BODY COMPOSITION AND NUTRITIONAL INTAKE IN CHILDREN WITH CHRONIC KIDNEY DISEASE

BODY COMPOSITION AND NUTRITIONAL INTAKE IN CHILDREN WITH CHRONIC KIDNEY DISEASE

Accurate assessment of nutrition is an essential component in the management of children in chronic renal failure and post-renal transplantation. in children with chronic renal failure, protein-energy malnutrition is commonly encountered and its  etiology is multifactorial. in addition to anorexia and uraemia-associated effects, such as resistance to insulin and growth factors, hyperglucagonemia, hyperparathyroidism, or metabolic acidosis lead to a reduction in muscle mass and an acceleration of protein catabolism. recent studies have also shown the existence of a malnutrition-inflammation complex in which chronic inflammation leads to protein-energy malnutrition.
dietary intervention, ranging from oral supplementation to gastrostomy  feeding is therefore seen as fundamental step in the management of children with chronic renal failure.

   

Excessive weight gain in chronic kidney disease may also be associated with an increased risk of cardiovasculer morbidity. Althought the body mass index was developed as a reliable method of assessing body fat and nutritional status in public health studies. age-matched data have facilitated its use in childhood population studies and subsequently have increasingly been use to access nutritional status in children with chronic disease. however, its value in this setting, where children may also suffer from growth retardation has been questioned. in addition reduced levels of physical activity, and stage renal disease with the need for dialysis and immune-modulating therapy such as glucocorticoids may further confound the interpretation of body mass index. furthermore, it is increasingly being recognised that truncal obesity is associated with a higher risk of cardiovascular morbidity and, that body mass index by itself, has limited value in assessing regional body composition.

There is, therefore, a need to explore alternative tools that can be more reliably used as a measure of body composition   in the clinical setting of chronic kidney disease in children. Dual X-Ray energy absorptiometry is often used as relatively non-invasive and inexpensive method of as a assessing total and regional body composition and preliminary studies suggest that it may have a place in assessing body composition in children with chronic kidney disease. Ideally reference data of children should account for potential variables such as age. gender, sex, pubertal status and ethnicity but these are currently lacking. additionally, publish data have not examined the effect of short status on measures of body composition or reported regional changes.

Posted in: CHRONIC KIDNEY DISEASE