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American Academy of Pediatrics
Article

Nutritional Considerations in Pediatric Chronic Disease

Wednesday Marie A. Sevilla
Pediatrics in Review August 2017, 38 (8) 343-352; DOI: https://doi.org/10.1542/pir.2016-0030
Wednesday Marie A. Sevilla
*Division of Pediatric Gastroenterology, Hepatology and Nutrition, Children’s Hospital of Pittsburgh, University of Pittsburgh Medical Center, Pittsburgh, PA
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  1. Wednesday Marie A. Sevilla, MD, MPH, CNSC*
  1. *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

    1. Clinicians should be knowledgeable of the multiple factors that affect nutritional status and cause growth failure in children with chronic disease.

    2. Clinicians should be knowledgeable of the basic elements of nutritional assessment in children who need nutritional support for growth failure.

    3. 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:

    1. Determine the pathophysiological factors in childhood chronic disease that lead to growth failure.

    2. Describe components of clinical evaluation and basic anthropometric measurements that are used to monitor nutritional status in children with chronic disease.

    3. 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 …

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    Pediatrics in Review: 38 (8)
    Pediatrics in Review
    Vol. 38, Issue 8
    1 Aug 2017
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    Nutritional Considerations in Pediatric Chronic Disease
    Wednesday Marie A. Sevilla
    Pediatrics in Review Aug 2017, 38 (8) 343-352; DOI: 10.1542/pir.2016-0030

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    Nutritional Considerations in Pediatric Chronic Disease
    Wednesday Marie A. Sevilla
    Pediatrics in Review Aug 2017, 38 (8) 343-352; DOI: 10.1542/pir.2016-0030
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