Nutritional concerns in pediatric inflammatory bowel disease patients

Abstract

In approximately one-fourth of patients with Crohn's disease (CD) and ulcerative colitis (UC), disease onset occurs during childhood and adolescence. In addition to gastrointestinal and extraintestinal symptoms of inflammatory bowel disease (IBD), children with these conditions often experience one or more nutritional complications of their disease including growth failure, delayed puberty, osteoporosis, anemia, and micronutrient deficiencies. This article provides an overview of the epidemiology, pathophysiology, evaluation, and management of selected nutritional complications in pediatric IBD.

Osteoprotegerin in pediatric Crohnʼs disease and the effects of exclusive enteral nutrition

“…1,11 As well as altered bone turnover, children with IBD, and especially CD, often experience other complications where nutrition may contribute to their disease, including weight loss, micronutrient deficiencies, 5,15 delayed pubertal development, and linear growth failure. 15,16 Consequently, nutrition is central in the management of pediatric IBD. Furthermore, exclusive enteral nutrition (EEN), a specific nutritional therapy, ameliorates nutritional status but also downregulates the mucosal production of proinflammatory cytokines (TNF-a, interleukin [IL]-2, and IL-8) and induces mucosal remission.…”

Nutritional impact of inflammatory bowel diseases on children and adolescents

“…Stunted growth and pubertal delay are significantly important manifestations in pediatric patients and may be the first clinical findings of this condition, an aspect observed in several studies35 - 37 emphasizing the growth delay, which was reported in 18 to 22% of patients.…”

“…In association with growth retardation, impairment of pubertal development is observed in 20-30% of patients, mainly in those with CD38 , 41 , 42 of multifactorial etiology 3536 …”

“…, 41 Se não identificada e tratada, a desnutrição em pacientes pediátricos pode causar graves problemas para a saúde, com piora do prognóstico e consequente redução da competência imunológica, aumento de infecções, retardo no crescimento e no desenvolvimento, problemas sociais e maiores taxas de comorbidades. A parada no crescimento e o retardo dos caracteres pubertários são manifestações da faixa pediátrica de importância significativa e podem ser os primeiros achados clínicos nesta condição, aspecto observado em várias publicações,35 - 37 enfatizando-se o retardo de crescimento relatado em 18 a 22% dos pacientes. Diversos estudos demonstram altas taxas de retardo de crescimento, muitas vezes antecedendo as manifestações intestinais, variando entre 5% e 88%, sendo que os pacientes com DC experimentaram maiores taxas de comprometimento nutricional quando comparados com os portadores de RCU.…”

Use of Gastrostomy Tubes in Children and Adolescents With Eating Disorders and Related Illnesses

“…However, this is a common practice in patients with a variety of other pediatric health problems, including cystic fibrosis [10], neuromuscular conditions [11,12], and inflammatory bowel disease [13,14], that will need long-term assisted feeding. These studies have demonstrated that patients tolerate the tubes well with minimal side-effects and experience a good response in terms of weight gain and nutritional status.…”