Nutritional status and growth in pediatric Crohn's disease: a population-based study.
OBJECTIVE
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.
Pôle de Santé Publique, Parc Eurasanté, University Hospital, Université de Lille 2 EA2694, Lille Cedex, France.
Francis
F
Vasseur
Corinne
C
Gower-Rousseau
Gwenola
G
Vernier-Massouille
Jean Louis
JL
Dupas
Veronique
V
Merle
Beatrice
B
Merlin
Eric
E
Lerebours
Guillaume
G
Savoye
Jean Louis
JL
Salomez
Antoine
A
Cortot
Jean Frederic
JF
Colombel
Dominique
D
Turck
D000293:Adolescent; D002097:C-Reactive Protein / Q000032:analysis; D002648:Child; D003424:Crohn Disease / Q000150:complications* / Q000188:drug therapy / Q000503:physiopathology*; D005260:Female; D005602:France; D006130:Growth Disorders / Q000209:etiology* / Q000503:physiopathology*; D006801:Humans; D008297:Male; D009752:Nutritional Status; D011237:Predictive Value of Tests; D012044:Regression Analysis; D012189:Retrospective Studies; D012307:Risk Factors; D018709:Statistics, Nonparametric; D011795:Surveys and Questionnaires
D002097:C-Reactive Protein