Stanje prehranjenosti pri otrocih s primarnimi imunskimi pomanjkljivostmi

Lipovec, Neža (author), Ihan, Alojz (mentor), Avčin, Tadej (comentor)

Pri otrocih s primarnimi imunskimi pomanjkljivostmi (PIP), zlasti pri tistih s težjimi oblikami, je tveganje za pojav podhranjenosti zaradi pogostih in težje potekajočih okužb, veliko. Le bolniki s primernim stanjem prehranjenosti imajo optimalne pogoje za ugoden razplet bolezni, zato je pomembno, da podhranjene posameznike čim prej prepoznamo in jim nudimo ustrezno prehransko podporo. Namen naše raziskave je bil opredeliti stanje prehranjenost otrok s PIP. Ugotoviti smo želeli, ali se stanje prehranjenosti s časom izboljšuje. Raziskovali smo tudi stanje prehranjenosti pri bolnikih, ki so prejeli presaditev krvotvornih matičnih celic (KMC). Zanimalo nas je, ali po opravljeni presaditvi KMC dosežejo stanje prehranjenosti primerljivo z zdravo populacijo. S pomočjo 3-dnevnih prehranskih dnevnikov smo zbirali podatke o prehrani bolnikov. Želeli smo preveriti, ali se prehranjujejo skladno s priporočili. K sodelovanju smo povabili bolnike s PIP, mlajše od 19 let, ki so vodeni v Centru za PIP na Pediatrični kliniki v Ljubljani. Pri oceni stanja prehranjenosti je sodelovalo 38 bolnikov, 14 jih je izpolnilo prehranske dnevnike. Podatke o telesni masi, višini, indeksu telesne mase (ITM) in načinu zdravljenja smo zbirali retrospektivno iz ambulantnih kartotek. Stanje prehranjenosti smo ocenjevali z uporabo rastnih krivulj (masa, višina in ITM za starost). Prehranske dnevnike smo analizirali s pomočjo programa Prodi 6.7 Expert Plus. Ugotovili smo, da je bilo ob prvem pregledu podhranjenih 13 - 18 %, ob pregledu po 1,5 - 3,5 letih 3 - 24 % in ob zadnjem pregledu 3 - 13 % preiskovancev, odvisno od uporabljenega kriterija (masa, višina, ITM za starost). Bolniki, ki so prejeli KMC, ob zadnjem pregledu niso bili podhranjeni. Prehranski vnos pri preiskovancih ni bil optimalen. Opažali smo prenizek energijski vnos, prenizek vnos n-3 maščobnih kislin, kalcija, železa, bakra, cinka ter nekaterih vitaminov (A, C, E, B12 in folne kisline). Pri 3 bolnikih (25 %) smo ugotovili previsok vnos beljakovin. Z raziskavo smo potrdili, da je delež podhranjenih otrok s PIP razmeroma visok in da se bolniki ne prehranjujejo skladno s priporočili. Dobljeni rezultati kažejo na pomembnost vključitve dietetika v obravnavo bolnikov s PIP.

• Language: Slovenian
• Keywords: prehrana, stanje prehranjenosti, podhranjenost, primarne imunske pomanjkljivosti, otroci, mladostniki
• Work type: Master's thesis/paper
• Typology: 2.09 - Master's Thesis
• Organization: BF - Biotechnical Faculty
• Publisher: [N. Lipovec]
• Year: 2018
• PID: 20.500.12556/RUL-99965
• UDC: 613.24-053.2:616-097
• COBISS.SI-ID: 4883576
• Publication date in RUL: 28.02.2018

Secondary language

• Language: English
• Title: Nutritional status of children with primary immunodeficiency diseases

Abstract

Children with primary immunodeficiency diseases (PIDs), especially those with severe forms, have a high risk of malnutrition due to recurrent and severe infections. Patients with adequate nutritional status have better chances for more favourable outcome of PIDs. Therefore, it is important that the malnourished individuals are recognized and provided with nutritional support as soon as possible. The purpose of this study was to assess the nutritional status of children with PIDs. We aimed to determine if the nutritional status improved over time. We studied the nutritional status of patients who received hematopoietic stem cell transplantation (HSCT) as well. Furthermore, we were interested whether their nutritional status after the HSCT was comparable to a healthy population. The data on patient nutrition were obtained from 3-day dietary records and analyzed with the Prodi 6.7 Expert Plus software. All patients with PIDs under the age of 19, admitted to the Center for PIDs at the Pediatric Clinic in Ljubljana were invited to take part in our study. Thirty-eight patients participated in the assessment of nutritional status and fourteen of them filled-out their dietary records. Information about patients weight, height, body mass index (BMI) and type of treatment was collected retrospectively from the outpatient medical records. The nutritional status was evaluated using growth charts (weight, height and BMI for age). Our research showed that at the first examination, 13 - 18 % patients were malnourished, at examination after 1,5 - 3,5 years 3 - 24 % and at the last examination 3 - 13 %, depending on the criteria that we have used (weight, height, BMI for age). Patients who received HSCT were not malnourished at the last examination. We concluded that the diet of children with PIDs is inadequate. It was characterized by low energy intake and deficient intake of n-3 fatty acids, calcium, iron, copper, zinc and some vitamins (A, C, E, B12 and folic acid). In three patients (25%) we observed excessive protein consumption. The study confirmed that the proportion of malnourished children among patients with PIDs is relatively high and that their nutrition is inadequate. Incorporating the dietitian into the treatment of patients with PIDs is therefore essential.

• Keywords: nutrition, nutritional status, malnutrition, primary immunodeficiency diseases, children, adolescents