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Nutrient Deficiencies in Tube-fed Children

Department of Pediatrics, Medical College of Wisconsin, Milwaukee, WI

Peter L. Havens, MD

Department of Pediatrics, Medical College of Wisconsin, Milwaukee, WI

Steven L. Werlin, MD

Department of Pediatrics, Medical College of Wisconsin, Milwaukee, WI

The charts of children with gastrostomy or jejunostomy tubes followed in the Tube Feeding Clinic at the Children’s Hospital of Wisconsin from January 1999 to June 2002 were reviewed. Prevalence of selected nutrient deficiencies were determined and their association with growth and caloric intake was measured. One hundred fifty patients (60% male) met the inclusion criteria. The mean age of children was 7 years 6 months (SD ± 5 years 4 months). As a proportion of total caloric intake, the mean percentage of calories from formula was 92% (± 15). No deficiencies of vitamins D or E were found. Ferritin concentration below lower limits of the age-appropriate range of normal (LLN) was found in 30 of 122 (25%) and hemoglobin was below LLN in 12 of 139 (9%). One patient each had vitamin A, calcium, phosphorus, and magnesium serum concentrations below LLN. Below normal serum zinc was found in 43 of 142 (30%). Ninety-one of 134 patients (68%) had below normal selenium levels, and 29 of 126 (23%) had both zinc and selenium deficiency. A significant association was found between percentage of recommended daily allowance (RDA) of calories received and selenium concentration below LLN. Patients with selenium deficiency received a mean of 75% (± 21) of the RDA of calories for age, whereas patients without deficiency received a mean of 91% (± 19) of the RDA of calories for age (p < 0.0001). There was a negative association between deficiency and weight for age: patients with selenium deficiency were 33% mean weight for age percentile (± 30), compared to 21% (± 27, p < 0.05) for those without selenium deficiency. There was a negative correlation between the percentage of RDA of calories and height for age, weight for age, and weight for height (p < 0.05).

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