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Aktuelle Ernährungsmedizin 2014; 39(04): 270-283
DOI: 10.1055/s-0034-1370237
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© Georg Thieme Verlag KG Stuttgart · New York

Pädiatrische Ernährungsmedizin

Pediatric Clinical Nutrition
M. B. Krawinkel
Institut für Ernährungswissenschaft und Zentrum für Kinderheilkunde & Jugendmedizin, Justus-Liebig-Universität
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Publikationsdatum:
07. August 2014 (online)

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Zusammenfassung

Die Ernährungsmedizin hat zentrale Bedeutung im Fach Kinderheilkunde und Jugendmedizin, da sie sich sowohl mit der Gewährleistung „normaler“ Entwicklung körperlicher und geistiger Funktionen beschäftigt, als auch für viele Krankheitsbilder spezifische Ernährungstherapien beinhaltet. In einem Artikel dieser Art können lediglich ausgewählte Themen kurz angesprochen werden. Die Entwicklung der künstlichen Ernährung ist eine noch relativ junge Dimension pädiatrischer Ernährungsmedizin.

Eine ganze Reihe angeborener Stoffwechselstörungen bedürfen einer spezifischen Ernährungstherapie, für die die genaue Kenntnis der Stoffwechselwege der Nährstoffe und ihrer Metaboliten unabdingbare Voraussetzung ist. Bei Magen-Darm-Erkrankungen ist die diätetische therapeutische Intervention essenziell. Schließlich sind heute Kinder mit chronischem Darmversagen, die noch bis vor ca. 30 Jahren für nicht lebensfähig erachtet wurden, langfristig künstlich ernährt und darunter gediehen und gewachsen.

Während in der Klinik ein wesentliches Feld der pädiatrischen Ernährungsmedizin die Ernährung von Frühgeborenen und schwer kranken Kindern darstellt, stehen in der ambulanten Medizin die Ernährungsberatung und die Durchführung von Therapien in Kooperation mit Spezialambulanzen im Vordergrund. Gleichzeitig mit dem Verschwinden von Unterernährung und Mangel an einzelnen Nährstoffen, die heute bei uns nur noch als Folge von schwerer Vernachlässigung und „nutritiver Kindesmisshandlung“ vorkommen, ist eine neue Herausforderung mit der Prävention und Behandlung der Adipositas gewachsen. Für zahlreiche Ernährungsstörungen im Kindesalter gibt es Leitlinien, die je nach Stand des Wissens auf mehr oder weniger „harte“ Evidenzkriterien aufgebaut sind.

Abstract

Nutrition medicine is an essential part of paediatrics and adolescent medicine because it is concerned with normal physical and mental development and with specific nutrition interventions for a number of diseases. Artificial oral, enteral, and parenteral nutrition have been developed more recently.

A number of inborn errors of metabolism require specific nutrition therapies, and the detailed knowledge about the metabolic pathways of nutrition substrates and their metabolites is mandatory. For gastrointestinal diseases in children dietary therapies are essential part of any treatment. Finally, children with chronic gut failure can get parenterally nourished over long periods and achieve near normal or normal growth and development.

In children’s hospitals the nutrition of premature babies and severely ill children is focus of nutrition medicine whilst outpatient settings deal with nutrition counselling and specific longterm therapies in and in cooperation with specialized clinics.

With disappearance of undernutrition and lack of single nutrients observed in cases of neglect and “nutritive maltreatment” overweight and obesity have appeared as a new challenge. Guidelines have been developed for various paediatric nutrition topics; they are based on more or less scientific evidence depending on the state of knowledge at the time of guideline preparation.

Schlüsselwörter

Kinderernährung - Stoffwechselstörungen - Diarrhöen - Unterernährung - Adipositas

Keywords

infant and child feeding - metabolic diseases - diarrhea - undernutrition - obesity
 

  • Literatur

  • 1 Koletzko B, Brönstrup A, Cremer M et al. Säuglingsernährung und Ernährung der stillenden Mutter. Monatsschr Kinderheilkunde 2010; 157: 679-689
    PubMedSuche in Google Scholar
  • 2 Kramer MS, Kakuma R. Optimal duration of exclusive breastfeeding. Cochrane Database Syst Rev 2012; 8 CD003517
    PubMedSuche in Google Scholar
  • 3 Andres A, Cleves MA, Bellando JB et al. Developmental status of 1-year-old infants fed breast milk, cow’s milk formula, or soy formula. Pediatrics 2012; 129: 1134-1140
    CrossrefPubMedSuche in Google Scholar
  • 4 Ivarsson A, Hernell O, Stenlund H et al. Breast-feeding protects against celiac disease. Am J Clin Nutr 2002; 75: 914-921
    PubMedSuche in Google Scholar
  • 5 Ivarsson A, Myléus A, Norström F et al. Prevalence of childhood celiac disease and changes in infant feeding. Pediatrics 2013; 131: e687-694
    CrossrefPubMedSuche in Google Scholar
  • 6 Greer FR, Sicherer SH, Burks AW. American Academy of Pediatrics Committee on Nutrition; American Academy of Pediatrics Section on Allergy and Immunology. Effects of early nutritional interventions on the development of atopic disease in infants and children: the role of maternal dietary restriction, breastfeeding, timing of introduction of complementary foods, and hydrolyzed formulas. Pediatrics 2008; 121: 183-191
    CrossrefPubMedSuche in Google Scholar
  • 7 Chung M, Ip S, Yu W et al. Interventions in Primary Care to Promote Breastfeeding: A Systematic Review. Prepared for the Agency for Healthcare Research and Quality by the Tufts-New England Medical Center Evidence-based Practice Center, under Contract No. 290-02-0022. AHRQ Publication No. 08-05125-EF-1. Rockville, Maryland: Agency for Healthcare Research and Quality; 2008
    Suche in Google Scholar
  • 8 Hisgen S, Dennison BA, FitzPatrick E et al. Improving maternity care practices in New York: answering the Surgeon General’s Call to Action. Breastfeed Med 2012; 7: 337-342
    CrossrefPubMedSuche in Google Scholar
  • 9 Cattaneo A, Yngve A, Koletzko B et al. Promotion of Breastfeeding in Europe project. Protection, promotion and support of breast-feeding in Europe: current situation. Public Health Nutr 2005; 8: 39-46
    CrossrefPubMedSuche in Google Scholar
  • 10 DGE-Qualitätsstandard für die Verpflegung in Tageseinrichtungen für Kinder. Im Internet: 2013. http://www.dlr.rlp.de/Internet/global/themen.nsf/0/E04A86468C3A3A27C12575AC005C989C?OpenDocument (Stand: 14.11.2013)
    Suche in Google Scholar
  • 11 DGE-Qualitätsstandard für die Schulverpflegung. Im Internet: 2013. http://www.schuleplusessen.de/service/medien.html#c246 (Stand: 14.11.2013)
    Suche in Google Scholar
  • 12 Moore LL, Bradlee ML, Singer MR et al. Dietary Approaches to Stop Hypertension (DASH) eating pattern and risk of elevated blood pressure in adolescent girls. Br J Nutr 2012; 108: 1678-1685
    CrossrefPubMedSuche in Google Scholar
  • 13 Schaffrath RA, Kurth B-M. Regionale Unterschiede in der Häufigkeit von Übergewicht und Adipositas bei deutschen Einschülern – Realität oder Artefakt?. Bundesgesundheitsbl 2009; 52: 643-646
    CrossrefPubMedSuche in Google Scholar
  • 14 Schaefer A, Winkel K, Finne E et al. An effective lifestyle intervention in overweight children: one-year follow-up after the randomized controlled trial on “Obeldicks light”. Clin Nutr 2011; 30: 629-633
    CrossrefPubMedSuche in Google Scholar
  • 15 Schum J, Blumenstock G, Weber K et al. DISKUS-Study Group. Variants of the FTO gene in obese cildren and their impact on body composition and metabolism before and after lifestyle intervention. Exp Clin Endocrinol Diabetes 2012; 120: 128-131
    Thieme ConnectPubMedSuche in Google Scholar
  • 16 Zlatohlavek L, Vrablik M, Motykova E et al. FTO and MC4R gene variants determine BMI changes in children after intensive lifestyle intervention. Clin Biochem 2013; 46: 313-316
    CrossrefPubMedSuche in Google Scholar
  • 17 Kalavainen M, Utriainen P, Vanninen E et al. Impact of childhood obesity treatment on body composition and metabolic profile. World J Pediatr 2012; 8: 31-37
    CrossrefPubMedSuche in Google Scholar
  • 18 Leitlinie für Diagnostik, Therapie und Prävention der Adipositas im Kindes- und Jugendalter. Arbeitsgemeinschaft Adipositas im Kindes- und Jugendalter; (04.10.2012). http://www.adipositas-gesellschaft.de/fileadmin/PDF/Leitlinien/AGA_S2_Leitlinie.pdf (Stand: 29.10.2013)
  • 19 Kirk S, Brehm B, Saelens BE et al. Role of carbohydrate modification in weight management among obese children: a randomized clinical trial. J Pediatr 2012; 161: 320-327
    CrossrefPubMedSuche in Google Scholar
  • 20 Mirza NM, Palmer MG, Sinclair KB et al. Effects of a low glycemic load or a low-fat dietary intervention on body weight in obese Hispanic American children and adolescents: a randomized controlled trial. Am J Clin Nutr 2013; 97: 276-285
    CrossrefPubMedSuche in Google Scholar
  • 21 Parillo M, Licenziati MR, Vacca M et al. Metabolic changes after a hypocaloric, low-glycemic-index diet in obese children. J Endocrinol Invest 2012; 35: 629-633
    PubMedSuche in Google Scholar
  • 22 Cooper SB, Bandelow S, Nute ML et al. Breakfast glycaemic index and cognitive function in adolescent school children. Br J Nutr 2012; 107: 1823-1832
    CrossrefPubMedSuche in Google Scholar
  • 23 Brindal E, Baird D, Slater A et al. The effect of beverages varying in glycaemic load on postprandial glucose responses, appetite and cognition in 10–12-year-old school children. Br J Nutr 2013; 110: 529-537
    CrossrefPubMedSuche in Google Scholar
  • 24 Hay Jr WW. Aggressive Nutrition of the Preterm Infant. Curr Pediatr Rep 2013; Dec; 1(4)
    PubMedSuche in Google Scholar
  • 25 Fusch C, Hungerland E, Scharrer B et al. Water turnover of healthy children measured by deuterated water elimination. Eur J Pediatr 1993; 152: 110-114
    CrossrefPubMedSuche in Google Scholar
  • 26 Agostoni C, Buonocore G, Carnielli VP et al. ESPGHAN Committee on Nutrition. Enteral nutrient supply for preterm infants: commentary from the ESPGHAN Committee on Nutrition. J Pediatr Gastroenterol Nutr 2010; 50: 85-91
    CrossrefPubMedSuche in Google Scholar
  • 27 Alfaleh K, Anabrees J, Bassler D et al. Probiotics for prevention of necrotizing enterocolitis in preterm infants. Cochrane Database Syst Rev 2011; (03) CD005496
    PubMedSuche in Google Scholar
  • 28 Cross JH. New research with diets and epilepsy. J Child Neurol 2013; 28: 970-974
    CrossrefPubMedSuche in Google Scholar
  • 29 Cullingford TE. The ketogenic diet; fatty acids, fatty acid-activated receptors and neurological disorders. Prostaglandins Leukot Essent Fatty Acids 2004; 70: 253-264
    CrossrefPubMedSuche in Google Scholar
  • 30 Thammongkol S, Vears DF, Bicknell-Royle J et al. Efficacy of the ketogenic diet: which epilepsies respond?. Epilepsia 2012; 53: e55-59
    CrossrefPubMedSuche in Google Scholar
  • 31 Raju KN, Gulati S, Kabra M et al. Efficacy of 4:1 (classic) versus 2.5:1 ketogenic ratio diets in refractory epilepsy in young children: a randomized open labeled study. Epilepsy Res 2011; 96: 96-100
    CrossrefPubMedSuche in Google Scholar
  • 32 Caraballo R, Vaccarezza M, Cersósimo R et al. Long-term follow-up of the ketogenic diet for refractory epilepsy: multicenter Argentinean experience in 216 pediatric patients. Seizure 2011; 20: 640-645
    CrossrefPubMedSuche in Google Scholar
  • 33 Borowitz D, Stevens C, Brettman LR et al. Liprotamase 767 Study Group. Liprotamase long-term safety and support of nutritional status in pancreatic-insufficient cystic fibrosis. J Pediatr Gastroenterol Nutr 2012; 54: 248-257
    CrossrefPubMedSuche in Google Scholar
  • 34 Sapone A, Bai JC, Ciacci C et al. Spectrum of gluten-related disorders: consensus on new nomenclature and classification. BMC Med 2012; 10: 13
    CrossrefPubMedSuche in Google Scholar
  • 35 Størdal K, White RA, Eggesbø M. Early feeding and risk of celiac disease in a prospective birth cohort. Pediatrics 2013; 132: e1202-1209
    CrossrefPubMedSuche in Google Scholar
  • 36 Henker J, Lentze MJ. Leitlinien der GPGE: Zöliakie. – Version vom 06.12.2009 (unter Mitarbeit von Koletzko S und Zimmer P). Im Internet: http://www.gpge.de/frameset.htm?/ll_zoeliakie.html (Stand: 25.3.2014)
    Crossref
  • 37 Cooper SE, Kennedy NP, Mohamed BM et al. Immunological indicators of coeliac disease activity are not altered by long-term oats challenge. Clin Exp Immunol 2013; 171: 313-318
    CrossrefPubMedSuche in Google Scholar
  • 38 Comino I, Real A, de Lorenzo L et al. Diversity in oat potential immunogenicity: basis for the selection of oat varieties with no toxicity in coeliac disease. Gut 2011; 60: 915-922
    CrossrefPubMedSuche in Google Scholar
  • 39 Leffler DA, Kelly CP, Abdallah HZ et al. A randomized, double-blind study of larazotide acetate to prevent the activation of celiac disease during gluten challenge. Am J Gastroenterol 2012; 107: 1554-1562
    CrossrefPubMedSuche in Google Scholar
  • 40 Heuschkel R. Inflammatory bowel disease in children. Clin Med 2008; 8: 297-298
    CrossrefPubMedSuche in Google Scholar
  • 41 Heuschkel RB, Menache CC, Megerian JT et al. Enteral nutrition and corticosteroids in the treatment of acute Crohn’s disease in children. J Pediatr Gastroenterol Nutr 2000; 31: 8-15
    CrossrefPubMedSuche in Google Scholar
  • 42 Ezri J, Marques-Vidal P, Nydegger A. Impact of disease and treatments on growth and puberty of pediatric patients with inflammatory bowel disease. Digestion 2012; 85: 308-319
    CrossrefPubMedSuche in Google Scholar
  • 43 Bradley GM, Oliva-Hemker M. Infliximab for the treatment of pediatric ulcerative colitis. Expert Rev Gastroenterol Hepatol 2012; 6: 659-665
    CrossrefPubMedSuche in Google Scholar
  • 44 Turner D, Levine A, Escher JC. Eur Crohn’s & Colitis Organization and ESPGHAN. Management of pediatric ulcerative colitis: joint ECCO and ESPGHAN evidence-based consensus guidelines. J Pediatr Gastroenterol Nutr 2012; 55: 340-361
    CrossrefPubMedSuche in Google Scholar
  • 45 Critch J, Day AS, Otley A et al. Use of enteral nutrition for the control of intestinal inflammation in pediatric Crohn disease. J Pediatr Gastroenterol Nutr 2012; 54: 298-305
    CrossrefPubMedSuche in Google Scholar
  • 46 Krawinkel M, Scholz D, Busch A et al. Chronisches Darmversagen im Kindesalter. Dt Ärzteblatt 2012; 109: 409-415
    PubMedSuche in Google Scholar
  • 47 Squires RH, Duggan C, Teitelbaum DH et al. Natural History of Pediatric Intestinal Failure: Initial Report from the Pediatric Intestinal Failure Consortium. J Pediatr 2012; 161: 723-728
    CrossrefPubMedSuche in Google Scholar
  • 48 Pironi L, Joly F, Forbes A et al. Home Artificial Nutrition & Chronic Intestinal Failure Working Group of the European Society for Clinical Nutrition and Metabolism(ESPEN). Long-term follow-up of patients on home parenteral nutrition in Europe: implications for intestinal transplantation. Gut 2011; 60: 17-25
    CrossrefPubMedSuche in Google Scholar
  • 49 Kurvinen A, Nissinen MJ, Andersson S et al. Parenteral plant sterols and intestinal failure-associated liver disease in neonates. J Pediatr Gastroenterol Nutr 2012; 54: 803-811
    CrossrefPubMedSuche in Google Scholar
  • 50 Lilja HE, Finkel Y, Paulsson M et al. Prevention and reversal of intestinal failure-associated liver disease in premature infants with short bowel syndrome using intravenous fish oil in combination with omega-6/9 lipid emulsions. J Pediatr Surg 2011; 46: 1361-1367
    CrossrefPubMedSuche in Google Scholar
  • 51 Mercer DF, Hobson BD, Fischer RT et al. Hepatic fibrosis persists and progresses despite biochemical improvement in children treated with intravenous fish oil emulsion. J Pediatr Gastroenterol Nutr 2013; 56: 364-369
    CrossrefPubMedSuche in Google Scholar
  • 52 Lacaille F, Vass N, Sauvat F et al. Long-term outcome, growth and digestive function in children 2 to 18 years after intestinal transplantation. Gut 2008; 57: 455-461
    PubMedSuche in Google Scholar
  • 53 LaRosa C, Jorge Baluarte H, Meyers KEC. Outcomes in pediatric solid-organ transplantation. Pediatr Transplantation 2011; 15: 128-141
    CrossrefPubMedSuche in Google Scholar
  • 54 Jahja R, Huijbregts SC, de Sonneville LM et al. Neurocognitive evidence for revision of treatment targets and guidelines for phenylketonuria. J Pediatr 2014; 164: 895-899
    CrossrefPubMedSuche in Google Scholar
  • 55 Koch R, Trefz F, Waisbren S. Psychosocial issues and outcomes in maternal PKU. Mol Genet Metab 2010; 99 (Suppl. 01) 68-74
    CrossrefPubMedSuche in Google Scholar
  • 56 Cunningham A, Bausell H, Brown M et al. Recommendations for the use of sapropterin in phenylketonuria. Mol Genet Metab 2012; 106: 269-276
    CrossrefPubMedSuche in Google Scholar
  • 57 Keil S, Anjema K, van Spronsen FJ et al. Long-term follow-up and outcome of phenylketonuria patients on sapropterin: a retrospective study. Pediatrics 2013; 131: e1881-1888
    CrossrefPubMedSuche in Google Scholar