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Nutrition and Immunological Status in Long-Term Follow Up of Children with Short Bowel Syndrome

Horacio F. González, MD^*, Néstor B. Pérez, MD^*,, Agustina Malpeli^*, María I. Martínez, MD^*, Beatriz Del Buono, PhD^* and Fernando E. Viteri, MD

From the ^* Instituto de Desarrollo e Investigaciones Pediátricas, Hospital de Niños "Sor María Ludovica," La Plata, Argentina; Comisión de Investigaciones Científicas de la Provincia de Buenos Aires, La Plata, Argentina; and the Department of Nutritional Sciences and Toxicology, University of California, Berkeley, California

Correspondence: Horacio F. González, MD, DIP–Instituto de Desarrollo e Investigaciones, Pediátricas Hospital de Niños "Sor María Ludovica" de La Plata, Calle 16 No 1069 1900, La Plata, Argentina. Electronic mail may be sent to institutoinvestigaciones{at}hotmail.com.

Background: Little is known about the long-term evolution, nutrition status, growth, and eventual deficiencies of patients with short bowel syndrome (SBS) adapted to oral feeding after parenteral nutrition (PN). Because there are not absolute criteria for weaning from parenteral or enteral nutrition to oral feeding, new nutrient deficiencies may develop. Subtle nutrition deficits could induce subclinical immune deficiencies; therefore, we studied long-term growth, nutrition status, and the state of the immune system in 10 patients with SBS after weaning PN for at least 2 years. Methods: Ten children with SBS (3–12 years old; mean, 7.4 years) who had not received PN for at least 2 years were studied. Anthropometric measurements, hemoglobin values, and indicators of iron, zinc, copper, folate and vitamin B₁₂ nutrition status were evaluated, along with immunoglobulins, lymphocyte subpopulations, and polymorphonuclear candidicidal activity. Results: Weight-for-height was normal in 8 children; height-for-age was low in 5 children whose SBS was established early in life. Fat body mass was also low in 5 subjects. Four children presented macrocytosis, 2 with anemia. Low serum levels of vitamin B₁₂ (1 child), folates (4 children), and ferritin (2 children) were observed. Diminished candidicidal activity (4 children) was the only remarkable immunological abnormality. Conclusion: Many biologic and growth deficiencies are frequently seen in patients with SBS, even in children adapted to enteral feeding. This finding and the existence of previously unreported decreased candidicidal activity in some patients with SBS deserve long-term clinical and biologic follow up.

Journal of Parenteral and Enteral Nutrition, Vol. 29, No. 3, 186-191 (2005)
DOI: 10.1177/0148607105029003186


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