Nutritional Status and Growth in Pediatric Crohn's Disease: ... : Official journal of the American College of Gastroenterology | ACG (original) (raw)

ORIGINAL CONTRIBUTIONS: PEDIATRICS

Nutritional Status and Growth in Pediatric Crohn's Disease: A Population-Based Study

Vasseur, Francis PhD1; Gower-Rousseau, Corinne MD2; Vernier-Massouille, Gwenola MD3; Dupas, Jean Louis MD, PhD4; Merle, Veronique MD5; Merlin, Beatrice MD2; Lerebours, Eric MD, PhD5; Savoye, Guillaume MD5; Salomez, Jean Louis MD, PhD2; Cortot, Antoine MD, PhD3; Colombel, Jean Frederic MD, PhD3; Turck, Dominique MD, PhD6

1Pôle de Santé Publique, Parc Eurasanté, University Hospital, Université de Lille 2 EA2694, Lille Cedex, France

2Registre des Maladies Inflammatoires Chroniques de l'Intestin du Nord-Ouest de la France (EPIMAD), Service Régional d'Epidémiologie, Parc Eurasanté, University Hospital, Lille Cedex, France

3Service d'Hépato-Gastroentérologie, Hôpital Claude Huriez, University Hospital, Lille Cedex, France

4Registre des Maladies Inflammatoires Chroniques de l'Intestin, Amiens University Hospital, Amiens Cedex, France

5Registre des Maladies Inflammatoires Chroniques de l'Intestin, Rouen University Hospital, Rouen Cedex, France

6Service de Pédiatrie, Hôpital Jeanne de Flandre, University Hospital, Lille Cedex, France

Correspondence: Jean Frederic Colombel, MD, PhD, Department of Hepato-Gastroenterology and EPIMAD Registry, Hôpital Claude Huriez, Lille Cedex, CHRU 59037, France. E-mail: [email protected]

published online 9 February 2010

Received 3 September 2009; accepted 11 January 2010

Abstract

OBJECTIVES:

Growth retardation and malnutrition are major features of pediatric Crohn's disease (CD). We examined nutritional and growth parameters from diagnosis to maximal follow-up in a population-based pediatric cohort, and we determined predictive factors.

METHODS:

A total of 261 patients (156 boys, 105 girls) with onset of CD before the age of 17 were identified from 1988 to 2004 through the EPIMAD registry (Registre des Maladies Inflammatoires Chroniques de l'Intestin) in northern France. Median age at diagnosis was 13 years (11.2–15.4) and median follow-up was 73 months (46–114). Z -scores of height/age, weight/age, and body mass index (BMI)/age were determined. Multivariate stepwise regression analysis identified predictive factors for malnutrition and growth retardation at maximal follow-up.

RESULTS:

At diagnosis, 25 children (9.5%) showed height less than −2 s.d., 70 (27%) weight less than −2 s.d., and 84 (32%) BMI less than −2 s.d. At maximal follow-up, growth retardation was present in 18 children (6.9%), whereas 40 (15%) had malnutrition. Nutritional status was more severely impaired in children with stricturing disease. Growth and nutritional retardation at diagnosis, young age, male gender, and extraintestinal manifestations at diagnosis were indicators of poor prognosis. A significant compensation was observed for weight and BMI in both genders and for height in girls. No treatment was associated with height, weight, or BMI at maximal follow-up.

CONCLUSIONS:

In our pediatric population-based study, growth retardation and severe malnutrition were still present at maximal follow-up in 6.9 and 15% of CD children, respectively. Young boys with substantial inflammatory manifestations of CD have a higher risk of subsequent growth failure, especially when growth retardation is present at diagnosis.