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Sarcopenia is a Predictor for Adverse Clinical Outcome in Pediatric Inflammatory Bowel Disease
Lilian Atlan1, Shlomi Cohen2, Shelly Shiran1
1Pediatric Imaging Unit, Imaging Division.
Insights
Low muscle mass in pediatric inflammatory bowel disease (IBD) predicts worse outcomes. Measuring psoas index via MRI can identify children with higher risks of disease exacerbation and need for biologic therapy.
Area of Science:
- Pediatric Gastroenterology
- Radiology
- Nutritional Science
Background:
- Inflammatory bowel disease (IBD) significantly impacts pediatric patients' nutritional status and disease trajectory.
- Sarcopenia, or muscle wasting, is linked to adverse outcomes in adult IBD but is understudied in children.
- Assessing muscle mass may offer insights into disease severity and prognosis in pediatric IBD.
Purpose of the Study:
- To evaluate muscle mass, specifically the psoas index, as a predictor of disease outcomes in pediatric patients with IBD.
- To compare muscle mass measurements between pediatric IBD patients and a control group.
- To determine if sarcopenia is associated with increased risk of disease exacerbation or need for advanced therapies.
Main Methods:
- Retrospective analysis of 101 pediatric IBD patients (Crohn disease and ulcerative colitis) who underwent magnetic resonance enterography (MRE) between 2008-2019.
- Muscle mass quantified by measuring the psoas muscle area at L3 on MRE, normalized to body surface area (psoas index).
- Comparison of psoas index between IBD patients and 87 non-IBD controls; analysis of clinical and radiological data for association with disease outcomes.
Main Results:
- Pediatric IBD patients exhibited a significantly lower psoas index compared to controls (326 vs. 528, P < 0.001).
- Patients in the lowest quartile of psoas index had a substantially higher risk of requiring biologic therapy (HR=12.1, P=0.046) and experiencing disease exacerbation (HR=9, P=0.047), independent of BMI.
- These findings highlight a correlation between reduced muscle mass and radiological severity in pediatric IBD.
Conclusions:
- Sarcopenia, indicated by a low psoas index, is a significant predictor of adverse clinical outcomes in pediatric IBD.
- Muscle mass assessment via MRE may serve as a valuable prognostic marker for disease course and severity in children with IBD.
- Early identification of sarcopenia could guide therapeutic strategies and improve management of pediatric IBD.
Objectives:
Inflammatory bowel disease (IBD) has a high impact on nutritional status. Sarcopenia is related to higher risk of surgery and rescue therapy in adults with IBD; however, comparable data in pediatric populations are scarce. We evaluated muscle mass as a predictor of disease outcome in pediatric IBD.
Methods:
All pediatric IBD patients who underwent magnetic resonance enterography (MRE) during 2008 to 2019 were included. Muscle mass was assessed by measuring the area of the psoas muscle at the upper level of L3 on MRE. The psoas area divided by the body surface area (BSA) yielded the psoas index. Clinical and radiological data, including disease location, activity, course, and medications were documented. The control group included non-IBD children who underwent an MR imaging study.
Results:
We enrolled 101 IBD patients, 69 (68.3%) with Crohn disease (CD) and 32 (31.7%) with ulcerative colitis (UC) (mean age 15.03 ± 3.27 years). The psoas index was significantly lower in the IBD patients compared with the 87 controls (326 vs 528, respectively, P < 0.001). Patients with a psoas index in the lowest quartile had significantly higher risk for biologic therapy (multivariate analysis, hazard ratio [HR] = 12.1, P = 0.046) and disease exacerbation (HR = 9, P = 0.047) independently of body mass index, compared with patients with a psoas index in the uppermost quartile.
Conclusions:
Sarcopenia correlates with the radiological severity of pediatric IBD and serves as a predictor for adverse clinical disease outcome. Muscle mass measurement in MRE studies may serve as a possible marker for disease outcome in this population.
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