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Assessment of Child Anthropometry in a Large Epidemiologic Study
Published on: February 2, 2017
Determinants of changes in linear growth and body composition in incident pediatric Crohn's disease
Meena Thayu1, Lee A Denson, Justine Shults
1Department 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
Insights
Pediatric Crohn's disease (CD) impacts growth and body composition. While lean and fat mass improved after diagnosis, therapies targeting immune mechanisms are crucial for addressing persistent deficits and promoting overall growth in children with CD.
Area of Science:
- Pediatric Gastroenterology
- Inflammatory Bowel Disease Research
- Human Growth and Development
Background:
- Pediatric Crohn's disease (CD) is characterized by significant deficits in height, lean mass (LM), and fat mass (FM).
- Understanding the factors influencing changes in these parameters is critical for effective management.
Purpose of the Study:
- To assess changes in height and body composition in children with CD post-diagnosis.
- To identify the key determinants of these changes, including therapeutic interventions and biomarkers.
Main Methods:
- Dual-energy x-ray absorptiometry (DXA) was used to measure whole-body LM and FM in 78 pediatric CD patients.
- Z scores for LM and FM relative to height were calculated and compared to control data.
- Serum cytokine and growth factor levels were analyzed, with regression models identifying determinants of body composition and height changes.
Main Results:
- Significant improvements in LM-ht-Z and FM-ht-Z were observed post-diagnosis, though females showed persistent LM deficits.
- Therapies like infliximab, along with increased albumin and decreased inflammatory markers (ESR, IL-6, LBP), were associated with improved LM and FM.
- While height-Z did not significantly improve overall, increases in IGF-1 and decreases in TNF-α, IL-6, and LBP correlated with height gains.
Conclusions:
- Immune-mediated pathways play a substantial role in the growth and body composition deficits seen in pediatric CD.
- Targeted therapies addressing these immune mechanisms are essential for improving growth and body composition in affected children.
Background & Aims:
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.
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