The impact of national lockdown on nutritional status of children with inflammatory bowel disease
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Published on: January 5, 2017
Luise V Marino1,2,3, James J Ashton3,4,5, Robert Mark Beattie3,4,5
1Department of Dietetics and Speech & Language Therapy, University Hospital Southampton NHS Foundation Trust, Southampton, UK.
Insights
The COVID-19 lockdown worsened malnutrition in children with inflammatory bowel disease, as dietetic reviews were limited. Identifying and supporting these at-risk children is crucial during the pandemic.
Area of Science:
- Pediatric Gastroenterology
- Public Health Nutrition
- Epidemiology
Background:
- The COVID-19 pandemic presented significant health challenges, necessitating public health interventions like national lockdowns.
- The UK's national lockdown (March-early summer 2020) impacted healthcare delivery, including for patients with inflammatory bowel disease (IBD).
- Technology-enabled care services (TECS) were widely adopted for IBD patient follow-up during this period.
Purpose of the Study:
- To investigate the impact of the COVID-19 pandemic and national lockdown on the nutritional status of pediatric IBD patients.
- To assess changes in nutritional status, specifically body mass index Z-scores (BMIZ), before and after the lockdown period.
- To evaluate the role of TECS in nutrition reviews for IBD children during lockdown.
Main Methods:
- A retrospective study included pediatric patients (<18 years) with IBD treated at Southampton Children's Hospital.
- Patients with available nutritional data from before lockdown (November 2019-February 2020) and after lockdown (July-November 2020) were analyzed.
- Nutritional status was assessed using World Health Organization criteria and body mass index Z-scores (BMIZ).
Main Results:
- Of 116 patients, 19% (n=22) experienced mild malnutrition (BMIZ < -1), with a significant decrease in mean BMIZ post-lockdown (-1.3 to -1.9, p=0.03).
- Overweight children showed an increasing trend in BMIZ post-lockdown (1.2 to 1.6, p=0.2), though not statistically significant.
- Malnourished children were significantly more likely to receive a TECS nutrition review during lockdown (27%) compared to normally nourished (2%) or overweight (0%) children (p≤0.0001).
Conclusions:
- Dietetic reviews for pediatric IBD patients were significantly limited during the initial national lockdown.
- Children with pre-existing low BMIZ scores showed a trend towards increased malnutrition post-lockdown.
- Proactive identification and targeted support for children at nutritional risk are essential throughout the ongoing pandemic.
Background:
The COVID-19 pandemic has had wide-reaching primary and secondary health implications. The UK government implemented a national lockdown to slow the rate of infection at the end of March 2020, lasting until early summer 2020. The results from a UK nationwide survey suggest the majority of inflammatory bowel disease patients were followed up using technology-enabled care services (TECS) during this time. We therefore aimed to explore the impact of the pandemic on nutritional status of children with inflammatory bowel disease, focusing on the effect of national lockdown from March to early summer 2020.
Methods:
A retrospective study was conducted. All patients with a diagnosis of inflammatory bowel disease, aged <18 years, and under the care of Southampton Children's Hospital were eligible for inclusion. Those patients who attended an outpatient appointment during time period 1 (November 2019 to February 2020), and following the period of national lockdown, time period 2 (July to November 2020), were included in the analysis.
Results:
In total, 116 patients had paired measures. Using the World Health Organization criteria of nutritional status, 19% (n = 22/116) were mildly malnourished with a body mass index Z score (BMIZ) < -1. In this group, the mean BMIZ was -1.3 ± 0.9 at time point 1 versus -1.9 ± 0.9 at time point 2 (p = 0.03). The mean BMIZ score of those children who were overweight at time point 1 was 1.2 ± 1.2 versus 1.6 ± 1.4 at time point 2 (p = 0.2) During the period of lockdown, 27% of malnourished children (n = 6/22), 2% of normally nourished children (BMIZ > -1 to < 1) (n = 1/51) (p ≤ 0.0001) and none of the overweight children (BMIZ > 1) (n = 0/43) children (p ≤ 0.0001) had a TECS nutrition review.
Conclusions:
Dietetic reviews were severely restricted during the first national lockdown. Patients with low BMIZ prior to lockdown became more malnourished. During the ongoing pandemic, it is important to identify those children with nutrition risk, focusing support on this group of children.
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