Determinants of changes in linear growth and body composition in incident pediatric Crohn's disease.
OBJECTIVE
Pediatric Crohn's disease (CD) is associated with growth, lean mass (LM), and fat mass (FM) deficits. This study assessed and identified determinants of changes in height and body composition in children with CD following.


METHODS
Whole-body LM and FM were assessed using dual-energy x-ray absorptiometry in 78 CD subjects at diagnosis, 6, 12, and a median of 43 months (range, 24-63) later. Race- and sex-specific Z scores for lean mass (LM-ht-Z) and fat mass (FM-ht-Z) relative to height were derived using reference data in >900 controls. Serum cytokines and growth factors were measured, and quasi-least squares regression was used to identify determinants of changes in height and body composition.


RESULTS
LM-ht-Z and FM-ht-Z (both P<.005) improved significantly after diagnosis; however, female patients had persistent LM deficits vs controls (-0.50+/-1.02, P<.05). Serum interleukin-6, tumor necrosis factor-alpha, and lipopolysaccharide binding protein decreased significantly (all P<.001). Greater increases in LM-ht-Z were associated with infliximab therapy (P<.05), increases in albumin (P<.001) and decreases in erythrocyte sedimentation rate (P<.05), interleukin-6 (P<.005), and lipopolysaccharide binding protein (P<.05). Greater increases in FM-ht-Z were associated with glucocorticoid, methotrexate, and infliximab therapy, and increases in albumin (P<.05) and growth hormone binding protein (P<.05). Overall, height-Z did not improve; however, greater increases in insulin-like growth factor-1 (P<.05) and decreases in tumor necrosis factor-alpha (P<.05), interleukin-6 (P<.05), and lipopolysaccharide binding protein (P<.05) levels were associated with increases in height-Z.


CONCLUSIONS
Immune-mediated mechanisms contribute to growth and body composition deficits in CD. Therapies should target these deficits.
Thayu
Meena
M
Department of Pediatrics, The Children's Hospital of Philadelphia, Center for Clinical Epidemiology and Biostatistics, University of Pennsylvania School of Medicine, Philadelphia, Pennsylvania 19104, USA. thayu@email.chop.edu
Denson
Lee A
LA
Shults
Justine
J
Zemel
Babette S
BS
Burnham
Jon M
JM
Baldassano
Robert N
RN
Howard
Krista M
KM
Ryan
Anne
A
Leonard
Mary B
MB
D015502:Absorptiometry, Photon; D000293:Adolescent; D000367:Age Factors; D000375:Aging; D000886:Anthropometry; D000893:Anti-Inflammatory Agents / Q000627:therapeutic use; D015415:Biomarkers / Q000097:blood; D001823:Body Composition; D001827:Body Height; D016022:Case-Control Studies; D002648:Child; D002675:Child, Preschool; D003424:Crohn Disease / Q000188:drug therapy / Q000453:epidemiology / Q000276:immunology / Q000503:physiopathology*; D016207:Cytokines / Q000097:blood; D004797:Enzyme-Linked Immunosorbent Assay; D005260:Female; D005765:Gastrointestinal Agents / Q000627:therapeutic use; D006801:Humans; D015994:Incidence; D036341:Intercellular Signaling Peptides and Proteins / Q000097:blood; D016018:Least-Squares Analysis; D008297:Male; D016896:Treatment Outcome; D014481:United States / Q000453:epidemiology; D055815:Young Adult
D000893:Anti-Inflammatory Agents; D015415:Biomarkers; D016207:Cytokines; D005765:Gastrointestinal Agents; D036341:Intercellular Signaling Peptides and Proteins