Shahzad Ahmed, MD1, Heba Iskandar, MD, MSCI1, Zijun Liu, MS1, Kajari Mondal, PhD1, James Markowitz, MD2, Jeffrey Hyams, MD3, Lee Denson, MD4, Thomas Walters, MD5, Marla C. Dubinsky, MD6, Subra Kugathasan, MD1
1Emory University School of Medicine, Atlanta, GA; 2Cohen Children’s Medical Center / Northwell Health, Lake Success, NY; 3Connecticut Children's Medical Center, Hartford, CT; 4Cincinnati Children’s Hospital Medical Center, Cincinnati, OH; 5Hospital for Sick Children, Toronto, ON, Canada; 6Icahn School of Medicine at Mount Sinai, New York, NY
Introduction: Although malnutrition in children diagnosed with Crohn’s disease (CD) is common, the effect of malnutrition on clinical outcomes following diagnosis of CD has not been evaluated.
Methods: We used data from 948 CD subjects recruited from the RISK inception cohort to examine the impact of malnutrition on disease progression. Our primary exposures of interest were reported weight loss at diagnosis (reported as yes/no) as well as age specific body mass index (BMI) z-scores defined as the deviation of the value for an individual from the mean value of the reference population. Z-scores were stratified according 2015 guidelines of pediatric malnutrition to categorize the presence and severity of malnutrition over 3 years of follow-up. Our primary outcomes were development of complicated (stricturing or penetrating) disease, need for CD-related hospitalization, and surgery. Logistic regression models were used to define independent associations.
Results: Reported weight loss and malnutrition were present in 72.9% and 40.5% respectively of children diagnosed with Crohn’s disease (Table 1). Following diagnosis at 6 months, BMI z-scores improved significantly such that only 13.2% remained malnourished and the rate of moderate/severe malnutrition declined from 17.6% to 2.2% (Figure 1). Failure to improve BMI z-score from 6 months was associated with increased risk of surgery (22% vs. 9%, p< 0.05) and B2/B2 phenotype (18% vs. 12%, p< 0.01) but not hospitalization (35% vs 28%, p >0.05) at 3 years. The rate of overall malnutrition improved at 6 months but then remained stable until 3 years (range 13.9-15.9%, p >0.05) and the association with increased rates of surgery and B2/B3 disease remained significant.
Discussion: Weight loss and malnutrition at diagnosis are common following diagnosis of CD in children. Failure to improve BMI z-score at 6 months and beyond correlates with increasing risk of surgery and complicated disease phenotype. We speculate that aggressive pharmacologic and nutritional management may improve / reverse the course in this narrow phenotype, and prospective studies are warranted to prove this concept.
Citation: Shahzad Ahmed, MD; Heba Iskandar, MD, MSCI; Zijun Liu, MS; Kajari Mondal, PhD; James Markowitz, MD; Jeffrey Hyams, MD; Lee Denson, MD; Thomas Walters, MD; Marla C. Dubinsky, MD; Subra Kugathasan, MD. P2278 - PERSISTING MALNUTRITION AFTER MEDICAL THERAPY IN CHILDREN WITH CROHN’S DISEASE IS ASSOCIATED WITH INCREASED RATES OF SURGERY AND COMPLICATED DISEASE BEHAVIOR. Program No. P2278. ACG 2019 Annual Scientific Meeting Abstracts. San Antonio, Texas: American College of Gastroenterology.