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Nomogram for predicting 6-month BMIZ changes in children with Crohn's disease: a single-center retrospective study
Yifei Zhang1, Peilin Wu1, Xilin Peng1
1Department of Pediatrics, The First Affiliated Hospital of Fujian Medical University, Fuzhou, China.
Insights
Perianal disease (PD) in pediatric Crohn's disease (CD) patients significantly hinders short-term nutritional recovery. A new nomogram incorporating PD and other markers aids early risk identification for better management.
Area of Science:
- Pediatric Gastroenterology
- Inflammatory Bowel Disease Research
- Nutritional Science
Background:
- Perianal disease (PD) is a severe manifestation in pediatric Crohn's disease (CD).
- The impact of PD on short-term nutritional recovery in pediatric CD is not well understood.
- Early identification of nutritional risks is crucial for managing pediatric CD.
Purpose of the Study:
- To assess the independent effect of PD on the 6-month Body Mass Index Z-score (BMIZ) trajectory in pediatric CD patients.
- To develop a predictive nomogram for early risk stratification of nutritional recovery in pediatric CD.
- To evaluate the clinical utility of the nomogram for identifying patients at risk of inadequate nutritional recovery.
Main Methods:
- Retrospective cohort study of 51 pediatric CD patients with PD (n=29) and without PD (n=22).
- Linear mixed models (LMM) analyzed BMIZ trajectories over 6 months.
- LASSO regression identified predictors for a nomogram, validated by bootstrap resampling and decision curve analysis (DCA).
Main Results:
- PD significantly reduced the slope of BMIZ recovery (β = -0.085, P = 0.010) after adjusting for covariates.
- Key predictors identified: PD, fecal occult blood test (FOBT), biologic therapy, ESR, Hb, and 25(OH)D3.
- The nomogram showed good predictive performance (R² = 0.51) and clinical utility for predicting inadequate nutritional recovery (ΔBMIZ ≤ 0.40).
Conclusions:
- Perianal disease is independently linked to suboptimal short-term nutritional recovery in pediatric CD.
- The developed nomogram integrates clinical, inflammatory, and nutritional factors for risk stratification.
- This tool can aid in early identification of high-risk patients, guiding individualized nutritional monitoring and treatment planning.
Background:
Perianal disease (PD) is an aggressive phenotype in children with Crohn's disease (CD), but its measurable impact on short-term nutritional recovery remains understudied. This study aimed to evaluate the independent effect of PD on the 6-month Body Mass Index Z-score (BMIZ) trajectory and to develop a practical nomogram for early risk stratification in pediatric CD.
Methods:
A single-center retrospective cohort of 51 pediatric CD patients (29 with PD and 22 without PD) with at least 6 months of follow-up was enrolled from a tertiary hospital in Fujian, southern China, between July 2017 and March 2025. BMIZ trajectories over time were estimated using linear mixed models (LMM). Predictors of 6-month ΔBMIZ were screened using univariate regression (P < 0.20), followed by LASSO regression (tenfold cross-validation) to construct a nomogram. Model performance was internally validated using 1000 bootstrap resamples (R2, MAE, RMSE) and calibration plots. Decision curve analysis (DCA) was performed to evaluate clinical utility for predicting inadequate nutritional recovery (ΔBMIZ ≤ 0.40).
Results:
LMM analysis showed that PD status significantly reduced the slope of BMIZ recovery after adjusting for age, sex, and biologic therapy (β = -0.085, 95% CI -0.147 to -0.023, P = 0.010). LASSO regression identified six core predictors: perianal disease, positive fecal occult blood test (FOBT), biologic therapy, erythrocyte sedimentation rate (ESR), hemoglobin (Hb), and 25-hydroxyvitamin D3 (25(OH)D3). The nomogram demonstrated satisfactory predictive performance (R2 = 0.51, MAE = 0.40, RMSE = 0.49), with calibration plots showing good agreement between predicted and observed ΔBMIZ. DCA confirmed a positive net benefit for predicting inadequate nutritional recovery (ΔBMIZ ≤ 0.40) across a threshold probability range of 5% to 85%.
Conclusion:
Perianal disease was independently associated with suboptimal short-term nutritional recovery in children with CD. The proposed nomogram, integrating phenotypic, inflammatory, and nutritional markers, may help identify high-risk patients at diagnosis or early after diagnosis and support individualized nutritional monitoring and therapeutic planning in southern Chinese pediatric CD patients.
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