Abstract
Background
Malnutrition and growth retardation (GR) are major extraintestinal presentations of inflammatory bowel disease (IBD) in childhood and are especially prevalent among those with Crohn’s disease (CD). We aimed to evaluate nutritional and growth status and body composition (BC) of children with IBD during a 1-year follow-up.
Methods
Thirty-eight children with IBD and 57 age- and sex-matched controls were recruited prospectively. Anthropometry (weight, height, body mass index (BMI), and triceps skinfold thickness (TSFT) indicated as z scores for age and sex and mid-arm circumference) and bioelectrical impedance analysis were performed at baseline (T0) and after 1 year (T1). Disease activity was evaluated by clinical scoring systems. GR was defined as HAZ < −2, undernutrition as WAZ < −2, severe malnutrition (SM) as BMIZ < −2, and obesity was defined as BMIZ > +2. A p value of <0.05 was considered statistically significant.
Results
Thirty-six children with IBD (22 ulcerative colitis, 12 CD, and 2 indeterminate colitis) and 43 controls completed the study. Most patients were in remission during the study period (T0:71.4%; T1:72.2%). No significant differences were found regarding the frequency of GR (5.6%/8.3%), undernutrition (11.1%/2.8%), and SM (11.1%/5.6%) between T0 and T1 in the IBD group. The changes in anthropometrics and BC measurements during the study period did not differ between the groups except for the TSFT z score.
Conclusion
Most patients with IBD were well nourished and grown, although some children were underweight and had GR. Our results suggest that, in IBD patients, the fat mass (FM) showed a gradual increase over time compared with controls.
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References
Tremaine WJ, Timmons LJ, Loftus EV Jr, Pardi DS, Sandborn WJ, Harmsen WS, et al. Age at onset of inflammatory bowel disease and the risk of surgery for non-neoplastic bowel disease. Aliment Pharm Ther. 2007;25:1435–41.
Li X, Song P, Timofeeva M, Meng X, Rudan I, Little J, et al. Systematic meta-analyses and field synopsis of genetic and epigenetic studies in paediatric inflammatory bowel disease. Sci Rep. 2016;6:340–76.
Molodecky NA, Soon IS, Rabi DM, Ghali WA, Ferris M, Chernoff G, et al. Increasing incidence and prevalence of the inflammatory bowel diseases with time, based on systematic review. Gastroenterology. 2012;142:46–54.
Griffiths AM. Growth retardation in early-onset inflammatory bowel disease: should we monitor and treat these patients differently? Dig Dis. 2009;27:404–11.
Levine A, Koletzko S, Turner D, Escher JC, Cucchiara S, de Ridder L, et al. ESPGHAN revised porto criteria. For the diagnosis of inflammatory bowel disease in children and adolescents. J Pediatr Gastroenterol Nutr. 2014;586:795–806.
Marshall WA, Tanner JM. Variations in the pattern of pubertal changes in boys. Arch Dis Child. 1970;45:13–23.
Marshall WA, Tanner JM. Variations in pattern of pubertal changes in girls. Arch Dis Child. 1969;44:291–303.
Levine A, Griffiths A, Markowitz J, Wilson DC, Turner D, Russell RK, et al. Pediatric modification of the Montreal classification for inflammatory bowel disease: the Paris classification. Inflamm Bowel Dis. 2011;17:1314–21.
Tanner JM, Whitehouse RH, Takaishi M. Standards from birth to maturity for height, weight, height velocity, and weight velocity: British children, 1965. Ii Arch Dis Child. 1966;41:613–35.
Shamir R. Nutrition and growth in inflammatory bowel disease. World Rev Nutr Diet. 2013;106:156–61.
Hill RJ. Update on nutritional status, body composition and growth in paediatric inflammatory bowel disease. World J Gastroenterol. 2014;20:3191–7.
Miele E, Shamir R, Aloi M, Assa A, Braegger C, Bronsky J, et al. Nutrition in pediatric inflammatory bowel disease: a position paper on behalf of the porto inflammatory bowel disease group of the european society of pediatric gastroenterology, hepatology and nutrition. J Pediatr Gastroenterol Nutr. 2018;66:687–708.
Vasseur F, Gower-Rousseau C, Vernier-Massouille G, Dupas JL, Merle V, Merlin B, et al. Nutritional status and growth in pediatric Crohn’s disease: a population-based study. Am J Gastroenterol. 2010;105:1893–900.
Aurangzeb B, Leach ST, Lemberg DA, Day AS. Assessment of nutritional status and serum leptin in children with inflammatory bowel disease. J Pediatr Gastroenterol Nutr. 2011;52:536–44.
Sentongo TA, Semeao EJ, Piccoli DA, Stallings VA, Zemel BS. Growth, body composition, and nutritional status in children and adolescents with Crohn's disease. J Pediatr Gastroenterol Nutr. 2000;31:33–40.
Azcue M, Rashid M, Griffiths A, Pencharz PB. Energy expenditure and body composition in children with Crohn’s disease: effect of enteral nutrition and treatment with prednisolone. Gut 1997;41:203–8.
Wiskin AE, Wootton SA, Hunt TM, Cornelius VR, Afzal NA, Jackson AA, et al. Body composition in childhood inflammatory bowel disease. Clin Nutr. 2011;30:112–5.
Long MD, Crandall WV, Leibowitz IH, Duffy L, del Rosario F, Kim SC, et al. Prevalence and epidemiology of overweight and obesity in children with inflammatory bowel disease. Inflamm Bowel Dis. 2011;17:2162–8.
El Mouzan MI, Al Edreesi MH, Al-Hussaini AA, Saadah OI, Al Qourain AA, Al Mofarreh MA, et al. Nutritional status of children with inflammatory bowel disease in Saudi Arabia. World J Gastroenterol. 2016;22:1854–8.
Laakso S, Valta H, Verkasalo M, Toiviainen-Salo S, Viljakainen H, Mäkitie O. Impaired bone health in inflammatory bowel disease: a case-control study in 80 pediatric patients. Calcif Tissue Int. 2012;91:121–30.
Ward LM, Rauch F, Matzinger MA, Benchimol EI, Boland M, Mack DR. Iliac bone histomorphometry in children with newly diagnosed inflammatory bowel disease. Osteoporos Int 2010;21:331–7.
Burnham JM, Shults J, Semeao E, Foster BJ, Zemel BS, Stallings VA, et al. Body-composition alterations consistent with cachexia in children and young adults with Crohn disease. Am J Clin Nutr. 2005;82:413–20.
Tsiountsioura M, Wong JE, Upton J, McIntyre K, Dimakou D, Buchanan E, et al. Detailed assessment of nutritional status and eating patterns in children with gastrointestinal diseases attending an outpatients clinic and contemporary healthy controls. Eur J Clin Nutr. 2014;68:700–6.
Varille V, Cézard JP, de Lagausie P, Bellaiche M, Tounian P, Besnard M, et al. Resting energy expenditure before and after surgical resection of gut lesions in pediatric Crohn’s disease. J Pediatr Gastroenterol Nutr. 1996;23:13–9.
Dubner SE, Shults J, Baldassano RN, Zemel BS, Thayu M, Burnham JM, et al. Longitudinal assessment of bone density and structure in an incident cohort of children with Crohn's disease. Gastroenterology 2009;136:123–30.
Sylvester FA, Leopold S, Lincoln M, Hyams JS, Griffiths AM, Lerer T. A two-year longitudinal study of persistent lean tissue deficits in children with Crohn’s disease. Clin Gastroenterol Hepatol. 2009;7:452–5.
Thayu M, Denson LA, Shults J, Zemel BS, Burnham JM, Baldassano RN, et al. Determinants of changes in linear growth and body composition in incident pediatric Crohn’s disease. Gastroenterology. 2010;139:430–8.
Gerasimidis K, Talwar D, Duncan A, Moyes P, Buchanan E, Hassan K, et al. Impact of exclusive enteral nutrition on body composition and circulating micronutrients in plasma and erythrocytes of children with active Crohn's disease. Inflamm Bowel Dis. 2012;18:1672–81.
Sanderson IR. Growth problems in children with IBD. Nat Rev Gastroenterol Hepatol. 2014;11:601–10.
Miele E, Shamir R, Aloi M, Assa A, Braegger C, Bronsky J, et al. Nutrition in pediatric inflammatory bowel disease: a position paper on behalf of the porto inflammatory bowel disease group of the european society of pediatric gastroenterology, hepatology and nutrition. J Pediatr Gastroenterol Nutr. 2018;66:687–708.
Werkstetter KJ, Ullrich J, Schatz SB, Prell C, Koletzko B, Koletzko S. Lean body mass, physical activity and quality of life in paediatric patients with inflammatory bowel disease and in healthy controls. J Crohns Colitis. 2012;6:665–73.
Boot AM, Bouquet J, Krenning EP, de Muinck Keizer-Schrama SM. Bone mineral density and nutritional status in children with chronic inflammatory bowel disease. Gut. 1998;42:188–94.
Bechtold S, Alberer M, Arenz T, Putzker S, Filipiak-Pittroff B, Schwarz HP, et al. Reduced muscle mass and bone size in pediatric patients with inflammatory bowel disease. Inflamm Bowel Dis. 2010;16:216–25.
Acknowledgements
We thank all our patients and their families for consenting to this study. We also thank Nazmiye Kursun (Ankara University, School of Medicine, Department of Biostatistics) for statistical analysis.
Funding
This research was supported by the Ankara University Research Fund (research number: 15H0230004).
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SS was responsible for data acquisition and analysis, and drafting of the manuscript. KA was responsible for critical review of manuscript. BM and ŞZ were responsible for critical review of BC measurements. KZ was responsible for study concept and design, analysis, intrepretation of data and drafting of the manuscript. All authors approved the final version of the manuscript.
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Ethics
The Ethics Committee of our University, School of Medicine approved the study protocol (03-106-15). Written informed consent was obtained from all participants and their parents.
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Selbuz, S., Kansu, A., Berberoğlu, M. et al. Nutritional status and body composition in children with inflammatory bowel disease: a prospective, controlled, and longitudinal study. Eur J Clin Nutr 74, 1173–1180 (2020). https://doi.org/10.1038/s41430-019-0555-1
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DOI: https://doi.org/10.1038/s41430-019-0555-1