Bioelectrical impedance phase angle and nutritional status in children with intestinal failure on prolonged parenteral nutrition

Alves, Victória A.; Giesta, Juliana M.; Bosa, Vera L.; Goldani, Helena A.S.

doi:10.1016/j.jped.2023.12.006

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Sumário

Original article • J. Pediatr. (Rio J.) 100 (5) • 2024 • https://doi.org/10.1016/j.jped.2023.12.006 copy

Bioelectrical impedance phase angle and nutritional status in children with intestinal failure on prolonged parenteral nutrition^☆ ☆ Institution: Post-Graduate Program of Child and Adolescent Health, Faculdade de Medicina, Universidade Federal do Rio Grande do Sul and Hospital de Clinicas de Porto Alegre.

Authorship SCIMAGO INSTITUTIONS RANKINGS

Abstract

Objective

To compare the phase angle (PhA) through bioelectrical impedance (BIA) of children with intestinal failure (IF) using prolonged parenteral nutrition (PN) followed by an Intestinal Rehabilitation Program, with a control group.

Methods

Children under 10 years of age with IF using prolonged PN for >60 days (study group) were included. The control group consisted of healthy children without chronic pathologies, matched by sex and age. Anthropometric parameters evaluated were: weight, height, weight/age z-score (W/A), height/age z-score (H/A), BMI, BMI/A z-score, arm circumference, triceps skinfold, subscapular skinfold, mid-arm muscle circumference. BIA parameters were resistance (R), reactance (Xc), and phase angle (PhA).

Results

Twenty-eight children were included in the study group, median (IQR) age was 11 (8-27) months, 53.6 % were male. In the control group, 28 children were included, median (IQR) age was 12.5 (8-24.7) months, 50 % were male. Children from the study group had W/A z-scores and H/A z-scores significantly lower than controls. There was no significant difference between PhA in the study group and controls, [median (IQR) 4.3° (3.8;4.6) vs 4.0° (3.8;5.4) respectively, p = 0.980]. Prematurity was significantly higher in the study group than in the controls, but there was no significant correlation between gestational age at birth and PhA of the children from the study group.

Conclusion

Children with IF using prolonged PN showed lower W/A and H/A compared to the control group, but without significant difference between the PhA of children with IF compared to controls.

Keywords
Phase angle; Bioelectrical impedance; Child; Intestinal failure; Short bowel syndrome; Parenteral nutrition

Characteristics	Study group (n = 28)
Days of use of PN¹ 1 PN - parenteral nutrition.	451.5 (280; 889.7)
RI² 2 RI - remaining intestine. (cm)	37.5 (19.2; 58.7)
SBS classification³ 3 SBS - short bowel syndrome. (n = 26)
type I	5 (19 %)
type II	14 (53 %)
type III	7 (26 %)
Absence of ICV⁴ 4 ICV - ileocecal valve.	19 (73 %)
Causes of IF⁵ 5 IF - intestinal failure.
volvo	7 (25 %)
atresia	7 (25 %)
enterocolitis	6 (21 %)
gastroschisis	4 (14.3 %)
long segment Hirschsprung	3 (10.7 %)
other causes	1 (3.6 %)
PN dependence ratio	0.97 (0.8; 1.2)
mild	7 (25 %)
moderate	14 (50 %)
high	7 (25 %)
Enteral nutrition⁶ 6 percentage of enteral feed calories in relation to Recommended Dietary Allowance (RDA) guidelines for energy intake.	72.8 % (43.0; 114.8)

Variable	Study Group n = 28	Control Group n = 28	p
Age (months)	11 (8; 27.2)	12.5 (8; 24.7)	0.908
Sex Masc	15 (53.6 %)	15 (53.6 %)	1.000
Prematurity	18 (64.3 %)	5 (17.9 %)	0.001^* ⁎ statistically significant. P values were determined using the t-Test or Mann-Whitney U test or Fisher chi-square test.
Gestational age at birth (weeks)	34.9 ± 4.4	38.2 ± 3.0	0.002^* ⁎ statistically significant. P values were determined using the t-Test or Mann-Whitney U test or Fisher chi-square test.
Weight (kg)	9.2 (7; 12.4)	9.6 (8; 13.2)	0.210
Height (cm)	71.7 (67.1; 88.7)	73.2 (68.5; 89.9)	0.362
W/A¹ 1 weight for age. (z-score)	−0.63 ± 1.1	0.3 ± 1.0	0.002*
W/A Rating:
Underweight	2 (7.1 %)	1 (3.6 %)
Eutrophic	26 (92.8 %)	27 (96.4 %)
Overweight	0 (0 %)	0 (0 %)
H/A² 2 height for age. (z-score)	−1.2 ± 1.3	−0.43 ± 0.1	0.023^* ⁎ statistically significant. P values were determined using the t-Test or Mann-Whitney U test or Fisher chi-square test.
H/A Rating:
Short	6 (21.4 %)	1 (3.6 %)	−0.101
Eutrophic	22 (78.6 %)	27 (96.4 %)
BMI³ 3 body mass index. (kg/m²)	16.6 ± 1.5	17.4 ± 1.7	0.063
BMI/I⁴ 4 body mass index for age. (z-score)	0.05 ± 1.1	0.6 ± 1	0.066
BMI/A Rating:
Underweight	2 (7.1 %)	0 (0 %)
Eutrophic	24 (85.7 %)	27 (96.4 %)	0.285
Overweight	2 (7.1 %)	1 (3.6 %)
AC⁵ 5 arm circumference. (cm)	15.2 ± 2	15.5 ± 2.3	0.530
TST⁶ 6 triceps skinfold. (mm)	9.4 (7.2; 10)	7 (5.1; 10)	0.104
SST⁷ 7 subscapular skinfold. (mm)	7 ± 3	5.9 ± 1.6	0.077
MAMC⁸ 8 mid-arm muscle circumference. (cm)	12.3 ± 2.1	13.1 ± 2.9	0.234
Bioimpedance (BIA)
Resistance (ohms)	675.9 ± 87.4	713.3 ± 81.1	0.102
Reactance (ohms)	51.0 (44.7; 58.7)	51.7 (47.4; 63.3)	0.283
PhA⁹ 9 phase angle. (°)	4.3 (3.8; 4.6)	4.0 (3.8; 5.4)	0.980

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[1] ☆
Institution: Post-Graduate Program of Child and Adolescent Health, Faculdade de Medicina, Universidade Federal do Rio Grande do Sul and Hospital de Clinicas de Porto Alegre.