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Published on: November 9, 2018
Nutrition and growth in inflammatory bowel disease
1Institute of Gastroenterology, Nutrition and Liver Diseases, Schneider Children's Medical Center and Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel. shamirraanan@gmail.com
Insights
Growth failure affects up to 40% of pediatric inflammatory bowel disease (IBD) patients, particularly Crohn
Area of Science:
- Pediatric gastroenterology
- Inflammatory bowel disease (IBD) research
- Childhood growth and development
Background:
- Growth failure is a significant complication in pediatric inflammatory bowel disease (IBD), especially Crohn's disease (CD), affecting up to 40% of cases.
- Multiple factors contribute to growth impairment in CD, including poor nutrition, malabsorption, increased metabolic demands, medication side effects (e.g., steroids), disease activity, genetics, and reduced physical activity.
- While malnutrition, genetic factors, and inflammation are implicated in human growth impairment, animal studies also highlight the role of cytokines and lipopolysaccharide exposure.
Purpose of the Study:
- To review the multifactorial causes of growth failure in pediatric Crohn's disease.
- To evaluate the role of exclusive enteral nutrition (EEN) in managing growth failure.
- To identify areas for future research and improved therapeutic strategies for growth impairment in IBD.
Main Methods:
- Literature review and synthesis of existing research on growth failure in pediatric IBD.
- Analysis of factors contributing to growth impairment, including nutritional, inflammatory, genetic, and medication-related aspects.
- Evaluation of the efficacy of exclusive enteral nutrition (EEN) as a treatment modality.
Main Results:
- Exclusive enteral nutrition (EEN) is a primary treatment for pediatric CD, effective in inducing and prolonging remission, and positively impacts growth by addressing malnutrition and inflammation.
- The positive effect of EEN on growth failure is limited, likely due to incomplete control of underlying inflammation.
- Growth failure in pediatric IBD necessitates regular monitoring from diagnosis through follow-up visits.
Conclusions:
- Improved strategies are needed to enhance growth in pediatric IBD patients.
- Future research should focus on novel nutritional interventions, identifying genetic markers responsive to enteral nutrition, and promoting physical activity to increase lean body mass.
- Comprehensive assessment and management of growth failure are crucial for children with IBD.
Abstract:
Growth failure is common in children with inflammatory bowel disease (IBD), mainly those with Crohn's disease (CD). The prevalence of growth failure varies in different cohorts, mainly due to the heterogeneity of the population treated by the reporting centers (primary vs. referral), but can be as high as 40% of the cases. Factors related to growth impairment in CD include low dietary intake, stool loss, increased energy and nutrient requirements, the use of medications (for example, steroids interfere with the IGF-1 axis), disease activity (the effect of inflammation on growth), genetic background (parents height), and physical activity. In animals, malnutrition, genetic polymorphism, elevated pro inflammatory cytokines, and exposure to lipopolysaccharide are involved in growth impairment in IBD, while malnutrition, genetic polymorphism and increased inflammation have been shown to be associated with growth impairment in humans. Exclusive enteral nutrition (EEN) is the preferred first line treatment in CD. EEN induces remission, prolongs remission and affects growth failure via its effect on malnutrition and inflammation. However, similar to drug treatment, EEN effect on growth failure is limited, most probably due to incomplete control of inflammation. Children with IBD should be assessed for growth on diagnosis and on each follow-up visit. New nutritional strategies, identification of genetic polymorphisms that respond to EN, and methods to increase lean body mass (physical activity) are needed in order to improve growth in our IBD patients.
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