Assessment of growth and nutrition in children with chronic diseases

Background
Growth failure in chronic childhood disease is a multifactorial entity. The nutritional outcome is affected by baseline nutritional status, disease state, and, rarely, an inherent genetic abnormality.


Aim
To assess growth and nutritional status in children with some chronic illnesses, including children with chronic kidney disease on regular hemodialysis and children with type 1 diabetes.


Patients and methods
This case–control study was conducted on 120 children. Their ages ranged from 6 to 18 years. The study was carried out at the nephrology and hemodialysis unit of Al-Zahraa Hospital, Al Azhar University, and at National Research Center. The study population was divided into three groups: group 1 included 40 children with end-stage renal disease on regular hemodialysis, group 2 included 40 children and adolescents with type 1 diabetes, and group 3 included 40 healthy controls of comparable age and sex. The patients were subjected to full medical history; etiology, onset, and duration of disease; and medication regularity. Moreover, selective routine follow-up laboratory investigations were done for patient and control groups in the same line with anthropometric measurements and dietary assessments and were compared regarding their daily recommended diet for each group.


Results
Children on regular hemodialysis consumed fewer proteins, fats, fruits, and vegetables in comparison with their standard dietary recommended daily intake, which was 82.9, 57.9, 70.1, and 33.6%, respectively, with a significant decrease in their anthropometric measurements in comparison with diabetic and healthy groups. Children with type 1 diabetes consume more starches, proteins, and dairy products in comparison with their standard dietary daily intake but consumed less fat, fruits, and vegetables, and they had poor glycemic control and a significant increase in their anthropometric measurements in comparison of those values with available norms. We found a significant positive correlation between starches consumption and anthropometric measurements in type 1 diabetic children.


Conclusion
It is necessary to consider nutritional status in the assessment of the etiology and treatment of growth failure in children on regular hemodialysis. Nutritional policies and nutritional assistance programs and actions must be taken in children with chronic kidney disease to avoid growth failure and in type 1 diabetes to achieve normal glycemia and normal growth.