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Clinical Variables Associated With Statural Growth in Pediatric Crohn's Disease Differ by Sex (The Growth Study)
Neera Gupta1, Robert H Lustig2, Howard Andrews3
1Department of Pediatrics, Weill Cornell Medicine, New York, New York, USA.
Insights
Growth impairment in pediatric Crohn's disease (CD) differs by sex. This study identified distinct clinical factors influencing height in boys and girls with CD, indicating sex-specific treatment approaches may be needed.
Area of Science:
- Pediatric Gastroenterology
- Endocrinology
- Genetics
Background:
- Statural growth impairment is a recognized complication in pediatric Crohn's disease (CD).
- Existing research indicates a higher prevalence of growth issues in male patients with CD.
- Sex-specific differences in growth patterns necessitate further investigation within this population.
Purpose of the Study:
- To identify clinical variables associated with height differences between sexes in children with CD.
- To analyze sex-specific factors impacting growth impairment in pediatric CD patients.
- To inform tailored management strategies for growth deficits in pediatric CD.
Main Methods:
- Prospective, multicenter longitudinal study (Growth Study) of pediatric CD patients.
- Inclusion criteria based on bone age (BA) ranges for females (4y2m–12y) and males (5y–14y).
- Height z-score difference calculated as chronological age z-score minus BA z-score.
Main Results:
- 113 pediatric CD patients (36% female) were analyzed.
- Female patients exhibited a significantly greater mean height z-score difference (-0.9 ± 0.8) compared to males (-0.5 ± 0.9).
- Specific clinical factors (e.g., disease behavior, medications, symptoms) were differentially associated with height gain in females versus males.
Conclusions:
- Distinct clinical variables correlate with statural growth in male and female pediatric CD patients.
- These findings suggest the involvement of sex-specific molecular pathways in growth impairment.
- Sex-tailored approaches may be crucial for addressing growth deficits in pediatric CD.
Background:
Statural growth impairment is more common in male patients with Crohn's disease (CD). We identified clinical variables associated with height z score differences by sex in children participating in the Growth Study, a prospective multicenter longitudinal study examining sex differences in growth impairment in pediatric CD.
Methods:
Patients with CD (female patients with bone age [BA] ≥4 years 2 months and ≤12 years; male patients with BA ≥5 years and ≤14 years at screening) who had completed study visit 1 qualified. The height z score difference was computed as height z score based on chronological age minus height z score based on BA.
Results:
One hundred thirteen patients with CD (36% female) qualified. The mean chronological age was 12.0 ± 1.8 (SD) years. The magnitude of the mean height z score difference was significantly greater in female patients (-0.9 ± 0.8) than in male patients (-0.5 ± 0.9; P = 0.021). An initial classification of inflammatory bowel disease as CD (P = 0.038) and perianal disease behavior at diagnosis (P = 0.009) were associated with higher standardized height gain with BA progression, and arthralgia at symptom onset (P = 0.016), azathioprine/6-merpcaptopurine (P = 0.041), and probiotics (P ≤ 0.021) were associated with lower standardized height gain with BA progression in female patients. Patient-reported poor growth at symptom onset (P = 0.001), infliximab (P ≤ 0.025), biologics (P ≤ 0.015), methotrexate (P = 0.042), and vitamin D (P ≤ 0.010) were associated with higher standardized height gain with BA progression, and initial classification as CD (P = 0.025) and anorexia (P = 0.005) or mouth sores (P = 0.004) at symptom onset were associated with lower standardized height gain with BA progression in male patients.
Conclusions:
Different clinical variables were associated with statural growth in male patients vs female patients, suggesting that sex-specific molecular pathways lead to statural growth impairment in CD.
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