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Clinical risk factors for body composition deficits in children with inflammatory bowel disease
Erin Alexander1,2, Ronen Stein2, Sharmistha Rudra3
1Division of Pediatric Gastroenterology, Hepatology and Nutrition, Department of Pediatric and Adolescent Medicine, Mayo Clinic Children's Center, Rochester, Minnesota, USA.
Insights
Body composition deficits, specifically low lean mass, are common in pediatric inflammatory bowel disease (IBD) and often masked by normal BMI. Early identification of these deficits is crucial for better clinical outcomes in children with IBD.
Area of Science:
- Pediatric gastroenterology
- Nutritional science
- Body composition analysis
Background:
- Children with inflammatory bowel disease (IBD) frequently exhibit low body mass index (BMI).
- BMI does not differentiate between fat and lean body mass.
- Body composition deficits may correlate with adverse clinical outcomes in pediatric IBD patients.
Purpose of the Study:
- To determine the prevalence of risk factors linked to body composition deficits in pediatric IBD.
- To identify factors associated with low lean mass in children with IBD who have a normal BMI Z-score (BMI-Z).
Main Methods:
- Retrospective analysis of 516 newly diagnosed IBD patients (ages 5-20) with dual energy x-ray absorptiometry scans (2014-2019).
- Appendicular lean soft tissue mass index (AppLSTMI) and fat mass index (FMI) were calculated as age- and sex-specific Z-scores.
- Logistic regression analyzed associations between clinical/demographic data and body composition outcomes.
Main Results:
- 26% of patients had low appendicular lean soft tissue mass index (AppLSTMI-Z < -2), while only 4% had low BMI-Z.
- Low AppLSTMI-Z was associated with Crohn's disease, Asian ethnicity, active disease, elevated platelets, and glucocorticoid use.
- Low lean mass with normal BMI-Z was linked to Crohn's disease, Asian and Black ethnicity, and elevated platelets.
Conclusions:
- Body mass index (BMI) is an inadequate measure of body composition in pediatric IBD, often concealing prevalent lean mass deficits.
- Further research is needed to understand the long-term effects and potential reversibility of lean mass deficits in pediatric IBD.
Objectives:
Children with inflammatory bowel disease (IBD) often have low body mass index (BMI). BMI does not distinguish between fat and lean mass. Body composition deficits may be associated with worse clinical outcomes. We examined the prevalence of risk factors associated with body composition deficits in youth with pediatric-onset IBD, and factors associated with low lean mass in the presence of a normal BMI Z-score (BMI-Z).
Methods:
Newly diagnosed IBD patients ages 5-20 years with whole body dual energy x-ray absorptiometry scans acquired between 2014 and 2019 were included. Appendicular lean soft tissue mass index (AppLSTMI) and fat mass index (FMI) were expressed as age and sex-specific Z-scores. Clinical and demographic data were collected retrospectively. Logistic regression was used to assess associations with body composition outcomes.
Results:
Five hundred sixteen patients were included, 26% had AppLSTMI Z-score (AppLSTMI-Z) < -2, 4% had BMI-Z < -2, and none had FMI Z-score (FMI-Z) < -2. Increased risk of low AppLSTMI-Z associated with Crohn's diagnosis, Asian ethnicity, disease activity, elevated platelets, and glucocorticoid use. Females had lower FMI-Z. Low AppLSTMI-Z within the context of BMI-Z (n = 112) was associated with Crohn's disease, Asian (odds ratio [OR] = 3.77, p = 0.001) and Black identity (OR = 0.32, p = 0.02), and elevated platelets (OR = 1.76, p = 0.02) compared to those with normal BMI-Z and normal AppLSTMI-Z.
Conclusions:
BMI is a poor indicator of body composition in children with IBD as it masks lean mass deficits which are highly prevalent. Future studies regarding the long-term consequences and reversibility of this deficit are warranted.
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