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Growth Pattern in Paediatric Crohn Disease Is Related to Inflammatory Status
Delphine Ley1, Alain Duhamel, Hélène Behal
1*Division of Gastroenterology, Hepatology and Nutrition, Department of Paediatrics, Lille University Jeanne de Flandre Children's Hospital †Biostatistics Unit, Lille University Hospital, EA 2694 ‡Department of Public Health, Epidemiology and Economic Health, Epimad Registry, Lille University Hospital, University of Lille §Lille Inflammation Research International Centre LIRIC UMR 995, University of Lille, Inserm, CHU Lille, Lille, France.
Insights
In paediatric-onset Crohn disease (CD), uncontrolled inflammation significantly impairs growth velocity, independent of steroid therapy. Maintaining low inflammatory status is crucial for optimizing growth in these children.
Area of Science:
- Pediatric Gastroenterology
- Inflammatory Bowel Disease Research
- Growth and Development Studies
Background:
- The impact of disease activity versus steroid therapy on growth impairment in pediatric Crohn disease (CD) remains debated.
- Understanding these factors is crucial for effective management and optimizing growth outcomes in affected children.
Purpose of the Study:
- To investigate the correlation between growth patterns and inflammatory status in children with CD during the disease course.
- To determine if this correlation persists regardless of the cumulative duration of steroid therapy.
Main Methods:
- A cohort of 107 pediatric-onset CD patients with at least two years of follow-up and height measurements were analyzed.
- Linear mixed-effects models with random coefficients were used to assess the relationship between growth velocity and inflammatory markers (CRP, orosomucoid) over time.
- Steroid therapy duration was accounted for in the analysis.
Main Results:
- Growth velocity was significantly and negatively correlated with the evolution of C-reactive protein (CRP) and orosomucoid levels.
- These correlations remained statistically significant even after adjusting for the cumulative duration of steroid therapy.
- A low incidence of growth failure was observed at diagnosis (8%) and maximal follow-up (5%).
Conclusions:
- Uncontrolled inflammatory status in pediatric-onset CD is associated with reduced growth velocity.
- Optimizing growth in these patients necessitates maintaining inflammatory status as close to normal as possible.
- Disease activity, rather than steroid duration alone, appears to be a key determinant of growth impairment.
Objectives:
The respective role of disease activity and steroid therapy in growth impairment in paediatric-onset Crohn disease (CD) is still debated. Our aim was to investigate whether the growth pattern of children with CD was correlated with the inflammatory status during the disease course, regardless the cumulative duration of steroid therapy.
Methods:
One hundred and seven patients with a diagnosis of CD <17 years, followed during ≥2 years and for whom ≥2 height measures were available during follow-up, were identified between 1998 and 2010. Height, C-reactive protein (CRP), orosomucoid, and steroid therapy duration were collected at each visit. The relationship between the evolution of growth velocity and inflammatory status during follow-up was investigated using a linear mixed model with random coefficients.
Results:
Median age at diagnosis was 11.7 years (Q1-Q3: 9.8-13.5). Mean height for age (H/A) z score was 0.14 ± 1.29 at diagnosis and 0.05 ± 1.23 among the 75 patients who had reached their final height at maximal follow-up (median: 4.9 years; Q1-Q3: 3.8-6.4). Growth failure (H/A z score <-2) was present in 7 (8%) patients at diagnosis and 5 (5%) at maximal follow-up. Growth velocity was negatively correlated with the evolution of CRP (P < 0.0001) and orosomucoid (P < 0.0001) during follow-up. After adjustment for the cumulative duration of steroid therapy, these 2 correlations remained significant (CRP: P = 0.0008; orosomucoid: P < 0.0001).
Conclusions:
Children with CD with uncontrolled inflammatory status have a lower growth velocity. The inflammatory status should be kept as close to normal as possible in paediatric-onset patients with CD to optimize their growth pattern.
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