Bone mineral density in short bowel syndrome: correlation with BMI and serum vitamins C, E and K.

OBJECTIVE: Bone loss has been established as a major extra-intestinal complication of short bowel syndrome (SBS). The purpose of this study was to correlate bone mineral density (BMD) with body mass index (BMI), serum vitamin and mineral levels in patients with SBS. MATERIAL AND METHODS: The study was conducted on 13 patients (8 male and 5 female, 54.7 ± 11.4 years) with SBS (residual small bowel length of 10 to 100 cm). We determined the food ingestion, anthropometry, serum levels of vitamins C, A, D, E and K, as well as serum and urinary levels of phosphorus and calcium. BMD was measured by dual-energy x-ray absorptiometry (DXA). RESULTS: Osteopenia and osteoporosis was diagnosed in all but one SBS patient. Serum levels of vitamin D were low in all volunteers. Sixty-one percent of patients had vitamin E deficiency; hypovitaminosis A and C occurred in one subject. BMI and C, E and K vitamin serum levels correlated with T-score of BMD. CONCLUSIONS: Osteopenia and osteoporosis were common in SBS patients. There was a correlation between BMD and the serum levels of vitamins C, E and K, an indicative that such vitamins may influence bone health.

Copper and magnesium deficiencies in patients with short bowel syndrome receiving parenteral nutrition or oral feeding.

BACKGROUND: Patients with short bowel syndrome have significant fluid and electrolytes loss. OBJECTIVE: Evaluate the mineral and electrolyte status in short bowel syndrome patients receiving intermittent parenteral nutrition or oral feeding. METHODS: Twenty two adults with short bowel syndrome, of whom 11 were parenteral nutrition dependent (PN group), and the 11 remaining had been weaned off parenteral nutrition for at least 1 year and received all nutrients by oral feeding (OF group). The study also included 14 healthy volunteers paired by age and gender (control group). Food ingestion, anthropometry, serum or plasma levels of sodium, potassium, phosphorus, magnesium, calcium, zinc, iron and copper were evaluated. PN group subjects were evaluated before starting a new parenteral nutrition cycle. RESULTS: The levels of sodium, potassium, phosphorus, calcium and zinc were similar between the groups. The magnesium value was lower in the PN group (1.0 ± 0.4 mEq /L) than other groups. Furthermore, this electrolyte was lower in the OF group (1.4 ± 0.3 mEq /L) when compared to the Control group (1.8 ± 0.1 mEq/L). Lower values of copper (69±24 vs 73±26 vs 109±16 µg/dL) were documented, respectively, for the PN and OF groups when compared to the control group. CONCLUSION: Hypomagnesemia and hypocupremia are electrolyte disturbances commonly observed in short bowel syndrome. Patients with massive intestinal resection require monitoring and supplementation in order to prevent magnesium and copper deficiencies.

Copper and magnssium deficiencies in patients wth short bowel syndrome receiviing parenteral nutrition or oral feedngg / Deficiência de cobre e magnésio em pacientes com Síndrome do Intestino Curto sob nutrição parenteral ou alimentação por via oral

Background Patients with short bowel syndrome have significant fluid and electrolytes loss. Objective Evaluate the mineral and electrolyte status in short bowel syndrome patients receiving intermittent parenteral nutrition or oral feeding. Methods Twenty two adults with short bowel syndrome, of whom 11 were parenteral nutrition dependent (PN group), and the 11 remaining had been weaned off parenteral nutrition for at least 1 year and received all nutrients by oral feeding (OF group). The study also included 14 healthy volunteers paired by age and gender (control group). Food ingestion, anthropometry, serum or plasma levels of sodium, potassium, phosphorus, magnesium, calcium, zinc, iron and copper were evaluated. PN group subjects were evaluated before starting a new parenteral nutrition cycle. Results The levels of sodium, potassium, phosphorus, calcium and zinc were similar between the groups. The magnesium value was lower in the PN group (1.0 ± 0.4 mEq /L) than other groups. Furthermore, this electrolyte was lower in the OF group (1.4 ± 0.3 mEq /L) when compared to the Control group (1.8 ± 0.1 mEq/L). Lower values of copper (69±24 vs 73±26 vs 109±16 µg/dL) were documented, respectively, for the PN and OF groups when compared to the control group. Conclusion Hypomagnesemia and hypocupremia are electrolyte disturbances commonly observed in short bowel syndrome. Patients with massive intestinal resection require monitoring and supplementation in order to prevent magnesium and copper deficiencies. .

Contexto Ressecções intestinais extensas resultam em perda de fluídos e eletrólitos. Objetivo Avaliar os níveis séricos de minerais e eletrólitos em pacientes com síndrome do intestino curto, dependentes ou não de nutrição parenteral. Métodos O estudo incluiu 22 adultos com síndrome de intestino curto, sendo 11 dependentes de nutrição parenteral (Grupo NP) e 11 sujeitos que recebiam todo aporte nutricional por via oral (Grupo VO). Foram incluídos 14 voluntários saudáveis, pareados para a idade e o gênero (Grupo Controle). A avaliação da ingestão alimentar, antropometria, níveis sanguíneos de sódio, potássio, fósforo, magnésio, cálcio, zinco, ferro e cobre foram documentados em todos os voluntários. Resultados Os níveis sanguíneos de sódio, potássio, fósforo, cálcio e zinco foram similares entre os grupos de estudo. Os níveis séricos de magnésio foram menores no Grupo NP (1,0±0,4 mEq/L) em relação aos demais grupos. Além disso, a concentração desse eletrólito foi menor no Grupo VO (1,4±0,3 mEq/L) em relação ao Grupo Controle (1,8±0,1 mEq/L). Foram documentados menores valores cobre (69±24 vs 73±26 vs 109±16 µg/dL) nos grupos NP e VO quando comparados com o Grupo Controle, respectivamente. Conclusão Hipomagnesemia e hipocupremia são distúrbios eletrolíticos comumente observados na síndrome de intestino curto. Os pacientes com ressecção intestinal extensa requerem monitorização e suplementação de magnésio e cobre a fim de prevenir deficiências. .

Bone mineral density in short bowel syndrome: correlation with BMI and serum vitamins C, E and K

Objective Bone loss has been established as a major extra-intestinal complication of short bowel syndrome (SBS). The purpose of this study was to correlate bone mineral density (BMD) with body mass index (BMI), serum vitamin and mineral levels in patients with SBS.Material and methods The study was conducted on 13 patients (8 male and 5 female, 54.7 ± 11.4 years) with SBS (residual small bowel length of 10 to 100 cm). We determined the food ingestion, anthropometry, serum levels of vitamins C, A, D, E and K, as well as serum and urinary levels of phosphorus and calcium. BMD was measured by dual-energy x-ray absorptiometry (DXA).Results Osteopenia and osteoporosis was diagnosed in all but one SBS patient. Serum levels of vitamin D were low in all volunteers. Sixty-one percent of patients had vitamin E deficiency; hypovitaminosis A and C occurred in one subject. BMI and C, E and K vitamin serum levels correlated with T-score of BMD.Conclusions Osteopenia and osteoporosis were common in SBS patients. There was a correlation between BMD and the serum levels of vitamins C, E and K, an indicative that such vitamins may influence bone health. Arch Endocrinol Metab. 2015;59(3):252-8.

Serum 7-alpha-hydroxy-4-cholesten-3-one as a marker for bile acid loss in children.

OBJECTIVE: To establish age-related reference values for 7-alpha-hydroxy-4-cholesten-3-one (C4) in a pediatric population and to investigate bile acid malabsorption in children with short bowel syndrome (SBS). STUDY DESIGN: Serum was obtained between 8:00 a.m. and 11:00 a.m. from 100 healthy children (52% males, 9 months to 18 years of age) after 10 hours of fasting. Pediatric patients with SBS served as disease controls (n = 12). Following solid-phase extraction and purification, C4 was determined by high-performance liquid chromatography using a ultraviolet detector at a wavelength of 241 nm. The upper limit of normal for C4 concentrations was defined as the mean plus 2 SD of the log-normal distribution. RESULTS: The mean concentration and SD of C4 in healthy children was 22.8 ± 15.8 ng/mL with no relation to age or sex and an upper limit of normal of 66.5 ng/mL. Normal C4 values were found in 97 of 100 healthy children, and all 12 patients with SBS had C4 concentrations above 100 ng/mL (mean 299.6 ± 167.8 ng/mL; range 105.7-562.1 ng/mL, P < .0001 compared with controls). CONCLUSIONS: The determined upper limit of normal for C4 concentration in healthy children corresponds to previously published levels in healthy adults and is independent of age and sex. The consistently elevated C4 concentrations in our patients with SBS confirm the reliability of this noninvasive, nonisotopic method to assess bile acid malabsorption in children.

Vitamin serum level variations between cycles of intermittent parenteral nutrition in adult patients with short bowel syndrome.

BACKGROUND: An alternative form of nutrition therapy for patients with short bowel syndrome (SBS) who do not have home parenteral nutrition (PN) available is the administration of the PN cycle during regular hospital admissions and oral vitamin supplement at home. The aim of this study was to evaluate serum levels of folic acid and vitamins A, B(12), C, and E before and after the PN cycle in patients with SBS. MATERIALS AND METHODS: This research was conducted with 10 patients with SBS (less than 15 minutes of total barium transit time) who were receiving the PN cycle and oral vitamin supplement at home. Patients were evaluated regarding total food ingestion and oral vitamin supplement intake. Serum levels of vitamins were evaluated immediately after the end of each PN cycle (phase 1) and before the beginning of the next PN cycle (phase 2). RESULTS: Patients' nutrient ingestion was in accordance with recommendations for healthy individuals. Regarding the oral vitamin supplement intake, 20% of the patients presented low adherence. Although all patients had a normal serum level of folic acid and vitamin B(12), PN vitamin infusion during hospitalization and home oral vitamin supplement were not enough to make the serum levels of vitamins A, C, and E achieve normal values. CONCLUSION: This study documented that patients did not receive an adequate administration of oral vitamin supplements of vitamins A, C, and E through PN. More studies need to be conducted investigating higher doses of vitamin administration (oral or intravenous administration), assessing differences between water and liposoluble supplements.

Ingestion of ferrous sulfate increases ferremia in patients with short bowel syndrome.

OBJECTIVE: Because short bowel syndrome is associated with iron deficiency, the objective of the present study was to monitor ferremia after the ingestion of different iron compounds and doses in enterectomized patients. METHODS: This was a randomized, double-blind, cross-over study conducted in 13 patients of both sexes in the metabolic unit of Hospital das Clínicas de Faculdade de Medicina de Ribeirão Preto-Universídade de São Paulo and was divided into two stages. Three different iron compounds, ferrous sulfate (FS), sodium iron ethylenediaminetetra-acetic acid (EDTA), and dehydrated cell fraction (DCF), were studied. The patients were randomly assigned to one of four groups receiving high-dose DCF (120mg) and low-dose DCF (5mg) and the two iron compounds. The subjects (n=7) receiving high-dose DCF participated in 2 test days. All patients receiving the physiologic dose (low-dose DCF, n=6) participated in 3 test days with a 1-mo interval between compounds. After an 8-h fast, blood samples were collected at 0.25, 0.5, 1, and 2h. Serum iron curve and the sum of the area under the curve were calculated and adjusted according to a mixed-effect linear model (P<0.05). RESULTS: Serum FS levels were higher in the 120-mg group compared with the others (P<0.005). The mean areas under the curve for FS and EDTA at the doses of 120 and 5mg of elemental iron were 238, 224, 177, and 153 microg/dL, respectively. The mean area under the curve for DCF was 165 microg/dL, with no significant difference between groups. CONCLUSION: Regardless of dose, FS was the compound that resulted in higher ferremia compared with the other doses and compounds.

Serum citrulline levels correlate with enteral tolerance and bowel length in infants with short bowel syndrome.

OBJECTIVE: To determine if serum levels of CIT (a nonprotein amino acid synthesized by the intestine) correlate with total parenteral nutrition (PN)-independence in children with short bowel syndrome (SBS). STUDY DESIGN: We prospectively obtained serum amino acid profiles over a 24-month interval from all infants with SBS 3 weeks to 4 years of age. Remaining small intestine length was recorded at surgery, and percent enteral calories tolerated (enteral calories divided by enteral plus parenteral calories x 100) was determined in 24 infants with SBS and 21 age-matched controls (blood drawn for non-gastrointestinal symptoms). RESULTS: Mean CIT for controls was 31 +/- 2 micromol/L. In patients with SBS (n = 24), serum CIT correlated linearly with percent enteral calories (R = 0.85; P <.001) and with bowel length (R = 0.47; P < or =.03). CIT level in patients with SBS weaned off PN was 30 +/- 2 micromol/L; in those subsequently weaned off PN, 20 +/- 2 micromol/L; and in those who would remain PN-dependent, 11 +/- 2 micromol/L ( P < or =.01). Serum CIT > or =19 micromol/L had 94% sensitivity and 67% specificity for being off or coming off total PN. CONCLUSIONS: Serum CIT level >19 micromol/L in children with SBS is associated with development of enteral tolerance and may be a useful predictive test.

Cysteine supplementation results in normalization of plasma taurine concentrations in children receiving home parenteral nutrition.

We evaluated plasma sulfur amino acid concentrations in children with short gut syndrome receiving home parenteral nutrition (n = 6). Cysteine HCl addition to solutions formulated with a pediatric amino acid product will increase plasma taurine concentrations to within the normal reference range.

Bone mineral content in children with short bowel syndrome after discontinuation of parental nutrition.

To determine whether children with short bowel syndrome had evidence of metabolic bone disease, total body bone mineral content was measured by dual-energy x-ray absorptiometry in 18 patients and 36 age-, sex-, and race-matched control subjects. Children with short bowel syndrome had decreased bone mineral content compared with control subjects; however, it was not significant when adjusted for differences in weight and height. Whether these children will have normal bone accretion throughout puberty is not known.

Serum trace elements in children receiving long-term parenteral nutrition.

The trace elements iron (Fe), copper (Cu), zinc (Zn), selenium (Se), chromium (Cr), manganese (Mn), nickel (Ni), rubidium (Rb), and bromine (Br) were determined in serum from 18 children, ages 4 to 65 months, who received long-term total parenteral nutrition (TPN). Nine patients (group 1) received TPN as their only source of nutrition; the other nine (group 2) ingested 30% to 70% of their total calorie requirement and received the remainder intravenously. The reference group consisted of 19 healthy children of similar age and sex distribution. Groups 1 and 2 had received parenteral nutrition for 28.4 +/- 13.7 (SD) and 23.1 +/- 17.1 (SD) months, respectively. All patients in group 1 and four in group 2 had short bowel syndrome; four in group 2 had pseudo-obstruction syndrome. Patients in group 1 had normal serum levels of Fe, Cu, and Mn, but increased levels of Zn; they had decreased serum concentrations of Se, Cr, Ni, Rb, and Br. Patients in group 2 had decreased serum levels of Mn, Cr, Ni, Rb, and Br. Those trace elements not supplemented in TPN solutions (Se, Cr, Mn, Ni, Rb, and Br) were lower in the children receiving TPN than in the control children, indicating inadequate intake of these trace elements from food and TPN solutions. However, no obvious clinical signs or symptoms of trace element deficiencies were observed.