Nutritional assessment of a population with a history of childhood craniopharyngioma seen at Hospital “Prof. Dr. Juan P. Garrahan”

Abstract

Introduction.Craniopharyngiomas are histologically benign malformations located between the pituitary and hypothalamus that may affect key hormone secretion for endocrine regulation and satiety modulation. Although this is a relatively benign disease, the combination of severe hypothalamic obesity and associated comorbidities results in a reduced quality of life. Objective. To assess the nutritional status of patients after craniopharyngioma surgery. Population and Methods. Patients younger than 21 years old at the time of the study who required craniopharyngioma surgery at Hospital de Pediatría Garrahan and who signed an informed consent. Anthropometric characteristics, body composition by impedance analysis, energy expenditure by indirect calorimetry and energy intake were assessed. Insulin resistance and dyslipemia were estimated. Results. A total of 39 patients were included; 41% had a normal weight and 59% were obese. Overall, 68% of patients had a central fat distribution; 40% had insulin resistance; and 32%, dyslipemia. No significant differences were observed in terms of insulin resistance, dyslipemia, energy expenditure at rest, or energy intake between normal weight and obese patients. Among obese patients, 77% had a low energy expenditure, regardless of their percentage of lean body mass (62 ± 2.7% versus 61.2 ± 1.8% of normal versus low energy expenditure at rest; p = 0.8). Conclusions. A total of 59% of the studied population was obese. No significant differences were observed in terms of metabolic complications between normal weight and obese patients. A lower energy expenditure was observed, regardless of the lean body mass percentage and a similar energy intake.

Resting energy expenditure in children at risk of hypothalamic dysfunction

“…REE was shown to be lower in CP patients compared to children with multifactorial obesity regardless of the amount of fat-free mass or when compared to matched controls ( 18 ). In another study, CP patients were shown to have a 17% lower REE value compared to the values that were expected from the WHO equation ( 49 ). Our study results confirm that REE may be lowered in children with hypothalamic damage and shows that this is associated to the degree of clinical HD (in the multivariate analysis), as well as to radiological posterior hypothalamic damage (in the univariate analysis).…”

“…To our knowledge, this is the first study in which REE measurements of children with brain injury at risk of HD have been associated with scores for clinical HD and radiological hypothalamic damage. Previous cohort studies have examined REE measurements in children with brain injury and compared them to obese children without brain injury or compared REE measurements in normal weight craniopharyngioma (CP) patients with those in obese CP patients ( 15 , 18 , 49 , 50 , 51 , 52 ). REE was shown to be lower in CP patients compared to children with multifactorial obesity regardless of the amount of fat-free mass or when compared to matched controls ( 18 ).…”