Nutritional Considerations in Pediatric Chronic Disease

Wednesday Marie A. Sevilla

doi:10.1542/pir.2016-0030

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Wednesday Marie A. Sevilla, MD, MPH, CNSC*

^*Division of Pediatric Gastroenterology, Hepatology and Nutrition, Children’s Hospital of Pittsburgh, University of Pittsburgh Medical Center, Pittsburgh, PA

AUTHOR DISCLOSURE
Dr Sevilla has disclosed no financial relationships relevant to this article. This commentary does not contain a discussion of an unapproved/investigative use of a commercial product/device.

Abbreviations

BMI:: body mass index
CF:: cystic fibrosis
CHD:: congenital heart disease
CKD:: chronic kidney disease
DRI:: daily required intake
ESLD:: end-stage liver disease
GH:: growth hormone
GI:: gastrointestinal
IBD:: inflammatory bowel disease
MCT:: medium-chain triglycerides

Practice Gaps

Clinicians should be knowledgeable of the multiple factors that affect nutritional status and cause growth failure in children with chronic disease.
Clinicians should be knowledgeable of the basic elements of nutritional assessment in children who need nutritional support for growth failure.
Clinicians should be aware of the effects of limited dietary intake on nutritional status and growth.

Objectives

After completing the article, readers should be able to:

Determine the pathophysiological factors in childhood chronic disease that lead to growth failure.
Describe components of clinical evaluation and basic anthropometric measurements that are used to monitor nutritional status in children with chronic disease.
Recognize the effects of a restricted diet on nutritional intake adequacy.

Introduction

Growth failure, defined as the inability to reach expected growth potential based on standard anthropometric measurements for age regarding weight and height, is common in chronic childhood disease. Growth failure in chronic childhood disease is multifactorial. Nutritional outcome is affected by baseline nutritional status, disease state, and, rarely, an inherent genetic abnormality. (1) A sign of growth failure is stunting, defined as length or stature below the minimum cutoff for age, usually the fifth percentile. (2) It represents systemic dysfunction during an important phase of physical development and is the hallmark of chronic malnutrition. Related to this is the definition of short stature—a height measurement 2 standard deviations (SD) scores below the mean for age and sex. Wasting, on the other hand, is an indicator of acute malnutrition and is defined as weight-for-height or -length 2 SD scores or more below the mean for age and sex. It usually signals more recent weight loss. (2)

The measurement of height and …