Early-onset Crohn’s disease is a risk factor for smaller final height

Abstract

OBJECTIVES: Growth retardation is a frequent complication of paediatric inflammatory bowel disease (IBD). Only a few studies report the final height of these patients, with controversial results. We compared adult height of patients with paediatric IBD with that of patients with adultonset disease. METHODS: Height data of 675 women 19-44 years of age and 454 men 23-44 years of age obtained at inclusion in the Swiss IBD cohort study registry were grouped according to the age at diagnosis: (a) prepubertal (men13, women11 years), (b) pubertal (men 13-22, women 11-18 years) and (c) adult (men>22, women>18 years of age), and compared with each other and with healthy controls. RESULTS: Male patients with prepubertal onset of Crohn's disease (CD) had significantly lower final height (mean 172±6 cm, range 161-182) compared with men with pubertal (179±6 cm, 161-192) or adult (178±7 cm, 162-200) age at onset and the general population (178±7 cm, 142-204). Height zscores standardized against heights of the normal population were significantly lower in all patients with a prepubertal diagnosis of CD (-0.8±0.9) compared with the other patient groups (-0.1±0.8, P<0.001). Prepubertal onset of CD emerged as a risk factor for reduced final height in patients with prepubertal CD. No difference for final height was found between patients with ulcerative or unclassified IBD diagnosed at prepubertal, pubertal or adult age. CONCLUSION: Prepubertal onset of CD is a risk for lower final height, independent of the initial disease location and the necessity for surgical interventions.

Adult height in patients with childhood‐onset inflammatory bowel disease: a nationwide population‐based cohort study

“…Whether or not the growth delay frequently seen in children with IBD also leads to shorter final height in adult age has been investigated before, but previous studies suffer from a number of limitations; small number of patients, restriction to referral centres with highly selected study populations, study periods that do not represent current paediatric care and no adjustment for parental height (Table S1). Moreover, comparisons between these studies have been difficult as different definitions of growth retardation have been used (Table S2). According to some of these studies, mostly from tertiary centres, a substantial proportion of childhood‐onset IBD patients (19‐31%) will end up shorter .…”

“…According to some of these studies, mostly from tertiary centres, a substantial proportion of childhood‐onset IBD patients (19‐31%) will end up shorter . Other, mostly population based, studies suggest that although a large proportion of children with IBD may have subnormal growth during childhood, the attained adult height is only reduced in a small subset of patients with CD (but not in patients with UC or IBD‐U) . In a recently published large national population‐based study from Israel, the authors did not find any overall significant difference in mean height between conscripts for military service with or without IBD (even though height was measured at age 17 years).…”

Adult height, nutrition, and population health

“…73,87,88 In addition, asthma has also been associated with reduced stature in high-income countries, as has the incidence of any major disease in childhood. 73,89,90 Moreover, treatments for some diseases may themselves retard growth.…”

“…However, the association between adult height and health remains robust in studies adjusting for adult income, education, and other measures of socioeconomic circumstances. 6,89,115,124,125,129,137,141,199,200 Yet, there certainly is a strong argument that childhood conditions may confound part of the association between adult income, education, and height and that socioeconomic conditions during childhood is linked to both adult height (through nutrition and disease) and to adult socioeconomic status. For example, wealthy and more educated parents are likely both to provide better nutrition and to invest more in their children's education.…”

Steroid Administration and Growth Impairment in Children with Crohnʼs Disease

“…21 To compare findings related to adult height from our study to those within steroid users and nonusers of an independent population, we analyzed data from a recent study 22 that was based on the Swiss IBD Cohort Study. Data from this study were acquired on the subset of individuals who were diagnosed with CD during childhood (,18 yr of age).…”