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The Impact of Sarcopenia on Clinical Outcomes in Pediatric Crohn's Disease
Giulia D'Arcangelo1,2, Delia De Mitri1, Ludovica Busato3
1Pediatric Gastroenterology and Liver Unit, Sapienza University of Rome, Rome, Italy.
Insights
Sarcopenia, or low muscle mass, at diagnosis increases the risk of clinical relapses in children with Crohn's disease (CD). Early identification via MRI can help predict worse outcomes.
Area of Science:
- Pediatric Gastroenterology
- Inflammatory Bowel Disease Research
- Clinical Nutrition and Body Composition
Background:
- The impact of sarcopenia on pediatric Crohn's disease (CD) clinical outcomes remains largely unexplored.
- Understanding early predictors of disease course is crucial for timely intervention in pediatric CD.
Purpose of the Study:
- To investigate the association between sarcopenia at diagnosis and clinical outcomes in pediatric CD patients.
- To determine if sarcopenia predicts disease flares, hospitalizations, complications, or treatment escalation.
Main Methods:
- Retrospective case-control study of newly diagnosed pediatric CD patients (2011-2022).
- Sarcopenia assessed via psoas muscle area (tPMA) on MRI at L3-L4, defined as z-score ≤2 SDs.
- Comparison of outcomes (relapse, hospitalization, complications, treatment changes) over 2 years between sarcopenic and non-sarcopenic groups.
Main Results:
- Sarcopenia was present in 59% of the 78 included children.
- Patients with sarcopenia had a significantly higher risk of clinical relapse at 6 and 12 months (OR 7.5 and 6.5, respectively).
- Sarcopenia independently predicted clinical relapses (OR 1.7), with lower relapse-free survival observed in sarcopenic children.
Conclusions:
- Sarcopenia at diagnosis is a significant risk factor for clinical relapses in pediatric Crohn's disease within the first year.
- MRI-based assessment of total psoas muscle area (tPMA) can identify children with CD at higher risk for adverse outcomes.
- Early detection of sarcopenia may guide proactive management strategies in pediatric CD.
Background:
The effect of sarcopenia on clinical outcomes in children with Crohn's disease (CD) is unknown. We investigated whether sarcopenia at the diagnosis impacts the outcomes of children with CD.
Methods:
This was a retrospective, single-center, case-control study of newly diagnosed children with CD undergoing magnetic resonance (MR) within 1 month from the diagnosis, from 2011 to 2022. Sarcopenia was assessed by measuring total psoas muscle area (tPMA) at L3-L4 level on the MR and defined as z-score values ≤2 SDs. Children with and without sarcopenia were compared for the risk of disease flares, CD-related hospitalization, complications, need for step-up treatment, and courses of steroids over a 2-year follow-up.
Results:
Seventy-eight children were included (median age 10.7 years), 46 (59%) with sarcopenia and 32 (41%) without. The risk of clinical relapse was higher in patients with sarcopenia at 6 [19.5% vs 3%, odds ratio (OR) 7.5 (95% CI, 1.5-85)] and 12 months [30% vs 6%, OR 6.5 (95% CI, 1.4-30.4)]. Kaplan-Meier analysis showed lower survival free from relapses in children with sarcopenia (log rank P = .01, hazard ratio 2.7, 95% CI, 1.4-4.5). Multivariate analysis identified sarcopenia as independent predictors of clinical relapses (OR 1.7, 95% CI, 1-3.1, P = .045). No other independent predictor of unfavorable outcome was detected.
Conclusions:
The presence of sarcopenia at the diagnosis increases the risk of clinical relapses in the first year of diagnosis. Magnetic resonance evaluation of the tPMA could therefore help identify children at higher risk of worse outcomes.
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