Measuring body composition by bioelectrical impedance analysis for nutritional management in children with respirator-dependent severe motor and intellectual disabilities due to hypoxia.

Abstract

Objective: Nutritional management in children with medically dependent severe motor and intellectual disabilities (SMID) is difficult. SMID children with respirator support sometimes showed obesity in spite of proper nutrition. The optimal energy intake in these children remains unclear. The objective of this study is to determine the features of body composition and the optimal calorie intake in children with respirator-dependent SMID due to severe hypoxia. Methods: The study was a retrospective chart review of five children with respirator-dependent SMID due to severe hypoxia. They were treated between 2012 and 2015 at the National Center for Child Health and Development in Tokyo, Japan. Their ages ranged from one to nine years. All patients were clinically stable under continuous mechanical ventilation. Body composition including body fat percentage (%Fat), muscle mass (MM) and fat-free mass (FFM) were measured by a multi-frequency bioelectrical impedance analysis (BIA) (InBody S20®). When necessary, adjustments for calorie intake were made. Results: %FAT was high (range, 40 to 70%) and MM was low, indicating that all children were under excessive nutrition. A markedly decrease in FFM was also observed. After the adjustment, daily calorie intake was maintained at 210 to 350 kcal/day. Daily calorie intake per FFM ranged from 25 to 42 kcal/kg/day. Conclusions: The children’s body composition revealed that FFM was decreased. As FFM is a major influencing factor for basal metabolic rate, FFM-based calorie adjustment is useful to determine the optimal calorie intake in children with respirator-dependent SMID due to severe hypoxia. Nutritional assessment using BIA is recommended in such children.