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World J Gastroenterol. Mar 28, 2014; 20(12): 3191-3197
Published online Mar 28, 2014. doi: 10.3748/wjg.v20.i12.3191
Update on nutritional status, body composition and growth in paediatric inflammatory bowel disease
Rebecca J Hill
Rebecca J Hill, Children’s Nutrition Research Centre, Queensland Children’s Medical Research Institute, The University of Queensland, Herston, Qld 4029, Australia
Rebecca J Hill, School of Medicine, The University of Queensland, Herston, Qld 4029, Australia
Author contributions: Hill RJ was solely responsible for all facets of manuscript writing and preparation.
Supported by Hill RJ in receipt of the Reginald Ferguson Research Fellowship in Gastroenterology, The University of Queensland
Correspondence to: Rebecca J Hill, PhD, Children’s Nutrition Research Centre, Queensland Children’s Medical Research Institute, The University of Queensland, Old Milk Kitchen, Crn Fourth and Back Rds, Herston, Qld 4029, Australia. rj.hill@uq.edu.au
Telephone: +61-7-33655351 Fax: +61-7-33464684
Received: September 27, 2013
Revised: December 2, 2013
Accepted: February 20, 2014
Published online: March 28, 2014
Processing time: 180 Days and 22.9 Hours
Abstract

Growth and nutritional status are important issues in paediatric inflammatory bowel disease (IBD). While linear growth is easy to assess, nutritional status is more complicated, with reports often compromised by the use of simple measures, such as weight and the body mass index, to assess nutritional status rather than more appropriate and sophisticated techniques to measure body composition. This review is an update on what is currently known about nutritional status as determined by body composition in paediatric IBD. Further, this review will focus on the impact of biologics on growth in paediatric IBD. Significant lean mass deficits have been reported in children with IBD compared with controls, and there is evidence these deficits persist over time. Furthermore, data imply that gender differences exist in body composition, both at diagnosis and in response to treatment. With respect to growth improvements following treatment with biologics, there are conflicting data. While some studies report enhancement of growth, others do not. The relationship between disease severity, impaired growth and the requirement for biologics needs to be considered when interpreting these data. However, key features associated with improvements in growth appear to be successful clinical response to treatment, patients in early stages of puberty, and the presence of growth failure at the onset of treatment.

Keywords: Crohn’s disease; Ulcerative colitis; Lean mass; Pubertal status; Infliximab; Inflammatory bowel disease

Core tip: Assessing body composition gives a much better indication of nutritional status than measures of anthropometry, such as BMI. In children with IBD, significant and persistent deficits in lean mass, suggestive of compromised nutritional status, have been reported, both at diagnosis and following treatment. Data pertaining to body composition in response to biologics is lacking, and data concerning growth improvements is controversial. However, evidence suggests that the key components associated with linear growth improvements when treating with biologics are (1) successful clinical response to treatment; (2) patients in early stages of puberty; and (3) the presence of growth failure at the onset of treatment.