Nutritional evaluation of children with cholestatic diseases

Abstract

Objetivo: Caracterizar o grau de desnutrição e a utilidade dos índices antropométricos em crianças com doença crônica do fígado.Métodos: Foram examinados 11 pacientes, com idades variando de 5 a 105 meses. A definição do estado nutricional se fez através da determinação dos escores Z de peso para a idade (P/I) e estatura para a idade (E/I). Também se avaliou o estado nutricional através do critério de Waterlow: comparação do peso do paciente com o peso ideal para a estatura (P*), e estatura do paciente em relação à estatura ideal para a idade (E*). A estimativa dos depósitos de gordura foi feita através da medida da prega cutânea tricipital (PCT), e aquela do teor protéico do organismo, através da circunferência muscular do braço (CMB). A avaliação da ingestão alimentar, tanto qualitativa como quantitativamente, foi feita pelo método do recordatório de 24 horas.Resultados: Os escores Z médios de peso/idade (-1,18) e de estatura/idade (-1,26) foram inferiores a um desvio padrão da média, enquanto o escore Z médio de peso /estatura (0.8) situou-se numa faixa normal. A avaliação pelo método de Waterlow mostra uma média normal de P* e um pouco abaixo do normal de E*. Apenas 3 pacientes tinham medida de PCT maior que o percentil 15, e 5 deles tinham as medidas de CMB maior que esse mesmo percentil. A ingestão alimentar do ponto de vista qualitativo foi adequada em apenas 4 dos pacientes. Quanto à distribuição calórica dos nutrientes, em todos ela foi inadequada.Conclusões: A determinação dos escores Z permite caracterizar esse grupo de pacientes como desnutridos crônicos, com uma média de escore Z de P/E dentro da faixa do normal. O diagnóstico nutricional feito através do método de Waterlow aponta para a necessidade de se ter cautela na sua interpretação, uma vez que esses pacientes geralmente têm visceromegalia. O escore Z médio da prega cutânea tricipital foi o parâmetro que melhor refletiu o comprometimento nutricional dos pacientes. Do ponto de vista alimentar, considerando-se o fator de risco da patologia, tanto qualitativa como quantitativamente, a ingestão mostrou-se inadequada. J. pediatr. (Rio J.). 1997; 73(1):43-50:antropometria, avaliação nutricional, doença crônica do fígado, colestase. AbstractObjective: To characterize the type of malnutrition and to determine the usefulness of anthropometric indices in children with chronic liver disease (CLD) Methods: 11 children (aged 5 -105 mo) with CLD underwent anthropometric evaluation when they were clinically stable. The nutritional evaluation was made by the determination of Weight/ Age (W/A), Height/Age (H/A) and Weight/Height (W/E) Z scores. The nutritional evaluation by Waterlow's method was also made. The fat and protein body deposits were estimated by triceps skinfold and midarm muscular circumference measurements. The analysis of the 24-hour recall was used to evaluate the quality and pattern of the feeding. Results:The mean weight / age (W/A = -1.18) and height / age (H/A = -1.26) Z scores were depressed under 1 SD, whereas mean weight / height (W/H) Z...

Nutritional evaluation of children with chronic cholestatic disease

“…This finding differed from the results reported by Cardoso et al, 21 who observed higher initial loss Note: For evaluation of height/age index, Z-score was categorized as very low (Z-score < −3); low (Z-score ≥ −3 and <−2); adequate (Z-score ≥ −2). For the weight/age index, as very low (Z-score < −3); low (Z-score ≥ −3 and <−2); adequate (Z-score ≥ −2 and ≤+2); high (Z-score > +2).…”

“…The estimate of fat deposits through TST and of protein content by AMC and AC are complementary data that allow for an accurate nutritional evaluation of these patients. 3,21,22 In the present study, one-third of patients showed W/A and H/A indices under −2 Z-scores. Considering the W/H index, only 12.1% of patients had Z-score lower than −2; in relation to the BMI, the percentage was 16.5%.…”

“…These methods proved to be similar and important in the nutritional assessment of patients with chronic cholestatic liver disease. Accordingly, Cardoso et al 21 showed even higher indices of inadequate diet (90%) when food intake was evaluated qualitatively and quantitatively. This is even more worrying, since caloric intake should be optimized to up 140% of the expected.…”

“…21 The anthropometric indices that consider weight and height, such as W/H and BMI, may also not reveal the real degree of depletion attributable to chronic clinical condition of these patients, in which both weight and height are impaired. TST and AC measures appear to be more accurate parameters for nutritional evaluation of patients with liver diseases and cholestasis.…”

Feeding practices in 6-24-month-old children with chronic cholestatic liver diseases: A mixed-method study

“…Previous studies revealed that the feeding practices were suboptimal, but these studies lacked detailed descriptions and analyses of dietary intake and had small sample sizes. In addition, these studies were conducted before the feeding guidelines for children with chronic cholestasis were published; thus, their conclusions were drawn through comparison to the RDA of normal children instead of cholestatic children [11,12] . Moreover, the reasons behind parents' feeding practices remain unclear, making it di cult to cost-effectively promote behavioral changes.…”