Meryem KEÇELİ BAŞARAN, Nur ZENGIN, Ali DOĞAN, Alihan SURSAL, Fatih OZDENER

Malnutrisyonlu çocuklarda enteral beslemeye dayalı vücut kitle indeksi'nin kademeli iyileştirilmesi ve mikrobesinlerin normalleşmesi

Amaç: Malnutrisyon, dünya çapında 900 milyondan fazla insanı etkileyen ciddi ve sık karşılaşılan bir durumdur. Malnutrisyon; olumsuz klinik sonuç, kötü prognoz ve hastalıklara yatkınlık ile yakından ilişkilidir, bu yüzden erken müdahalenin öneminin altını çizen çok sayıda çalışma yapılmıştır. Bu çalışmanın amacı, hiperkalorik enteral beslenme tedavisinin vücut kitle indeksi (VKİ) z-skorunun yanı sıra ferritin, B12 vitamini ve D vitamini mikro-besinlerinin üzerindeki yararlı etkilerini tanımlamaktır. Yöntemler: Bu çalışma geriye dönük gözlemsel bir çalışmadır. Doktor tarafından boy ve kilo ölçümleri -2 standart deviasyonun altında olarak malnütrisyon tanısı almış hastaların kayıtları, Türkiye’nin İstanbul ilinde bulunan Gaziosmanpaşa Eğitim ve Araştırma Hastanesinden toplanmıştır. Toplamda 205 pediatrik malnutrisyon hastasının (1-16 yaş) ilk ziyaretine ait VKİ, ferritin, B12 vitamini ve D vitamini kayıtları, hiperkalorik (1,5 kcal/mL) müdahaleye başlandıktan 6 ay sonrasına kadar yapılan 2 vizite ölçümleri ile karşılaştırılarak istatistiksel olarak analiz edilmiştir. Bulgular: VKİ z-skorları ile enteral beslenme tedavisi uygulama süresi arasında görsel ve istatistiksel olarak ek hastalık durumları farketmeksizin anlamlı bir ters korelasyon görülmüştür (Z=-12,4, P<0,001). Ortalama VKİ z-skoru %33,2'lik bir düzelme ile 6 aylık müdahale sonrası -2,11’den -0,7’ye yükselmiştir. Ek olarak, altı ay boyunca ferritin, B12 vitamini ve D vitamini konsantrasyonları gereğinden fazla veya yetersiz olan hasta sayısında sırasıyla %80, %41,7 ve %39,3 oranında azalma görülmüştür. Sonuçlar: Hiperkalorik beslenme tedavisi, malnutrisyon teşhisi konan pediyatrik hastalarda hızlı, etkili ve oldukça faydalı bir beslenme müdahalesi olup, altı aylık takviye sonrası BMI z-skorlarında anlamlı düzelme ve yukarıda bahsedilen mikro besinlerde 2-taraflı iyileşme sağlamıştır.

Anahtar Kelimeler:

Pediatri, Malnutrisyon, Gastroenteroloji, Tedavi

Enteral feed based gradual improvement of body mass index and normalization of micronutrients in children with malnutrition

Aim: Malnutrition is a serious and frequently encountered condition affecting more than 900 million individuals worldwide. Its relationship with negative clinical outcome, bad prognosis and susceptibility to diseases has been demonstrated in numerous studies alongside with the importance of early nutritional intervention. The aim of this study was to define the beneficial influence of a hypercaloric enteral supplement on body mass index (BMI) z-score as well as ferritin, vitamin B12 and vitamin D micronutrients. Methods: This study is a retrospective observational study. Records of patients who were diagnosed with malnutrition via a physician by having height and weight scores below -2 standard deviation were collected from Gaziosmanpaşa Training and Resource Hospital, Istanbul, Turkey. A comparative statistical analysis was performed on 205 pediatric malnutrition patients (ages 1 to 16) by gathering their BMI, ferritin, b12 and vitamin D at baseline with their measurements at 2 follow-up visits after the administration of hypercaloric (1.5kcal/mL) enteral supplement over 6 months. Results: There was a significant inverse correlation between BMI z-scores and the duration of enteral supplement administration, reflected by a 33.2% reduction of the mean BMI z-scores from -2.11 to -0.7 over 6 months (Z=-12.4, P<0.001). Additionally, there was a reduction in the number of patients with excessive or insufficient amounts of ferritin, b12 and vitamin D concentrations with 80%, 41.7% and 39.3% respectively over six months. Conclusions: Hypercaloric enteral supplementation is a short-acting and highly beneficial nutritional intervention in pediatric patients diagnosed with malnutrition, which provides a robust improvement in the BMI z-scores as well as a 2-tailed improvement of aforementioned micronutrients after six months of supplementation.

Keywords:

Pediatrics, Malnutrition, Gastroenterology, Therapeutics,

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