Pediatric Gastroenterology, Hepatology & Nutrition

The Korean Society of Pediatric Gastroenterology, Hepatology and Nutrition (대한소아소화기영양학회)
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Body Mass Index at Presentation of Inflammatory Bowel Disease in Children

  • Received : 2020.02.26
  • Accepted : 2020.05.29
  • Published : 2020.09.30
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Abstract

Purpose: The evidence for an association between inflammatory bowel disease (IBD) and obesity is conflicting. Therefore, we set out to review the body mass index (BMI) at presentation of IBD to understand if the rise of the obesity rate in the general population, lead to an increase of obesity in patients with IBD at the time of diagnosis. Methods: Retrospective review of all patients with IBD seen at Children's Hospital and Medical Center from January 1st 2010 to December 31st 2014. From the initial visit and endoscopy, we obtained: age; sex; BMI; disease phenotype; disease severity. Results: We had a total of 95 patients, 35 patients were excluded due to incomplete data or referral being made after diagnosis was made. 28 were males and 32 were females, Age range was 2-17 years. A 37 had Crohn's disease, 19 ulcerative colitis, and 4 indeterminate colitis. Disease severity in 19 cases was mild, 29 moderate and 12 severe. BMI distribution was as follows-obese (5.0%), overweight (6.7%), normal weight (65.0%), mild malnutrition (8.3%), moderate malnutrition (15.0%), severe malnutrition (1.7%). Conclusion: Our data is consistent with other series. Showing most children had a normal BMI, regardless of disease severity or phenotypes. One confounding factor is the possibility of delay in referral to GI. This could mean some obese children may fall in the normal BMI range at the time of diagnosis due to ongoing weight loss. Future studies should include prospective cohort studies, comparing incidence of IBD in obese and non-obese patients, severity at presentation, duration of symptoms, and clinical outcomes.

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References

  1. Hales CM, Carroll MD, Fryar CD, Ogden CL. Prevalence of obesity among adults and youth: United States, 2015-2016. NCHS Data Brief 2017;(288):1-8.
  2. Versini M, Jeandel PY, Rosenthal E, Shoenfeld Y. Obesity in autoimmune diseases: not a passive bystander. Autoimmun Rev 2014;13:981-1000. https://doi.org/10.1016/j.autrev.2014.07.001
  3. Stofkova A. Leptin and adiponectin: from energy and metabolic dysbalance to inflammation and autoimmunity. Endocr Regul 2009;43:157-68.
  4. Iikuni N, Lam QL, Lu L, Matarese G, La Cava A. Leptin and inflammation. Curr Immunol Rev 2008;4:70-9. https://doi.org/10.2174/157339508784325046
  5. Li L, Wu LL. Adiponectin and interleukin-6 in inflammation-associated disease. Vitam Horm 2012;90:375-95. https://doi.org/10.1016/B978-0-12-398313-8.00014-2
  6. Krysiak R, Handzlik-Orlik G, Okopien B. The role of adipokines in connective tissue diseases. Eur J Nutr 2012;51:513-28. https://doi.org/10.1007/s00394-012-0370-0
  7. Rosen MJ, Dhawan A, Saeed SA. Inflammatory bowel disease in children and adolescents. JAMA Pediatr 2015;169:1053-60. https://doi.org/10.1001/jamapediatrics.2015.1982
  8. Sykora J, Pomahacova R, Kreslova M, Cvalinova D, Stych P, Schwarz J. Current global trends in the incidence of pediatric-onset inflammatory bowel disease. World J Gastroenterol 2018;24:2741-63. https://doi.org/10.3748/wjg.v24.i25.2741
  9. Miele E, Shamir R, Aloi M, Assa A, Braegger C, Bronsky J, et al. Nutrition in pediatric inflammatory bowel disease: a position paper on behalf of the Porto Inflammatory Bowel Disease Group of the European Society of Pediatric Gastroenterology, Hepatology and Nutrition. J Pediatr Gastroenterol Nutr 2018;66:687-708. https://doi.org/10.1097/MPG.0000000000001896
  10. Chan SS, Luben R, Olsen A, Tjonneland A, Kaaks R, Teucher B, et al. Body mass index and the risk for Crohn's disease and ulcerative colitis: data from a European Prospective Cohort Study (The IBD in EPIC Study). Am J Gastroenterol 2013;108:575-82. https://doi.org/10.1038/ajg.2012.453
  11. Seminerio JL, Koutroubakis IE, Ramos-Rivers C, Hashash JG, Dudekula A, Regueiro M, et al. Impact of obesity on the management and clinical course of patients with inflammatory bowel disease. Inflamm Bowel Dis 2015;21:2857-63. https://doi.org/10.1097/MIB.0000000000000560
  12. Hu Q, Ren J, Li G, Wu X, Li J. The impact of obesity on the clinical course of inflammatory bowel disease: a meta-analysis. Med Sci Monit 2017;23:2599-606. https://doi.org/10.12659/MSM.901969
  13. Flores A, Burstein E, Cipher DJ, Feagins LA. Obesity in inflammatory bowel disease: a marker of less severe disease. Dig Dis Sci 2015;60:2436-45. https://doi.org/10.1007/s10620-015-3629-5
  14. Harper JW, Zisman TL. Interaction of obesity and inflammatory bowel disease. World J Gastroenterol 2016;22:7868-81. https://doi.org/10.3748/wjg.v22.i35.7868
  15. Centers for Disease Control and Prevention. Clinical growth charts, set 1: clinical charts with 5th and 95th percentiles [Internet]. Atlanta: Centers for Disease Control and Prevention; 2000 [cited 2019 Jan 15]. Available from: https://www.cdc.gov/growthcharts/clinical_charts.htm
  16. Himes JH, Dietz WH. Guidelines for overweight in adolescent preventive services: recommendations from an expert committee. The Expert Committee on Clinical Guidelines for Overweight in Adolescent Preventive Services. Am J Clin Nutr 1994;59:307-16. https://doi.org/10.1093/ajcn/59.2.307
  17. Becker P, Carney LN, Corkins MR, Monczka J, Smith E, Smith SE, et al. Consensus statement of the Academy of Nutrition and Dietetics/American Society for Parenteral and Enteral Nutrition: indicators recommended for the identification and documentation of pediatric malnutrition (undernutrition). Nutr Clin Pract 2015;30:147-61. https://doi.org/10.1177/0884533614557642
  18. Zwintscher NP, Horton JD, Steele SR. Obesity has minimal impact on clinical outcomes in children with inflammatory bowel disease. J Pediatr Surg 2014;49:265-8; discussion 268. https://doi.org/10.1016/j.jpedsurg.2013.11.033
  19. Levine A, Koletzko S, Turner D, Escher JC, Cucchiara S, de Ridder L, et al. ESPGHAN revised porto criteria for the diagnosis of inflammatory bowel disease in children and adolescents. J Pediatr Gastroenterol Nutr 2014;58:795-806. https://doi.org/10.1097/mpg.0000000000000239
  20. Turner D, Otley AR, Mack D, Hyams J, de Bruijne J, Uusoue K, et al. Development, validation, and evaluation of a pediatric ulcerative colitis activity index: a prospective multicenter study. Gastroenterology 2007;133:423-32. https://doi.org/10.1053/j.gastro.2007.05.029
  21. Hyams JS, Ferry GD, Mandel FS, Gryboski JD, Kibort PM, Kirschner BS, et al. Development and validation of a pediatric Crohn's disease activity index. J Pediatr Gastroenterol Nutr 1991;12:439-47. https://doi.org/10.1097/00005176-199105000-00005
  22. Kugathasan S, Nebel J, Skelton JA, Markowitz J, Keljo D, Rosh J, et al. Body mass index in children with newly diagnosed inflammatory bowel disease: observations from two multicenter North American inception cohorts. J Pediatr 2007;151:523-7. https://doi.org/10.1016/j.jpeds.2007.04.004
  23. Pituch-Zdanowska A, Banaszkiewicz A, Dziekiewicz M, Lazowska-Przeorek I, Gawronska A, Kowalska-Duplaga K, et al. Overweight and obesity in children with newly diagnosed inflammatory bowel disease. Adv Med Sci 2016;61:28-31. https://doi.org/10.1016/j.advms.2015.07.004
  24. Chandrakumar A, Wang A, Grover K, El-Matary W. Obesity is more common in children newly diagnosed with ulcerative colitis as compared to those with Crohn disease. J Pediatr Gastroenterol Nutr 2020;70:593-7. https://doi.org/10.1097/MPG.0000000000002639
  25. El Mouzan MI, Al Edreesi MH, Al-Hussaini AA, Saadah OI, Al Qourain AA, Al Mofarreh MA, et al. Nutritional status of children with inflammatory bowel disease in Saudi Arabia. World J Gastroenterol 2016;22:1854-8. https://doi.org/10.3748/wjg.v22.i5.1854
  26. Wiskin AE, Wootton SA, Hunt TM, Cornelius VR, Afzal NA, Jackson AA, et al. Body composition in childhood inflammatory bowel disease. Clin Nutr 2011;30:112-5. https://doi.org/10.1016/j.clnu.2010.07.014
  27. Reilly NR, Aguilar K, Hassid BG, Cheng J, Defelice AR, Kazlow P, et al. Celiac disease in normal-weight and overweight children: clinical features and growth outcomes following a gluten-free diet. J Pediatr Gastroenterol Nutr 2011;53:528-31. https://doi.org/10.1097/mpg.0b013e3182276d5e