Growth in children receiving contemporary disease specific therapy for Crohn's disease

Abstract

Although current therapy for CD is associated with improved rate of growth for the first few years, a substantial proportion of children remain short. This study also highlights the need for consistency in describing growth in children with chronic diseases.

Health Care Maintenance for the Pediatric Patient With Inflammatory Bowel Disease

“…However, growth delays often persist after diagnosis despite improvement in inflammatory biomarkers and treatment with biologic agents. 8,9 Therefore, failure to control inflammation puts this population at increased risk for fracture. The International Society for Clinical Densitometry recommends that children with IBD undergo a total body (excluding the skull) dualenergy radiograph absorptiometry (DXA) screen at diagnosis and at 6-month intervals if abnormalities are found.…”

Impact of Therapeutic Strategies on Growth in Pediatric Inflammatory Bowel Disease

“…A retrospective study by Turner et al [104] showed a significant effect on linear growth manifested as an improvement in mean height velocity z-score from -1.9 to -0.14 at one year. In contrast, Malik et al [12] found that height SDS was associated negatively with the use of either azathioprine or methotrexate. Unfortunately, current data is insufficient to draw any firm conclusions.…”

“…Lower parental height and minimum patient height Z-score were significant predictors of lower final adult height in IBD. Kanof et al [6] have demonstrated that 46% of children with CD will have a reduced height velocity before the appearance of suggestive symptoms and only 12% continue to follow normal growth patterns at the time of diagnosis while Malik et al [12] reported that the percentage of children with height velocity SDS between −1 and −2 was 49% at diagnosis. Unfortunately, the natural course of CD results in decreased adult height in 11-35% of pediatric patients [8,14,21].…”

“…Apparently, the age and pubertal stage at diagnosis are key factors for growth potential. Malik et al [12] have demonstrated that children with CD at pre-pubertal age did not improve their height velocity SDS during mean follow-up of 4.6 years while most children diagnosed at pubertal age did achieve normal height velocity SDS during follow-up. One of the most important risk factors for reduced height during the course of disease is the time from symptom onset to diagnosis [13].…”

Colitis, independent of macronutrient intake, compromises bone structure and strength in growing piglets

“…Children with IBD present with faltering linear growth and are often shorter (mean z-score -0.5) than expected for age compared to their parents and peers with up to 12.2% of this group being classified as stunted (<-2 z-score) (5). Similarly, dual-energy x-ray absorptiometry (DXA) imaging reveals that 75-89% have low areal bone mineral density (aBMD) during active disease states and 10-37% have low aBMD (z-score below -2.5) when in remission (6).…”