title: Growth abnormalities persist in newly diagnosed children with crohn disease despite current treatment paradigms.
abstract: OBJECTIVE
  We analyzed growth outcomes in children newly diagnosed with Crohn disease and determined whether growth abnormalities persist despite current therapies.
  
  
  METHODS
  Clinical and growth data were prospectively obtained on an inception cohort younger than 16 years old at diagnosis and Tanner I to III during the study.
  
  
  RESULTS
  In all, 176 children (mean age 10.1 years; 65% male) with mild (33%) or moderate/severe (67%) disease at diagnosis were studied. Disease activity at 1 year was inactive/mild (89%) or moderate/severe (11%). First-year treatments included immunomodulators (60%), corticosteroids (77%), 5-aminosalicylates (61%), infliximab (15%), and enteral nutrition (10%). By 2 years, 86% had received immunomodulators and 36% infliximab. Mean height z scores at diagnosis, 1 year, and 2 years were -0.49 +/- 1.2 standard deviations (SDs), -0.50 +/- 1.2, and -0.46 +/- 1.1, respectively. Of the subjects, 10%, 8%, and 6.5% had height z scores less than -2 SD at diagnosis, 1 year, and 2 years. A height velocity z score less than -1SD was seen in 45% of subjects at 1 year and 38% at 2 years. The mean height velocity z score, however, increased between 1 and 2 years from -0.71 to 0.26 (P < 0.03). Corticosteroid use greater than 6 months in the first year was associated with abnormal height velocity at 1 year (adjusted odds ratio = 4.5; 95% confidence interval [CI] = 2.2-9.6). No statistically significant effect on height velocity z scores was noted when comparing those receiving or not receiving infliximab.
  
  
  CONCLUSIONS
  Growth delay persists in many children with CD following diagnosis, despite improved disease activity and the frequent use of immunomodulators and biologics. Additional strategies to improve growth outcomes require development.
authors.affiliation: Riley Hospital for Children, Indianapolis, IN 46202, USA. mdelrosa@iupui.edu
authors.forename: Marian
authors.initials: M
authors.lastname: Pfefferkorn
authors.forename: Georgine
authors.initials: G
authors.lastname: Burke
authors.forename: Anne
authors.initials: A
authors.lastname: Griffiths
authors.forename: James
authors.initials: J
authors.lastname: Markowitz
authors.forename: Joel
authors.initials: J
authors.lastname: Rosh
authors.forename: David
authors.initials: D
authors.lastname: Mack
authors.forename: Anthony
authors.initials: A
authors.lastname: Otley
authors.forename: Subra
authors.initials: S
authors.lastname: Kugathasan
authors.forename: Jonathan
authors.initials: J
authors.lastname: Evans
authors.forename: Athos
authors.initials: A
authors.lastname: Bousvaros
authors.forename: M Susan
authors.initials: MS
authors.lastname: Moyer
authors.forename: Robert
authors.initials: R
authors.lastname: Wyllie
authors.forename: Maria
authors.initials: M
authors.lastname: Oliva-Hemker
authors.forename: Ryan
authors.initials: R
authors.lastname: Carvalho
authors.forename: Wallace
authors.initials: W
authors.lastname: Crandall
authors.forename: David
authors.initials: D
authors.lastname: Keljo
authors.forename: T D
authors.initials: TD
authors.lastname: Walters
authors.forename: Neal
authors.initials: N
authors.lastname: LeLeiko
authors.forename: Jeffrey
authors.initials: J
authors.lastname: Hyams
mesh_terms: D000293:Adolescent; D000305:Adrenal Cortex Hormones / Q000009:adverse effects / Q000627:therapeutic use; D000893:Anti-Inflammatory Agents / Q000627:therapeutic use; D000911:Antibodies, Monoclonal / Q000627:therapeutic use; D001827:Body Height / Q000187:drug effects / Q000502:physiology; D002648:Child; D015331:Cohort Studies; D016001:Confidence Intervals; D003424:Crohn Disease / Q000175:diagnosis / Q000503:physiopathology* / Q000628:therapy; D004750:Enteral Nutrition / Q000379:methods*; D005260:Female; D006128:Growth / Q000187:drug effects* / Q000502:physiology; D006130:Growth Disorders / Q000453:epidemiology* / Q000628:therapy*; D006801:Humans; D000069285:Infliximab; D008297:Male; D016017:Odds Ratio; D015995:Prevalence; D011446:Prospective Studies; D012720:Severity of Illness Index; D012741:Sexual Maturation; D016896:Treatment Outcome
chemical_list: D000305:Adrenal Cortex Hormones; D000893:Anti-Inflammatory Agents; D000911:Antibodies, Monoclonal; D000069285:Infliximab