Reduced strength is associated with abnormal body composition in children with a history of intestinal failure

Objective Data on the relationship between body composition and strength in children with intestinal failure (IF) is lacking. The objectives were to (1) assess strength in children with IF compared to published norms; (2) examine the relationship between body composition and strength. Methods Children aged 4–18 years with IF, excluding those with significant developmental delay or mobility challenges, were included. Functional strength was assessed using the Bruininks–Oseretsky Test of Motor Proficiency‐2 (BOT‐2) and muscle strength was measured with a dynamometer for handgrip strength (HGS) and knee flexion/extension. Body composition was assessed using dual‐energy X‐ray absorptiometry. Two‐sample t ‐test compared strength in IF patients to published norms, and the relationship between body composition and strength was analyzed using linear regression. Results Thirty‐one children (71% male, mean age 9.9 years) were included. Twelve (39%) received parenteral nutrition (PN). Children with IF had significantly lower HGS ( p = 0.004), knee flexion ( p = 0.002), and extension ( p < 0.001) compared to published norms. Specifically, 80.6% scored below the mean for HGS, 71.0% for knee flexion, and 74.2% for extension. BOT‐2 revealed 26.9% had scores less than −1 SD. No significant differences in strength were found between those on enteral nutrition or PN. A significant positive relationship between functional strength and increased fat‐free mass, and decreased fat mass was found ( r 2 = 0.36, p = 0.002), with male sex strengthening the relationship ( r 2 = 0.62, p < 0.001). Conclusion Children with IF, both on enteral nutrition and PN, are weaker than healthy literature controls. Decreased strength was associated with lower fat‐free mass. This relationship was stronger in males than in females, highlighting the need to further investigate the mechanisms behind body composition and strength in this population. Trial Registration ClinicalTrials.gov identifier: NCT04610918.