Systematic Review

“…Of the included studies, 260 (96%) had <100 participants, whereas 253 (93%) had <50 participants. Only 7 disease categories had participant cohorts >100: cystic fibrosis ( n = 236 [ 23 ]; n = 134 [ 24 ]); developmental disability ( n = 256 [ 25 ]); eating disorders ( n = 181 [ 26 ]); endocrine ( n = 292 [ 27 ]); neurological conditions ( n = 236 [ 23 ]; n = 131 [ 28 ]); neuromuscular disease ( n = 122 [ 22 ]); and other, mixed, and unstratified cohort ( n = 236 [ 23 ]; n = 398 [ 29 ]). Age of participants ranged from birth to 18 y.…”

Body Composition and Energy Expenditure in Youth With Spina Bifida: Protocol for a Multisite, Cross-Sectional Study

“…In fact, the use of these equations would grossly overestimate the energy needs of youth with SB, resulting in overfeeding and further weight gain [ 34 ]. There is evidence supporting that youth with SB have a reduced energy expenditure, but the amount has not been specified [ 8 , 31 , 32 , 34 , 59 ]. Similar to body composition measurement, preliminary studies in small samples have been conducted but need to be tested in larger samples with validated criterion measures of energy expenditure [ 31 , 32 , 34 ].…”