Adult height in patients with early onset of Crohn's disease

Alemzadeh, Nazanin; Rekers-Mombarg, L.T.M.; Mearin, M. L.; Wit, J. M.; Lamers, C. B. H. W.; Hogezand, R. A. van

doi:10.1136/gut.51.1.26

Cited by 65 publications

(52 citation statements)

References 19 publications

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“…In contrast to these findings, Markowitz et al 5 observed that children with CD and PGI were administered steroids for a longer duration. Alemzadeh et al 8 reported that steroid use during puberty was associated with a lower adult height. In a recent prospective study, Pfefferkorn et al 19 (n ¼ 176) reported that corticosteroid use for greater than 6 months in the first year was associated with abnormal height velocity at 1 year after adjusting for disease severity.…”

Section: Discussionmentioning

confidence: 99%

“…3,10 Although there is considerable biological data, epidemiological evidence of the impact of steroid use and growth impairment in children with CD remains limited and controversial. Although some studies suggest a detrimental effect on growth, 5,8 others do not support this relationship. 9 Furthermore, some studies have shown that although steroid use may result in temporary growth impairment (TGI), many children demonstrate catch-up growth such that their final adult heights are within reference ranges.…”

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confidence: 97%

“…Although some studies indicate that PGI is common, 4,5 others suggest otherwise. [6][7][8] Disease heterogeneity, variability in measures used to classify the growth impairment phenotype, and lack of accounting for genetic effects on growth may have resulted in these discrepant results. In this context, recently, using parental heights, Lee et al 9 showed that indeed the final adult heights of children with CD are strongly related to parental heights and that only ;11% of children had persistent growth impairment or PGI in adulthood.…”

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confidence: 99%

“…9 Furthermore, some studies have shown that although steroid use may result in temporary growth impairment (TGI), many children demonstrate catch-up growth such that their final adult heights are within reference ranges. 6,8,11 The major limitation of previous studies is the lack of comprehensive data on steroid use and the inability to adjust for other potential risk factors (disease activity, for example) that could influence growth independently of steroid usage. To further clarify the role of steroids in TGI and PGI, we performed a detailed study on a cohort of children who were administered steroids and in who we used parental heights to define the PGI phenotype.…”

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confidence: 99%

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Steroid Administration and Growth Impairment in Children with Crohnʼs Disease

Duchatellier¹,

Kumar²,

Krupoves³

et al. 2016

Inflammatory Bowel Diseases

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BACKGROUND: Growth impairment remains a major concern in children with Crohn's disease, but evidence remains unclear, in particular, whether steroid use is implicated. We aimed to (1) determine the frequency of temporary (TGI) and permanent (PGI) growth impairment in children administered steroids and (2) examine whether cumulative steroid administration was associated with TGI and/or PGI. METHODS: A retrospective cohort study was performed in patients with Crohn's disease (<18 yr) administered steroids at the gastroenterology clinics of Sainte-Justine Hospital, Montreal. Steroid dosage, height during follow-up, adult height (after age 20), and parental heights were ascertained. Patients with height z score <-1.64 on more than 1 occasion before age 18 were considered as patients with TGI. Patients with adult heights <8.5 cm below the expected target heights were considered as patients with PGI. Association between steroid dosage and TGI/PGI was studied using logistic regression analyses. Data from the Swiss IBD Cohort Study were analyzed for comparison. RESULTS: A total of 221 children were studied. Approximately 19% (42/221) children were deemed as TGI, and 8/137 patients (5.8%) had PGI. TGI was associated with diagnosis at younger age (P value 0.002) and steroid administration at younger age (P value 0.001), but not with steroid dosage. Final adult height was associated with target height, but not with cumulative steroid dosage. Rates of PGI in the Swiss cohort were 9.1% in steroid users and 2.7% in nonusers. CONCLUSIONS: Most children with TGI attain normal adult heights. Cumulative steroid use does not seem to be associated with either TGI or PGI in children with Crohn's disease.

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Section: Discussionmentioning

confidence: 99%

mentioning

confidence: 97%

mentioning

confidence: 99%

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confidence: 99%

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Steroid Administration and Growth Impairment in Children with Crohnʼs Disease

Duchatellier¹,

Kumar²,

Krupoves³

et al. 2016

Inflammatory Bowel Diseases

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“…In children with juvenile idiopathic arthritis, high-dose treatment with GH leads to a rise in systemic levels of IGF-I and has been reported to reduce the worsening growth retardation but does not seem to result in normalisation of height (Simon et al 2003). Furthermore, several studies of final height of adults with childhood onset inflammatory bowel disease show that these adults may be relatively short (Castile et al 1980, Griffiths et al 1993, Markowtiz et al 1993, Alemzadeh et al 2002, Sawczenko et al 2003. Our data would suggest that even a relatively short period of exposure to pro-inflammatory cytokines, especially when in combination, may have an irreversible effect on growth plate chondrogenesis.…”

Section: Discussionmentioning

confidence: 99%

The restricted potential for recovery of growth plate chondrogenesis and longitudinal bone growth following exposure to pro-inflammatory cytokines

MacRae¹,

Farquharson²,

Ahmed³

2006

Journal of Endocrinology

109

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Childhood chronic inflammatory disease can be associated with transient and permanent growth retardation. This study examined the potential for spontaneous growth recovery following pro-inflammatory cytokine exposure. Murine ATDC5 chondrogenic cells and postnatal metatarsals were exposed to interleukin (IL)-1 , IL-6 and tumour necrosis factor-(TNF ), and their growth and proliferative capacity were determined following recovery. TNF and IL-1 reduced chondrocyte proliferation and aggrecan and collagen types II and X expression at minimum concentrations of 10 ng/ml and 0·1 ng/ml respectively. TNF but not IL-1 exposure led to increased caspase-3 activity and altered cellular morphology, consistent with reduced viability. Cytokine exposure particularly inhibited proteoglycan synthesis. This effect was dose and duration dependent. Compared with the control, IL-1 and TNF led to a 71% and 45% reduction in metatarsal growth after 8 days of exposure respectively (P<0·05). An additive effect of IL-1 combined with TNF was observed (110% decrease; P<0·05). Metatarsals exposed to IL-1 or TNF individually for a 2-day period, and allowed to recover spontaneously in the absence of cytokines for a further 6 days, showed normal growth trajectories. In combination, growth was 59% lower (P<0·01) compared with control metatarsals at the end of the recovery period. Exposure to the combination for 4 days followed by a 4-day recovery period resulted in 87% decrement compared with controls (P<0·05). IL-6 did not alter any parameter studied. IL-1 and TNF exert diverse inhibitory effects on ATDC5 chondrocyte dynamics and metatarsal growth. The extent of recovery following cytokine exposure depends on the duration of exposure, and may be incomplete following longer periods of exposure.

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Growth Impairment in Children

Walters¹,

Griffiths²

2006

Challenges in Inflammatory Bowel Disease

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Adult height in patients with early onset of Crohn's disease

Cited by 65 publications

References 19 publications

Steroid Administration and Growth Impairment in Children with Crohnʼs Disease

Steroid Administration and Growth Impairment in Children with Crohnʼs Disease

The restricted potential for recovery of growth plate chondrogenesis and longitudinal bone growth following exposure to pro-inflammatory cytokines

Growth Impairment in Children

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