Nutritional impact of inflammatory bowel diseases on children and adolescents

A systematic review was performed using PubMed/MEDLINE, LILACS and SciELO databases, with inclusion of articles in Portuguese and in English with original data, that analyzed nutritional aspects of inflammatory bowel diseases in children and adolescents. The initial search used the terms "inflammatory bowel diseases" and "children" or "adolescents" and "nutritional evaluation" or "nutrition deficiency". The selection of studies was initially performed by reading the titles and abstracts. Review studies and those withouth data for pediatric patients were excluded. Subsequently, the full reading of the articles considered relevant was performed.

RESULTS:

237 studies were identified, and 12 of them were selected according to the inclusion criteria. None of them was performed in South America. During the analysis of the studies, it was observed that nutritional characteristics of patients with inflammatory bowel disease may be altered; the main reports were related to malnutrition, growth stunting, delayed puberty and vitamin D deficiency.

CONCLUSION:

There are nutritional consequences of inflammatory bowel diseases in children and adolescents, mainly growth stunting, slower pubertal development, underweight and vitamin deficiencies. Nutritional impairments were more significant in patients with Crohn's disease; overweight and obesity were more common in patients with ulcerative rectocolitis. A detailed nutritional assessment should be performed periodically in children and adolescents with inflammatory bowel disease.

Nutritional assessment; Nutritional status; Inflammatory bowel diseases; Child; Adolescent

Author/Year /local	Objective	Sample/ controls/Age	Main Results	CD X URC	Conclusion
Pappa et al^[30] 2006 USA	Report the prevalence of vitamin D deficiency in IBD	n. 130/ c. 0/ 8 months-2 years	The prevalence of vitamin D deficiency was 34.6 %.	Mean serum [25 OHD] was similar in patients with CD and URC	Vitamin D deficiency is highly prevalent among pediatric patients with IBD.
Kugathasan et al^[25] 2007 USA	Compare the BMI of all children with a recent diagnosis of IBD in two independent groups	n. 783/ c. 2,748/ <16 years	Most children with IBD had normal BMI (5% 84%).	BMI <5% was observed in 24% of children with CD and 9% in URC. 10% of the children with CD and 30% of those with URC had BMI consistent with overweight or risk of overweight.	Children with IBD are affected by current population trends in relation to overweight. A subgroup of children with newly diagnosed IBD has a BMI classified as overweight or at risk of overweight.
Thayu et al^[28] 2007 USA	To evaluate lean mass and fat mass in children and adolescents with CD at diagnosis.	n. 78/c. 669/ 5-21 years	CD was associated with height, BMI, lean and fat mass that was low for age.		CD was associated with deficits in lean mass and fat mass.
Sylvester et al^[33] 2009 USA	Observe the effects of CD on body composition in a cohort of children over a period of two years	n. 42/ c. 81/ 6-17 years	BMI z was reduced at diagnosis in children with CD compared with controls. During the study period of 2 years, BMI z scores will normalize in patients with CD.		The correction of BMI is associated with clinical improvement in children with CD two years after diagnosis
Heyman et al^[32] 2009 USA	Compare folate concentrations between children with newly diagnosed IBD and healthy controls	n. 37/ c. 41/ 5 to 17 years	Serum folate concentrations were 11.1% lower in controls than in patients with IBD (p=0.031).		Higher folate concentrations were observed in children with newly diagnosed untreated IBD than in the controls.
Lee et al^[26] 2010 USA	Compare final adult height of patients and the target height based on the heights of parents.	n. 295/c. 569/ 1-18 years	22% had impaired growth (zH /A<-1.64, equivalent to percentile <5). Only 11.3% with impaired growth up to adulthood.	Most patients with growth problems had CD (88% CD vs. 12% URC)	Most patients with IBD do not persist with impaired growth in adulthood.
Long et al^[24]2011 USA	Determine the prevalence of obesity in a multicentric cohort of children with IBD	n. 1,598/ c. 0/ 2-18 years	The prevalence of overweight and obesity in children and adolescents with IBD was 23.6%.	Higher rates of overweight and obesity were found in URC than in CD (30.1% and 20.0%, respectively)	Approximately 1/5 of children with CD and 1/3 with URC are overweight or obese. Obesity rate in URC is comparable to that of the general population.
Pappa et al^[29] 2011 USA	To evaluate the prevalence of hypovitaminosis D in children and adolescents with IBD.	n. 448/ c. /8-22 years	Serum [25-OHD] ≤20ng/mL (insufficiency) identified in 14.3% of patients and serum [25-OHD] ≤15ng/mL (deficiency) in 5.8%.	Both patients with URC and CD are at risk of hypovitaminosis D.	Hypovitaminosis D is prevalent among children and young individuals, including patients with IBD.
Levin et al^[31] 2011 Australia	Document the 25-OHD status in a population of Australian children with IBD.	n. 78/ c. 0/ mean age of 12.6 (±3.5) years	19% of the children had vitamin D deficiency and 38% had vitamin D insufficiency.		A high proportion of Australian children with IBD were vitamin-D deficient.
Wiskin et al^[23] 2011 UK	Describe the height, weight and body composition in a cohort of children with IBD.	n. 55/ c. 0/ 6.5-17.7 years	Malnutrition rate, according to the WHO criteria, was 2.2%. Growth deficit of 18.2% among the studied children.	Nutritional deficits were more common in Crohn's disease	Most children showed satisfactory height and weight, although some children were underweight for height and others were overweight.
Aurangzeb et al^[22] 2011 Pakistan	Define the nutritional status of children with newly diagnosed IBD	n. 28 c. 56 6 months to 16 years	Children with IBD have BMI z score and weight percentile for age lower than controls (p=0.05 and p=0.01, respectively)		Detailed nutritional assessment should be an integral part of the conduct for all children with IBD.
Hood et al^[27] 2011 USA	Compare heights at expected age of cessation of growth (16 for girls and 18 for boys) with those obtained after two years.	n. 475/ c. 0/ 16-20 years	Compared to the general population (163.8 cm at age 16 in girls and 176.8 cm at age 18 in boys), girls and boys with IBD were 2.7 cm and 2.6 cm shorter, respectively.		Most patients with IBD reach adult height within normal values for the population.

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[1] *Corresponding author.E-mail:gilton18@hotmail.com (G.M. Santos).

Brasil

Brasil

Nutritional impact of inflammatory bowel diseases on children and adolescents☆ ☆ Study conducted at the Service of Pediatric Gastroenterology and Hepatology (Complexo HUPES-CPPHO) and Faculdade de Medicina da Bahia, Universidade Federal da Bahia, Salvador, BA, Brazil.

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CONCLUSION:

Nutritional impact of inflammatory bowel diseases on children and adolescents^☆ ☆ Study conducted at the Service of Pediatric Gastroenterology and Hepatology (Complexo HUPES-CPPHO) and Faculdade de Medicina da Bahia, Universidade Federal da Bahia, Salvador, BA, Brazil.