Growth Failure in Pediatric Inflammatory Bowel Disease

Department of Pediatrics, North Shore University Hospital, Manhasset, NY 11030.
Journal of Pediatric Gastroenterology and Nutrition (Impact Factor: 2.63). 05/1993; 16(4):373-80. DOI: 10.1097/00005176-199305000-00005
Source: PubMed


To assess whether children with inflammatory bowel disease (IBD) develop permanent impairment of linear growth, we analyzed records from 48 young adults who had IBD during childhood or early adolescence (Tanner I-III; 11.8 +/- 2.4 years old at diagnosis). All were fully grown (Tanner V; 21.1 +/- 3.0 years) at last examination. Adult heights were predicted from data obtained at or shortly after the diagnosis of IBD by three methods: height for age percentile, the Bailey-Pinneau (BP), and Roche-Wainer-Thissen (RWT) methods. Predicted adult heights were then compared with the actual ultimate height of each subject. Permanent growth failure occurred in 19-35% of subjects, depending upon the method used to assess growth. Overall, 31% (15 of 48) of the subjects had deficits of adult height identified by two or more methods, including 14 of 38 (37%) of those with Crohn's disease but only one of 10 with ulcerative colitis. Age at diagnosis of IBD, age at last examination, age at cessation of linear growth, and site of IBD did not differ between impaired and normal growth groups. Duration of corticosteroid use was longer (p < 0.05) in growth-impaired subjects. In addition, although 60% of all subjects had periods of poor growth that put them in height-for-age percentiles two or more major growth channels below previous percentiles, only 19% remained at these levels upon achieving their final adult heights. Permanent impairment of linear growth leading to clinically meaningful deficits of ultimate adult height is common in patients with IBD in childhood or early adolescence. New therapeutic approaches are needed to address this problem.

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    • "Factors contributing to malnourishment include reduced intake (cytokine induced anorexia, avoidance of food due to fear of exacerbation of symptoms), increased resting energy expenditure (REE), malabsorption of fat, protein, vitamins and micronutrients, gastritis, esophagitis. Chronic GC therapy may affect growth by impairing a number of processes essential for normal growth such as endogenous GH secretion and action, bone and collagen formation, IGF-1 binding in cartilage and nitrogen retention [41,51]. It is however difficult to estimate the GC effect on growth since disease severity/activity, anatomic location and other clinical parameters are potential confounding factors; hence, not all studies have confirmed an association between GC use and growth failure in IBD [40,52,53]. "
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    ABSTRACT: Extraintestinal manifestations from nearly every organ system are common in inflammatory bowel disease (IBD). This review article describes the epidemiology, pathogenesis, diagnosis and management of the main endocrine and metabolic manifestations in IBD, including metabolic bone disease, growth retardation, hypogonadism, pubertal delay, lipid abnormalities and insulin resistance. These clinical problems are commonly interrelated and they share a common basis, influenced by disease-related inflammation and nutritional status. In addition to nutritional support, every effort should be made to achieve and maintain disease remission, thus correcting the underlying chronic inflammation. The criteria for screening and diagnosing osteoporosis are described and treatment options are discussed (lifestyle advice, vitamin D and calcium supplementation, use of bisphosphonates or other specific antiosteoporotic agents, correction of hypogonadism). Chronic glucocorticoid therapy may affect growth as well as predispose to osteoporosis. The diagnosis and management of growth failure, pubertal delay and hypogonadism in IBD are discussed.
    Annals of Gastroenterology 03/2012; 25(1):37-44.
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    • "Boys may also be more aware of variations in height. Furthermore, the limited duration of puberty limits the time before impaired linear growth becomes irreversible [23, 24]. "
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    ABSTRACT: The inflammatory bowel diseases (IBDs) are chronic inflammatory processes affecting the gastrointestinal tract. When diagnosed in childhood and adolescence, IBD almost always impacts adversely upon the nutritional state of the patient. Weight loss and impaired linear growth may be present at diagnosis or subsequently. Further potential nutritional consequences in childhood IBD include malnutrition, anaemia, osteopaenia, and delayed puberty. Understanding the nutritional aspects of IBD is paramount in growing children, especially those entering and advancing through puberty. This paper focuses upon the nutritional impacts of IBD in children and adolescents.
    04/2011; 2011:365712. DOI:10.5402/2011/365712
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