Nutrition Issues in Pediatric Crohn's Disease

Abstract

Twenty-five percent of inflammatory bowel disease (IBD) diagnoses present in childhood, with Crohn's disease (CD) being the most common type. Many children have poor nutrition status at presentation of the disease, which may worsen during the clinical course, with a significant number of children having impaired linear growth. The cause of this poor nutrition status is complex, and contributing factors include inadequate intake, malabsorption, altered energy demands, and losses through stool, particularly in colitis. The principal aim of medical management is to induce disease remission, with minimal side effects, thereby enabling normal growth and development. This must include active consideration of the nutrition needs of such children and how they may be best met. However, our understanding of the manner in which the disease process affects the energy demands of children with CD or how poor nutrition, in turn, may affect the disease course is limited. This may constrain the efficacy and effectiveness of standard therapeutic approaches to care. This review explores the many factors of relevance in the delivery of nutrition support to children with inflammatory bowel disease, and explores the role of exclusive enteral nutrition as a corticosteroid-sparing strategy to induce remission in children with active Crohn's disease.

Early Crohn disease: a proposed definition for use in disease-modification trials

“…First, about 10% of Crohn disease is diagnosed in childhood 8 63. Second, Crohn disease results in paediatric-specific complications, such as growth failure and delayed puberty 64 65. Third, in a population-based study from France, disease complications were already present in 29% of children at diagnosis, and disease progression led to a cumulative incidence of disease complication of 59% during a median follow-up of 7 years8 with a cumulative incidence of surgery of 34% at 5 years from diagnosis 8.…”

Nutritional Management of the Child With Crohn’s Disease

“…However, polymeric formula is more palatable than elemental formula, and commercially available flavorings can be added. 7 Similarly, a large volume of formula is required for efficacy-an amount not all patients are capable of consuming. NG tube feeds are always an option because some formulas can be concentrated.…”

“…46 Iron supplementation can improve the quality of life. 7 In addition, if the patient is receiving sulfasalazine as part of his or her medical therapy, vitamin B12 supplementation will be needed. 15 …”

Symposium 6: Young people, artificial nutrition and transitional care Nutrition, growth and puberty in children and adolescents with Crohn's disease

“…The result is an energy deficiency and a nutrient and micronutrient deficiency. In addition, potential contributing factors include: malabsorption secondary to gut inflammation or resection, fistula or stoma; losses secondary to diarrhoea including potentially substantial blood and electrolyte loss; disease-induced hypermetabolism; toxicity from drug treatment (6) . Nutrition per se will impact on linear growth, particularly during adolescence when the energy cost of growth is high, and not only in children with bowel inflammation.…”