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Bone Disease in TPN-dependent Infants and Children with Intestinal Failure

Appleman, Stephanie S., M.D.
http://rave.ohiolink.edu/etdc/view?acc_num=ucin1320326652

Abstract Details

2011, MS, University of Cincinnati, Medicine: Clinical and Translational Research.
Total parenteral nutrition (TPN) dependent infants and children with intestinal failure (IF) are at risk for reduced bone mineral content and density owing to inflammation, disturbances in the growth hormone-insulin-like growth factor (IGF)-1 axis or vitamin D and Ca metabolism, and/or aluminum toxicity. We performed a cross sectional study comparing infants and children with intestinal failure with duos of age, sex, and race matched controls. Bone mineral content (BMC) and density (BMD) of the lumbar spine was measured by dual x-ray absorptiometry, and serum cytokines, aluminum, IGF-1 and IGF-BP3, parathyroid hormone (PTH), 25(OH) Vitamin D, and 1, 25(OH)2 Vitamin D were measured. Generalized estimating equation models accounting for matching were used for comparisons. BMC and BMD were lower (15% and 12%) in IF participants than controls (p=0.0009 and p=0.004). However, group differences were attenuated (to 3% and 7%, respectfully) and did not differ (p=0.40 and p=0.07) when adjusted for length and weight. Length and weight percentiles were significantly lower in IF versus control participants (12.5% vs. 63%, p<0.0001; 29.5% vs. 54%, p=0.03). IF participants had significantly higher serum aluminum (23 vs. 7 mcg/L, p<0.0001), IGF-1 (97 vs. 64 ng/mL, p=0.04), and 25 (OH) Vitamin D concentrations (40 vs. 30 ng/mL, p=0.0005), and significantly lower IGF-BP3 (1418 vs. 1812 ng/mL, p<0.0001) and PTH concentrations (51 vs. 98 pg/mL, p=0.0002). No significant difference between IF and control participants was seen for serum cytokines (p=0.09). Additional investigation is needed to elucidate the cause of growth retardation in IF patients and its impact on bone mass and density, especially the role of IGF-1 resistance and aluminum toxicity.
Paul Succop, PhD (Committee Chair)
James Heubi, MD (Committee Member)
17 p.
Surgery
intestinal failure; growth; pediatric; bone mineral density; total parenteral nutrition; DXA

Recommended Citations

Citations

  • Appleman, M.D., S. S. (2011). Bone Disease in TPN-dependent Infants and Children with Intestinal Failure [Master's thesis, University of Cincinnati]. OhioLINK Electronic Theses and Dissertations Center. http://rave.ohiolink.edu/etdc/view?acc_num=ucin1320326652

    APA Style (7th edition)

  • Appleman, M.D., Stephanie. Bone Disease in TPN-dependent Infants and Children with Intestinal Failure. 2011. University of Cincinnati, Master's thesis. OhioLINK Electronic Theses and Dissertations Center, http://rave.ohiolink.edu/etdc/view?acc_num=ucin1320326652.

    MLA Style (8th edition)

  • Appleman, M.D., Stephanie. "Bone Disease in TPN-dependent Infants and Children with Intestinal Failure." Master's thesis, University of Cincinnati, 2011. http://rave.ohiolink.edu/etdc/view?acc_num=ucin1320326652

    Chicago Manual of Style (17th edition)

ucin1320326652
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© 2011, all rights reserved.
This open access ETD is published by University of Cincinnati and OhioLINK.