Anthropometric, biochemical and clinical assessment of malnutrition among Egyptian children with chronic liver diseases: a single institutional cross-sectional study

BMC Gastroenterol. 2019 Dec 21;19(1):223. doi: 10.1186/s12876-019-1145-3.

Abstract

Background: Malnutrition is a common problem among children with chronic liver diseases (CLD). We aimed to assess the nutritional status of children with CLD and to correlate the anthropometric indices with the severity of liver disease, liver function tests, insulin growth factor-1 (IGF-1) and 25-hydroxy vitamin D (25- OH D).

Methods: A total of 69 patients with CLD and 50 healthy controls (6 months - 6 years) were included in the study. Nutritional status was assessed by anthropometric indices expressed in standard deviation score (Z score), biochemical, hematological and clinical parameters.

Results: We found 52.2% of CLD patients underweight by weight for age (W/A); 50.2% were stunted by height for age/ length for age (HAZ or LAZ); and 39% exhibited wasting by weight/height or (length) for age (W/HZ or W/LZ) z scores analysis. The mean values of z scores for all anthropometric parameters were significantly correlated with unconjugated and conjugated bilirubin and INR (p < 0.05), except HAZ or LAZ. Also, a significant correlation to albumin was found, except for W/HZ or (W/LZ) (p = 0.157). The z scores < - 2 SD based on W/ H versus arm indicators showed significant differences in MUAC, UAA and AMA (p < 0.001). We found no correlation between anthropometric z-scores and the mean IGF-1 and (25- OH D) values (p > 0.05). Malnutrition was directly correlated with the severity of hepatic dysfunction, particularly, Child-Pugh C cases. The mean IGF-1 and (25- OH D) values were significantly correlated with the severity of liver disease (p < 0.001).

Conclusions: Our results identified anthropometric arm indicators and MUAC/A measurements as an effective applied methods for assessing nutritional status in CLD children. Moreover, Integrating comprehensive clinical assessment, anthropometric measurements and objective biochemical analyses is essential for evaluation, follow-up and management of CLD children with variable degree of malnutrition.

Keywords: Anthropometry; Children; Chronic liver diseases; Malnutrition; Nutritional assessment.

MeSH terms

  • Age Factors
  • Arm / anatomy & histology
  • Body Height
  • Body Weight
  • Carrier Proteins / blood
  • Case-Control Studies
  • Child
  • Child, Preschool
  • Chronic Disease
  • Cross-Sectional Studies
  • Egypt
  • Female
  • Growth Disorders / blood
  • Growth Disorders / diagnosis
  • Head / anatomy & histology
  • Humans
  • Infant
  • Insulin-Like Growth Factor I / analysis
  • Liver Diseases / blood
  • Liver Diseases / complications*
  • Liver Function Tests
  • Male
  • Malnutrition / blood
  • Malnutrition / diagnosis*
  • Malnutrition / etiology
  • Nutrition Assessment*
  • Serum Albumin / analysis
  • Severity of Illness Index
  • Skinfold Thickness
  • Thinness / blood
  • Thinness / diagnosis
  • Vitamin D / analogs & derivatives
  • Vitamin D / blood
  • Wasting Syndrome / blood
  • Wasting Syndrome / diagnosis

Substances

  • Carrier Proteins
  • IGF1 protein, human
  • Serum Albumin
  • bilirubin binding protein, human
  • Vitamin D
  • Insulin-Like Growth Factor I
  • 25-hydroxyvitamin D