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High and low body mass index may predict severe disease course in children with inflammatory bowel disease
Anat Yerushalmy-Feler1, Amir Ben-Tov1, Yael Weintraub1
1a Pediatric Gastroenterology Unit , ' Dana-Dwek' Children's Hospital, Tel Aviv Sourasky Medical Center, Sackler Faculty of Medicine, Tel Aviv University , Tel Aviv , Israel.
Insights
Children with inflammatory bowel disease (IBD) in the lowest and highest body mass index (BMI) quartiles at diagnosis experienced more severe disease courses. BMI can predict pediatric IBD prognosis.
Area of Science:
- Pediatric Gastroenterology
- Inflammatory Bowel Disease Research
- Clinical Nutrition in Pediatrics
Background:
- Inflammatory bowel disease (IBD) historically links to malnutrition, but adult IBD's relation to underweight and obesity is debated.
- This study investigates the association between body mass index (BMI) at diagnosis and disease progression in pediatric IBD patients.
Purpose of the Study:
- To determine the relationship between initial body mass index (BMI) and the clinical course of pediatric inflammatory bowel disease (IBD).
- To explore BMI as a potential predictor for disease severity and treatment response in children with IBD.
Main Methods:
- Retrospective review of 100 pediatric IBD patients' medical records from 2010-2016.
- Patients categorized into four body mass index (BMI) quartiles at diagnosis.
- Analysis of demographic data, disease characteristics, course, and therapy, including anti-tumor necrosis factor (TNF) treatment.
Main Results:
- Lower and upper BMI quartiles at diagnosis correlated with prolonged time to diagnosis and higher disease activity.
- Multivariate analysis revealed that extreme BMI quartiles (lowest and highest) were associated with disease exacerbation (HR 3.212 and 4.651, respectively).
- Patients in the lowest and highest BMI quartiles also showed increased likelihood of requiring anti-tumor necrosis factor (TNF) therapy (HR 4.489 and 3.972, respectively).
Conclusions:
- Body mass index (BMI) in the lower and upper quartiles is linked to a more severe disease course in pediatric inflammatory bowel disease (IBD).
- BMI serves as a simple, accessible predictor for the course and prognosis of pediatric IBD.
Objectives:
Inflammatory bowel disease (IBD) has been historically associated with underweight and malnutrition. The impact of both underweight and obesity on the clinical course of IBD in adults is controversial. This study described the association between body mass index (BMI) at diagnosis to disease course in children with IBD.
Methods:
We reviewed the medical records of children with IBD from the database of the 'Dana-Dwek' Children's Hospital between 2010 and 2016. Demographic and anthropometric data were collected as were disease characteristics, course and therapy. Patients were categorized in quartiles according to BMI percentiles at diagnosis (Q1-Q4).
Results:
Of 100 children who were identified, 62 had Crohn's disease (CD) and 38 had ulcerative colitis (UC). The median age (interquartile range, IQR) at diagnosis was 13.7 (range 11.9-15.2) years. The median (IQR) follow-up was 2.1 (1.2-3.8) years. At diagnosis, 46 children (46%) were in Q1, 20 (20%) in Q2, 19 (19%) in Q3 and 15 (15%) in Q4. Prolonged time to diagnosis was associated with BMI in Q1 and Q4, as well as high disease activity at diagnosis (p < .001). In a multivariate analysis, BMI in the lower and upper quartiles was associated with disease exacerbation (HR 3.212 and 4.651, respectively, p = .016) and anti-tumor necrosis factor (TNF) therapy (HR 4.489 and 3.972, respectively, p = .021).
Conclusions:
BMI in the lower and upper quartiles was associated with more severe disease course in children with IBD. BMI may serve as a simple and highly accessible predictor of pediatric IBD course and prognosis.
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