ibd - PEDIATRIC IBD Growth and Nutrition By Karla Au Yeung,...

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PEDIATRIC IBD Growth and Nutrition By Karla Au Yeung, MD MAJ, MC, USAR 3 November 2000
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Objectives Epidemiology/Definition Complications/ Mechanisms Malnutrition Medication effects Micronutrient deficiencies Effects unique to pediatrics Specific Nutritional Therapy
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Definition of Failed Growth Kleinman, et al Dec Ht > 0.3 SD per year growth velocity <5cm/yr Dec ht velocity > 2cm from preceding yr (during early to mid-puberty) Bone age and pubertal staging
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Our Situation 25% of all IBD are pediatric --> infants CD > UC 4:1 Growth failure is unique to pediatric IBD 30-50% of CD ped. Pts 10% of UC ped. Pts Malnutrition/micronutrient deficiencies more likely due to increased metabolic needs for growth
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Our Situation cont. Sole manifestation of IBD in 5% of pts Resemble anorexia nervosa wt loss/anorexia sx more prevalent than GI sx IBD pts do not have disordered body image or fear becoming fat Problem: heights (weights) do not get recorded regularly for school-age kids
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Problems We Face in This Situation 1. Growth/Nutrition is a problem before we meet the pt. Possible direct effects of inflam. mediators Anorexic effects of inflam. Mediators 2. Patients don’t feel well Post-prandial pain --> dec. intake anorexia (intake 55-80% of RDA of cal. Needs)
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Complications cont. 3. Malabsorption Protein Losing Enteropathy Bacterial Overgrowth Dec. surf. Area for absorption Lactose intolerance Micronutrient deficiencies Rapid transit
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Micronutrient Deficiencies Iron deficiency anemia is most common Tx with iron dextran if resistant to oral Fe Tx Folate and B12 Zinc deficiency (est. up to 40% pts) lower in growth impaired teens with CD Zinc repletion does not accelerate growth. Ca, Mg, Phos, Vit D - esp in adolescent pts.
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Complications Cont. 3. Chronic Dec Energy and Protein intake not able to keep up with needs endocrine functions altered 56% RDA was mean caloric intake in one study
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Complications Cont.: Medications Steroids alter linear growth proteolytic/ osteolytic inhibit bone growth Sulfasalazine use folic acid
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Complications Cont. 6. Time is our enemy
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ibd - PEDIATRIC IBD Growth and Nutrition By Karla Au Yeung,...

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