The Impact of Long-Term Parenteral Nutrition on Physical Development and Bone Mineralization in Children with Chronic Intestinal Failure

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.