Crohn's disease and growth deficiency in children and adolescents

Table 1 Summary of the main studies that were reviewed on nutritional concerns in pediatric Crohn’s disease

Ref.	Type of study	Patients	Results	Conclusion
Vaisman et al[25], Nutrition 2006	Prospective cohort study	16 pts with CD; Age 19-57 yr Remission of disease (CDAI Activity Disease Index < 150); 2 groups (BMI 18.5 kg/m2 as a cutoff point)	Subjects with lower BMIs tended to have less lean body mass (P = 0.006), less bone mineral density (P = 0.006), and lower resting energy expenditure (P = 0.003); No correlation between BMI and energy intake, although percentage of malabsorption negatively correlated with BMI (P = 0.07)	In the presence of similar energy intake, resting energy expenditure does not seem to contribute to lower BMI, although nutrient malabsorption is higher in malnourished patients with CD in remission; Malabsorption should be evaluated in patients with CD who fail to gain Wt during disease remission, to establish their extra caloric requirements
Gupta et al[28], Inflamm Bowel Dis 2013	Retrospective review	43 IBD pts (mean age 12.8 yr; range 5.1-17.4 yr) 67% M 33% F	Reductions in erythrocyte sedimentation rate (P < 0.0001) and C-reactive protein (P < 0.02), and increases in albumin (P < 0.03); Mean PCDAI score 26.9 at baseline and 10, 2 at follow-up (P < 0.0001); Induction of remission achieved in 65% and response in 87% at a mean follow-up of 2 mo (1-4 mo)	Novel protocol for enteral nutrition (80%-90% of patient’s caloric needs) seems to be effective for the induction of remission in CD children; The protocol may result in improved EN acceptance and compliance and will be evaluated prospectively
Wiskin et al[29], J Hum Nutr Diet 2012	Prospective cohort study	46 IBD children	No children scored low risk with STAMP, STRONGkids or PNRS; 23 children scored low risk with PYMS; Good agreement between STAMP, STRONGkids, and PNRS (K > 0.6); Modest agreement between PYMS and the other scores (K = 0.3); No agreement between the risk tools and the degree of malnutrition based on anthropometric data (K < 0.1)	Relevance of nutrition screening tools for children with chronic disease is unclear; There is the potential to under recognize nutritional impairment (and therefore nutritional risk) in children with IBD
Valentini et al[30], Nutrition 2008	Prospective, controlled, multicentric study	94 pts with CD (CDAI 71 +/- 47) 61 F 33 M 50 UC (UCAI 3.1 +/- 1.5) 33 F 17 M 61 healthy control subjects 41 F 20 M from centers in Berlin (Germany), Vienna (Austria), and Bari (Italy) 47 well-nourished patients with IBD pair-matched to healthy controls by BMI, sex, and age	74% IBD patients were well-nourished according to the SGA, BMI, and serum albumin; Body composition analysis demonstrated a decrease in BCM in patients with CD (P = 0.021) and UC (P = 0.041) compared with controls; Handgrip strength correlated with BCM (r = 0.703, P = 0.001) and was decreased in patients with CD (P = 0.005) and UC (P = 0.001) compared with controls; Lower BMC in patients with moderately increased serum CRP levels compared with patients with normal levels	In CD and UC, selected micronutrient deficits and loss of BCM and muscle strength are frequent in remission and cannot be detected by standard malnutrition screening
Chan et al[31], Am J Gastroenterol 2013	Prospective cohort study	300724 participants (recruited into the European Prospective Investigation into Cancer and Nutrition study) 177 UC and 75 CD	No associations with the four higher categories of BMI compared with a normal BMI for UC (P trend = 0.36) or CD (P trend = 0.83); Lack of associations when BMI analyzed as a continuous or binary variable (BMI 18.5 kg/m2vs≥ 25 kg/m2); Physical activity and total energy intake not associated with UC (P trends 0.79-0.18) or CD (P trends 0.42-0.11)	Obesity as measured by BMI not associated with the development of incident UC or CD; Alternative measures of obesity required to further investigate the role of obesity in the development of incident IBD
Werkstetter et al[32], J Crohns Colitis 2012	Prospective cohort study	39 IBD children in remission; 27 CD, 12 UC 24 M; 39 healthy age-sex-matched controls	IBD pts vs controls: Lower Z-scores for phase angle α [-0.72; 95%CI: (-1.10-0.34)] Lower grip strength [-1.02 (-1.58-0.47) Lesser number of steps per day [-1339 (-2760-83)] Shorter duration of physical activity [-0.44 h (-0.94-0.06)], particularly in F and patients with mild disease. Quality of life and energy intake did not differ between patients and controls	In spite of quiescent IBD, lean body mass and physical activity were reduced; Interventions to encourage physical activity may be beneficial in this lifelong disease
Gerasimidis et al[33] Inflamm Bowel Dis 2013	Prospective cohort study	184 new pediatric IBD Dg 139 one year follow-up IBD children 84 children treated with EEN	72% anemic at Dg; Anemic children with CD had shorter diagnosis delay, lower BMI, lower Dg delay (P < 0.001) and BMI Z-score, P = 0.003) than non-anemic patients; Extensive colitis associated with severe anemia in UC; After EEN, severe anemia decreased (32%-9%, P < 0.001) and hemoglobin concentration increased by 0.75 g/dL	Anemia is frequent at Dg and follow-up and should receive more attention from the clinical team; The focus should remain suppression of inflammatory process in active disease

Dg: Diagnosis; pt/pts: Patient/patients; CD: Crohn’s disease; UC: Ulcerative colitis; IBD-U: Unclassified IBD; rhGH: Recombinant growth factor; ESR: Erythrocyte sedimentation rate; BMC: Body cell mass; BMI: Body mass index; Ht: Height; Wt: Weight; BMD: Bone mineral density; DXA: Dual-energy X-ray absorptiometry; EEN: Exclusive enteral nutrition; GH: Growth hormone; (P)CDAI: (Pediatric) Crohn’s disease activity index; PUCAI: Pediatric ulcerative colitis activity index; M: Male; F: Female.