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30-01-2025 | Chronic Inflammatory Bowel Disease in Pediatrics | Editor's Choice | News

Growth impairment evident years before pediatric IBD diagnosis

Author: Dr. David Manning

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medwireNews: Children with inflammatory bowel disease (IBD) show signs of impaired growth in the years before diagnosis, with the most pronounced changes found in those with Crohn’s disease, according to a study published in JAMA Network Open.

Specifically, children with Crohn's disease showed reduced weight gain up to 3 years prior to diagnosis and reduced linear growth up to 1 year prior, while reduced weight gain was seen a year before a diagnosis of ulcerative colitis.

Maiara Brusco De Freitas, from Aalborg University in Copenhagen, Denmark, and colleagues, used data from the Danish Medical Birth Register and the Danish National Child Health Register to track the anthropometric measurements of 916,133 individuals (51.2% male). The cohort included 1522 children diagnosed with IBD between the ages of 5 and 17 years (median age 14.3 years), of whom 851 had Crohn's disease and 671 ulcerative colitis. Children with both Crohn's disease and ulcerative colitis were classified as having Crohn's disease.

The researchers focused on measurements taken after the children reached 1 year of age and included data from 10 years before, and 3 years after, IBD diagnosis. The follow-up of children with IBD included a median of three pairs of length or height and weight measurements. The researchers compared the anthropometric trajectories of children diagnosed with IBD with those of children without the condition to give estimated z averages for each measurement.

The study revealed that children with Crohn's disease showed a significant decline in weight and BMI for their age starting 3 years before diagnosis (estimated z score mean difference 0.12 g and 0.13 kg/m2, respectively), which worsened in the year before diagnosis (mean difference 0.38 g and 0.38 kg/m2). Linear growth was also impacted in children with Crohn's disease, with a significantly reduced height or length (mean difference 0.20 cm) in the year prior to their diagnosis that worsened during the diagnostic period (mean difference 0.34 cm).

Children who were diagnosed with ulcerative colitis, had significant estimated z scores of a 0.12 g decrease in weight gain and a 0.13 kg/m2 decline in BMI for their age in the year prior to diagnosis. They also showed a significant decline in linear growth (mean 0.20 cm), but not until the year of diagnosis.

For IBD overall, declines in weight gain were observed up to 4 years before a diagnosis, at an estimated mean z score of 0.07 g, reaching a mean of 0.27 g in the year before diagnosis. Declines in BMI were observed from 3 years prior to diagnosis (mean 0.10 kg/m2), with increasing impairment in the year before diagnosis (mean 0.27 kg/m2). Linear growth declined 1 year prior to diagnosis (mean 0.14 cm), with significant worsening during the diagnostic period (mean 0.28 cm).

The authors observe that anthropometric deviations persisted after diagnosis, with the slowest recovery occurring in children with Crohn's disease. While children with ulcerative colitis showed some recovery in the first year after diagnosis, significant deviations had returned after 3 years. The researchers suggest that “[t]reatment with corticosteroids and anti-[tumor necrosis factor] medications may be associated with the interpretation of early recovery.”

They say that their “findings add to the mounting evidence that IBD has its onset several years prior to diagnosis and suggest that the outcome of the preclinical phase is associated with growth impairment in children, potentially due to impaired nutritional status.”

In addition, the results highlight the “significance of frequent nutritional screening and monitoring once children are diagnosed with IBD to restore nutritional status and provide a healthy transition to adulthood,” the team concludes.

medwireNews is an independent medical news service provided by Springer Healthcare Ltd. © 2025 Springer Healthcare Ltd, part of the Springer Nature Group

JAMA Netw Open 2025; 8: e2455158

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