Peer-reviewed article
The Impact of Long-Term Parenteral Nutrition on Physical Development and Bone Mineralization in Children with Chronic Intestinal Failure.
Hanna Romanowska, Mikołaj Danko, Katarzyna Popińska, Joanna Żydak, Marta Sibilska et al. ·
Summary
Written by AI, not yet AICS's view · claude-haiku-4-5-20251001This study compared 26 children with chronic intestinal failure receiving long-term parenteral nutrition to 60 healthy children. Children on parenteral nutrition had significantly lower height, weight, and body mass index than healthy peers. While most had acceptable bone mineral density, about one-third showed signs of bone mineralization problems. The children had lower levels of key minerals like calcium, phosphorus, and magnesium in their blood, though no actual fractures or clinical bone disease was observed.
Key points
- CIF children had significantly lower height, weight, and BMI Z-scores than controls (p < 0.001)
- 34.7% of children had lumbar spine bone mineral density Z-scores ≤ -2, indicating increased risk for bone mineralization disorders
- Lower serum calcium, phosphorus, and magnesium were observed in LPN patients compared to controls (p < 0.001)
- Higher urinary calcium and aluminum excretion in parenteral nutrition patients, positively correlated with vitamin D levels
- No clinical complications such as pathological fractures were observed despite risk factors for metabolic bone disease
Limitations
The study is cross-sectional without longitudinal follow-up, so it cannot establish causation or show whether bone mineralization problems worsen or improve over time. The small sample size of 26 children with chronic intestinal failure limits generalizability of findings.
Abstract
BACKGROUND: This cross-sectional study aimed to assess growth, body weight, and bone mineralization and to identify predictors of metabolic bone disease (MBD) in children with chronic intestinal failure (CIF) on long-term parenteral nutrition (LPN). METHODS: Twenty-six children with CIF were evaluated on total parenteral nutrition (PN) for at least three years, and 60 healthy controls were assessed. Measurements included body weight, height, BMI, serum levels of 25-hydroxyvitamin D3 (25-OHD3), calcium (Ca), phosphorus (P), magnesium (Mg), and aluminum (Al), as well as urinary excretion of these elements. Dual-energy X-ray absorptiometry (DXA) and the mid-arm muscle area (MAMA) and mid-arm fat area (MAFA) of the CIF group were estimated. RESULTS: CIF children had significantly lower height, weight, and BMI Z-scores than controls (p < 0.001). While the median bone mineral density (BMD) Z-score was >-2, 34.7% had L1-L4 Z-scores ≤ -2. Urinary Ca and Al excretion were higher in LPN patients, positively correlating with serum 25-OHD3 levels (r = 0.48). Lower serum Ca, P, and Mg were observed in LPN patients (p < 0.001), and BMC L1-L4 correlated positively with MAMA, MAFA, and BMI. CONCLUSIONS: The physical development of children who require long-term parenteral nutrition due to intestinal failure is poorer than that of healthy children. Although there are risk factors for bone mineralization disorders in children with intestinal failure, no clinical issues, such as pathological fractures, have been observed.