title: Influence of exclusive enteral nutrition therapy on bone density and geometry in newly diagnosed pediatric Crohn's disease patients.
abstract: OBJECTIVE
  Exclusive enteral nutrition (EEN) induces remission in patients with Crohn's disease (CD). We investigated the short-term impact of EEN on bone quality and muscle mass in children with CD.
  
  
  METHODS
  Ten newly diagnosed CD patients (7 male, 10.6-17.7 years of age) were assessed by peripheral quantitative computed tomography (pQCT) at the forearm before starting an 8-weeks treatment with EEN, and after 12 and 52 weeks. No steroids or biologicals were applied. Trabecular and cortical bone mineral density, total bone, and muscle cross-sectional area (CSA) were measured by pQCT and expressed as age- and sex-specific z-scores; size-dependent CSAs were corrected for low height for age. Wilcoxon rank sum test was applied.
  
  
  RESULTS
  Remission at week 12 was achieved in 8 patients; 2 still had mild disease. Initially low trabecular density z-scores improved (+0.3; p = 0.006) at week 12; simultaneously, the increased cortical density z-scores normalized (-0.4; p = 0.027). The low z-score for muscle CSA corrected for height (median -2.5, range -3.49 to -0.97) increased within 12 weeks (+1.0; p = 0.002) with no further improvement thereafter.
  
  
  CONCLUSIONS
  The results indicate disturbed bone remodeling and severely impaired muscle mass in newly diagnosed CD children. Bone metabolism and muscle mass improved within 3 months after starting EEN with no further normalization thereafter.
authors.affiliation: Division of Pediatric Gastroenterology and Hepatology, Dr. von Hauner Children's Hospital, University of Munich Medical Center, Munich, Germany.
authors.forename: Katharina Julia
authors.initials: KJ
authors.lastname: Werkstetter
authors.forename: Stephanie Barbara
authors.initials: SB
authors.lastname: Schatz
authors.forename: Martin
authors.initials: M
authors.lastname: Alberer
authors.forename: Birgit
authors.initials: B
authors.lastname: Filipiak-Pittroff
authors.forename: Sibylle
authors.initials: S
authors.lastname: Koletzko
mesh_terms: D000293:Adolescent; D000886:Anthropometry; D015415:Biomarkers / Q000097:blood; D015519:Bone Density / Q000502:physiology*; D001842:Bone and Bones / Q000378:metabolism; D002648:Child; D003424:Crohn Disease / Q000628:therapy*; D003430:Cross-Sectional Studies; D004750:Enteral Nutrition / Q000379:methods*; D005260:Female; D018737:Hand Strength; D006801:Humans; D008297:Male; D018482:Muscle, Skeletal / Q000378:metabolism; D011627:Puberty; D015898:Tomography Scanners, X-Ray Computed
chemical_list: D015415:Biomarkers