Interventions for growth failure in childhood Crohn's disease

Newby, E.; Sawczenko, A; Thomas, Adrian G; Wilson, David C.

doi:10.1002/14651858.cd003873.pub2

Cited by 61 publications

(19 citation statements)

References 71 publications

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“…13 There is no universally accepted definition of growth failure or good evidence of how it should be treated. 40 Growth failure nevertheless remains a common problem, especially in paediatric Crohn's disease, and can persist into adult life. 41 There is also evidence from prospective paediatric studies that the growth failure is ''preprogrammed'', strongly suggesting a genetic influence.…”

Section: Discussionmentioning

confidence: 99%

Analysis of the influence of OCTN1/2 variants within the IBD5 locus on disease susceptibility and growth indices in early onset inflammatory bowel disease

Russell

2005

Gut

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Background and aims: The OCTN1 (SLC22A4 1672CRT) and OCTN2 (SLC22A5 2207GRC) variants within the IBD5 locus have been associated with susceptibility to adult onset Crohn's disease (CD), but their contribution in children has not been examined. Methods: These OCTN1/2 variants and IBD5 marker single nucleotide polymorphisms (SNPs) (IGR2096a_1, IGR2198a_1, and IGR2230a_1) were examined in 299 Scottish children (200 with CD, 74 with ulcerative colitis (UC), and 25 with indeterminate colitis (IC)), together with 502 parents (for transmission disequilibrium testing) and 256 controls. Results: All SNPs were in strong linkage disequilibrium (D9 .0.94). TDT analysis showed association of the OCTN1 variant with inflammatory bowel disease (IBD) (p = 0.01) and CD (p = 0.04). Allele frequencies of the OCTN1/2 variants were significantly higher in IBD/CD cases (p,0.04). The homozygous mutant OCTN1/2 haplotype was increased in IBD (24.3% v 16.1%, p = 0.02) and UC (28.2% v 16.1%, p = 0.02) compared with controls. The OCTN1/2 variants were not independent of the background IBD5 risk haplotype in conferring disease susceptibility. Unifactorial analysis in CD patients showed that carriage of the TC haplotype was associated with lower weight, height, and BMI centile (,9 th centile) at diagnosis (weight: 87.9% v 67.3% (p = 0.002), odds ratio (OR) = 3.52 (95% confidence interval, 1.51 to 8.22); height: 84.1% v 68.4% (p,0.05), OR = 2.44 (1.00 to 5.99); BMI: 79.6% v 61.1% (p = 0.02), OR = 2.49 (1.14 to 5.44)), and lower weight centile at follow up (87.5% v 64.6% (p = 0.03), OR = 3.83 (1.03 to 14.24)). Multifactorial binary logistic regression analysis confirmed association of the TC haplotype with lower weight centile at diagnosis (p = 0.02, OR = 3.41 (1.20 to 9.66)). Conclusions: These data implicate variants within the IBD5 haplotype, as determinants of disease susceptibility and growth indices in early onset IBD. The OCTN1/2 variants remain potential positional candidate genes, but require further analysis.

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Section: Discussionmentioning

confidence: 99%

Analysis of the influence of OCTN1/2 variants within the IBD5 locus on disease susceptibility and growth indices in early onset inflammatory bowel disease

Russell

2005

Gut

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“…A recent meta-analysis concluded that despite the lack of large well-controlled studies, nutritional therapy is comparable to glucocorticoids in inducing remission and superior in improving height velocity 141 . Elemental and polymeric formulas were found equally effective in inducing remission.…”

Section: Part B Interventions and Practises For Maintaining And Imprmentioning

confidence: 99%

Skeletal Health of Children and Adolescents With Inflammatory Bowel Disease

Pappa¹,

Thayu²,

Sylvester³

et al. 2011

J. pediatr. gastroenterol. nutr.

113

102

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Objectives Current evidence, albeit sparse, points to suboptimal bone health in children and adolescents with inflammatory bowel disease (IBD) when compared to healthy peers. In this clinical report we aimed to: a) review the current literature regarding the pathogenesis of suboptimal bone health and its clinical consequences and long term outcome in children with IBD, b) provide recommendations regarding screening and monitoring bone health, c) review the evidence on available measures and agents to prevent compromise and improve bone health d) summarize the gaps in knowledge and point to research directions. Methods Six experts in pediatric bone health and IBD reviewed the available literature specific to their area of expertise. Evidence was rated using an adjusted evidence rating system. Results The mechanism of suboptimal bone health in children with IBD lays in reduced bone formation and resorption. This could lead to reduced bone mineral density (BMD), which may predispose to fractures and suboptimal peak bone mass. Factors contributing to this derangement are: inflammation, delayed growth and puberty, lean mass deficits, and use of glucocorticoids. Improvement in linear growth and repletion of lean mass may help improve bone health in children with IBD. The role of vitamin D, calcium, exercise, biologics and bisphosphonates is under investigation. Conclusions We recommend: screening and monitoring BMD in children with IBD and certain identified risk factors, control of inflammation with steroid-sparing techniques, nutritional support in children with growth delays and/or lean mass deficits, optimization of vitamin D status, and weight bearing physical activity. Gaps in knowledge are numerous and require investigation.

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“…Contributing factors include reduced dietary intake as a result of reduced appetite, malabsorption and increased nutritional requirements associated with some diseases. Poor nutritional status and sub-optimal growth can have a detrimental effect on both short- and long-term disease outcomes (Corey 1988; CPS 1994; Koscik 2004). …”

Section: Introductionmentioning

confidence: 99%

Oral protein calorie supplementation for children with chronic disease

Smith

Saljuqi²,

Watling

2015

Cochrane Database of Systematic Reviews

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Background Poor growth and nutritional status are common in children with chronic diseases. Oral protein calorie supplements are used to improve nutritional status in these children. These expensive products may be associated with some adverse effects, e.g. the development of inappropriate eating behaviour patterns. This is a new update of a Cochrane review last updated in 2009. Objectives To examine evidence that in children with chronic disease, oral protein calorie supplements alter daily nutrient intake, nutritional indices, survival and quality of life and are associated with adverse effects, e.g. diarrhoea, vomiting, reduced appetite, glucose intolerance, bloating and eating behaviour problems. Search methods Trials of oral protein calorie supplements in children with chronic diseases were identified through comprehensive electronic database searches, handsearching relevant journals and abstract books of conference proceedings. Companies marketing these products were also contacted. Most recent search of the Group's Trials Register: 24 February 2015. Selection criteria Randomised or quasi‐randomised controlled trials comparing oral protein calorie supplements for at least one month to increase calorie intake with existing conventional therapy (including advice on improving nutritional intake from food or no specific intervention) in children with chronic disease. Data collection and analysis We independently assessed the outcomes: indices of nutrition and growth; anthropometric measures of body composition; calorie and nutrient intake (total from oral protein calorie supplements and food); eating behaviour; compliance; quality of life; specific adverse effects; disease severity scores; and mortality; we also assessed the risk of bias in the included trials. Main results Four studies (187 children) met the inclusion criteria. Three studies were carried out in children with cystic fibrosis and one study included children with paediatric malignant disease. Overall there was a low risk of bias for blinding and incomplete outcome data.Two studies had a high risk of bias for allocation concealment. Few statistical differences were found in the outcomes we assessed between treatment and control groups, except change in total energy intake at six and 12 months, mean difference 304.86 kcal per day (95% confidence interval 5.62 to 604.10) and mean difference 265.70 kcal per day (95% confidence interval 42.94 to 485.46), respectively. However, these were based on the analysis of just 58 children in only one study. Only two chronic diseases were included in these analyses, cystic fibrosis and paediatric malignant disease. No other studies were identified which assessed the effectiveness of oral protein calorie supplements in children with other chronic diseases. Authors' conclusions Oral protein calor...

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Interventions for growth failure in childhood Crohn's disease

Cited by 61 publications

References 71 publications

Analysis of the influence of OCTN1/2 variants within the IBD5 locus on disease susceptibility and growth indices in early onset inflammatory bowel disease

Analysis of the influence of OCTN1/2 variants within the IBD5 locus on disease susceptibility and growth indices in early onset inflammatory bowel disease

Skeletal Health of Children and Adolescents With Inflammatory Bowel Disease

Oral protein calorie supplementation for children with chronic disease

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