Nutritional Condition of Patients with Short Bowel Syndrome in the Post Parenteral Nutrition Period

AIM: To evaluate the anthropometric, iron, B12 Vitamin and folate nutritional condition in patients with short bowel syndrome (SBS) after suspending parenteral nutrition (PN) for no less than 2 years. PATIENTS AND METHODS: We studied 10 pediatric patients with SBS. Anthropometric parameters evaluated: weight, height, brachial perimeter, and width of subscapular, suprailiac, bicipital and tricipital cutaneous folds with Lange caliper. Waterlow′s classification of nutritional condition was used according to weight/height (W/H) and height/age (H/A) fitting percentages, usinge NCHS reference tables. Values, volume and concentration of hemoglobin were assessed, as well as those of ferritin, transferrin, ferremia and percent saturation of transferrin, folic acid, and B12 vitamin. A nutritional survey was also performed. RESULTS: The age range of the patients was 3.3 - 12.9 yrs. The mean of residual bowel was 46.3 cm (range:20–70), jejunum: 30.4 (10–60), ileum 17.9 cm (0–60). The average time of PN dependence was 378.5 days (range:70 – 900). W/H was normal in 8 patients, with a Score I deficit in 2 patients and a low percent of fatty and lean body mass in 1 patient. H/A was abnormally low in 5 patients: 3 Score 1, and 2 Score II. Height was already affected during the PN period The percent of adipose mass was low in 5 patients. Three patients presented anemia, two of which also developed macrocytosis. Such alteration in MCV was also found in two cases where anemia was absent. The levels of B12 vitamin (1 patient) and serum folates (4 patients) were low. The nutritional survey showed that the average daily intake of B12 vitamin and folic acid was adequate, while 50% of patients could not adapt to the intake of iron. Caloric and protein intakes were 110 (range: 67–238) and 326 (r:122–684), respectively. CONCLUSION: Malabsorption of macro and micronutrients can manifest subtly and late. Height in 50% of patients was affected since they were receiving PN. Despite the protein intake fitting percent was well above 100% in all patients, they would apparently not be able to develop a compensatory growth capacity in the post-PN period. Both nutritional control and long-term clinical-biological follow-up should be very strict in SBS patients after PN retrieval.