Total Energy Expenditure and Physical Activity in Children Treated with Home Parenteral Nutrition

0031-3998/03/5304-0684 PEDIATRIC RESEARCH Copyright © 2003 International Pediatric Research Foundation, Inc. Vol. 53, No. 4, 2003 Printed in U.S.A. Total Energy Expenditure and Physical Activity in Children Treated with Home Parenteral Nutrition LAURENT BÉGHIN, LAURENT MICHAUD, RÉGIS HANKARD, DOMINIQUE GUIMBER, EVELYNE MARINIER, JEAN-PIERRE HUGOT, JEAN-PIERRE CÉZARD, DOMINIQUE TURCK, AND FRÉDÉRIC GOTTRAND Division of Gastroenterology, Hepatology and Nutrition, Department of Paediatrics, Jeanne de Flandre University Children’s Hospital and Faculty of Medicine, Lille, France [L.B., L.M., D.G., D.T., F.G.]; Clinical Research Center, CIC-9301-INSERM-CHU, University Hospital, Lille, France [L.B.]; Clinical Research Center CIC-9202-INSERM-AP-HP [R.H.], Division of Gastroenterology, Hepatology and Nutrition [E.M., J.-P.H., J.-P.C.], Robert Debré University Children’s Hospital, Paris, France ABSTRACT 0.21 kJ/min/kg FFM for controls; p ⬍ 0.05, Wilcoxon rank test). These findings were explained by the high correlation between the energy flow infused by parenteral nutrition and sleeping energy expenditure (p ⬍ 0.05, Spearman test) and also-diet induced thermogenesis (p ⬍ 0.05 Spearman test). These results suggest that the energy requirements of children on long-term home parenteral nutrition programs do not differ from controls and that cyclic parenteral nutrition does not interfere with physical activity. (Pediatr Res 53: 684–690, 2003) Determining total energy expenditure (TEE) and its components in children treated with home parenteral nutrition (CHPN) under free-living conditions is an important consideration in the assessment of energy requirements and the maintenance of health. The aim of this study was to assess TEE and physical activity in CHPN. Eleven CHPN (three girls and eight boys; median age, 6.0 y; range, 4.5–15.0 y) were compared with 11 healthy children (three girls and eight boys; median age, 6.0 y, range, 4.5–14.0 y) after pairing for sex, age, and weight. Underlying diseases included chronic intractable diarrhea (n ⫽ 5), short bowel syndrome (n ⫽ 3), and intestinal dysmotility (n ⫽ 3). None of these children had inflammatory disease or recent infection when studied. Fat-free mass (FFM), measured by body impedance analysis, fat mass (FM), measured by skinfold thickness, and energy intake were similar between the two groups, suggesting that CHPN had normal body composition and energy intake. Resting energy expenditure (REE), measured by indirect calorimetry, and TEE, assessed by a technique using 24-h heartrate monitoring calibrated against indirect calorimetry and physical activity using a triaxial accelerometer, were simultaneously recorded and were also similar in the two groups. Sleeping energy expenditure (SEE), expressed per kilogram of FFM, was significantly greater in the CHPN group (median, 0.15; range, 0.10 – 0.23 kJ/min/kg FFM versus median, 0.12; range, 0.09 – Parenteral nutrition (PN) is a lifesaving procedure in children with gastrointestinal tract failure, which is defined as inadequate absorption of nutrients and electrolytes and inReceived February 8, 2002; accepted September 12, 2002. Correspondence: Professor F. Gottrand, Unité de Gastroentérologie, Hépatologie et Nutrition, Clinique de Pédiatrie, Hôpital Jeanne de Flandre, 2, Avenue Oscar Lambret, F59037 Lille Cedex, France; e-mail: Supported by a grant from the French Ministry of Health (Hospital Program for Clinical Research; 1997, Grant Number 1901). DOI: 10.1203/01.PDR.0000057208.05549.3B Abbreviations BMI, body mass index EE, energy expenditure DIT, diet-induced thermogenesis FFM, fat-free mass FM, fat mass HPN, home parenteral nutrition HR, heart rate HRMT, heart rate monitoring technique IC, indirect calorimetry REE, resting energy expenditure SEE, sleeping energy expenditure TEE, total energy expenditure cludes diseases such as chronic intractable diarrhea, short bowel syndrome, and severe intestinal dysmotility (1). This technique is used to supply the appropriate nutrients and fluids to these children, and has recently been used increasingly both in hospitals and at home (2), resulting in an appreciable improvement in these patients’ well-being (3). Estimation of the energy requirements of children treated with HPN (CHPN) is an important consideration in the maintenance of their health. Energy requirements vary according to age, medical condition, and nutritional status. Several methods can be used 684 685 ENERGY IN PARENTERAL NUTRITION to estimate nutrient intake. These are based on anthropometric, biochemical, clinical, and dietary parameters (4 –7). TEE takes into account basal metabolic rate, physical activity (PA), growth, DIT, fecal losses, and maintenance of body temperature. However, CHPN are often troubled by the inconvenience of restricted oral food intake, high intestinal output, and the presence of a stoma or catheter. Moreover, PN is a timeconsuming and intrusive procedure. These factors may impose severe restrictions on diurnal life in terms of social and leisure activities and PA. The high proportion of energy intake supplied to these patients intravenously instead of via the digestive tract may influence food metabolism, and, thus, a change in EE should be anticipated. These drawbacks may affect the EE and PA of these children, and consequently their energy requirements. The aim of this study was to assess TEE and PA in CHPN. PATIENTS AND METHODS Subjects. Twenty-two nonobese children participated in this study. Eleven were receiving cyclic HPN for underlying diseases, including chronic intractable diarrhea (n ⫽ 5), short bowel syndrome (n ⫽ 3), and intestinal dysmotility (n ⫽ 3). CHPN were clinically stable, with no evidence of active inflammatory disease, and had not had surgery for at least 2 mo before evaluation. Six CHPN wore a stoma. Eight were prepubertal, and three subjects were postpubescent. At the time of the study, children had been receiving PN for a median of 36 wk (range, 10 – 84 wk). Minerals, trace elements, and vitamins were provided according to the recommended intake (8). All patients received 12–16 h of nocturnal PN on a median cycle of 5 d (range, 2–7). PN provided 66.4% (range, 15.4 –100%) of the total energy intake of CHPN (Table 1). Total energy intake was in accordance with the French recommended dietary allowances and was similar between the two groups (9). There was no difference in the distribution of glucids, proteins, and fat in the total energy intake between the two groups. The median (range) infusion rate per kilogram of weight was 17.8 mg/min/kg (8.8 –27.2 mg/min/kg) for glucose, 2.5 mg/min/kg (1.5–3.5 mg/min/kg) for amino acids, and 2.2 mg/min/kg (1.2–2.9 mg/min/kg) for fats. Energy intake by PN was distributed as 67.6% glucose (60.9 –75.5%), 10.5% amino acids (6.6 –13.2%), and 20.9% fats (11.3–28.8%). When food consumption was taken into account, the relative distributions of glucids, proteins, and fats in total energ (...truncated)