Skip to main content

Thank you for visiting nature.com. You are using a browser version with limited support for CSS. To obtain the best experience, we recommend you use a more up to date browser (or turn off compatibility mode in Internet Explorer). In the meantime, to ensure continued support, we are displaying the site without styles and JavaScript.

  • Article
  • Published:

Body composition, energy expenditure and physical activity

Nutritional status and body composition in children with inflammatory bowel disease: a prospective, controlled, and longitudinal study

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.

This is a preview of subscription content, access via your institution

Access options

Rent or buy this article

Prices vary by article type

from$1.95

to$39.95

Prices may be subject to local taxes which are calculated during checkout

Fig. 1: Flow chart showing the allocation of children with IBD and control group.
Fig. 2: Anthropometric parameters over the course of 1 year.
Fig. 3: Body composition over the course of 1 year.
Fig. 4: Nutritional status of children with IBD over the course of 1 year.

Similar content being viewed by others

References

  1. 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.

    Article  CAS  Google Scholar 

  2. 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.

    Google Scholar 

  3. 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.

    Article  Google Scholar 

  4. Griffiths AM. Growth retardation in early-onset inflammatory bowel disease: should we monitor and treat these patients differently? Dig Dis. 2009;27:404–11.

    Article  Google Scholar 

  5. 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.

    Google Scholar 

  6. Marshall WA, Tanner JM. Variations in the pattern of pubertal changes in boys. Arch Dis Child. 1970;45:13–23.

    Article  CAS  Google Scholar 

  7. Marshall WA, Tanner JM. Variations in pattern of pubertal changes in girls. Arch Dis Child. 1969;44:291–303.

    Article  CAS  Google Scholar 

  8. 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.

    Article  Google Scholar 

  9. 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.

    Article  CAS  Google Scholar 

  10. Shamir R. Nutrition and growth in inflammatory bowel disease. World Rev Nutr Diet. 2013;106:156–61.

    PubMed  Google Scholar 

  11. Hill RJ. Update on nutritional status, body composition and growth in paediatric inflammatory bowel disease. World J Gastroenterol. 2014;20:3191–7.

    Article  Google Scholar 

  12. 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.

    Article  Google Scholar 

  13. 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.

    Article  Google Scholar 

  14. 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.

    Article  CAS  Google Scholar 

  15. 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.

    Article  CAS  Google Scholar 

  16. 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.

    Article  CAS  Google Scholar 

  17. 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.

    Article  Google Scholar 

  18. 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.

    Article  Google Scholar 

  19. 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.

    Article  CAS  Google Scholar 

  20. 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.

    Article  CAS  Google Scholar 

  21. 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.

    Article  CAS  Google Scholar 

  22. 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.

    Article  CAS  Google Scholar 

  23. 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.

    Article  CAS  Google Scholar 

  24. 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.

    Article  CAS  Google Scholar 

  25. 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.

    Article  Google Scholar 

  26. 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.

    Article  Google Scholar 

  27. 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.

    Article  Google Scholar 

  28. 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.

    Article  Google Scholar 

  29. Sanderson IR. Growth problems in children with IBD. Nat Rev Gastroenterol Hepatol. 2014;11:601–10.

    Article  CAS  Google Scholar 

  30. 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.

    Article  Google Scholar 

  31. 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.

    Article  Google Scholar 

  32. 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.

    Article  CAS  Google Scholar 

  33. 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.

    Article  Google Scholar 

Download references

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).

Author information

Authors and Affiliations

Authors

Contributions

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.

Corresponding authors

Correspondence to S. Selbuz or Z. Kuloğlu.

Ethics declarations

Conflict of interest

The authors declare that they have no conflict of interest.

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.

Additional information

Publisher’s note Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Supplementary information

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

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

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1038/s41430-019-0555-1

Search

Quick links