Growth abnormalities persist in newly diagnosed children with crohn disease despite current treatment paradigms

Marian Pfefferkorn, Georgine Burke, Anne Griffiths, James Markowitz, Joel Rosh, David MacK, Anthony Otley, Subra Kugathasan, Jonathan Evans, Athos Bousvaros, M. Susan Moyer, Robert Wyllie, Maria Oliva-Hemker, Ryan Carvalho, Wallace Crandall, David Keljo, T. D. Walters, Neal Leleiko, Jeffrey Hyams

Research output: Contribution to journalArticle

100 Citations (Scopus)

Abstract

OBJECTIVES:: We analyzed growth outcomes in children newly diagnosed with Crohn disease and determined whether growth abnormalities persist despite current therapies. PATIENTS AND METHODS:: Clinical and growth data were prospectively obtained on an inception cohort younger than 16 years old at diagnosis and Tanner I to III during the study. RESULTS:: In all, 176 children (mean age 10.1 years; 65% male) with mild (33%) or moderate/severe (67%) disease at diagnosis were studied. Disease activity at 1 year was inactive/mild (89%) or moderate/severe (11%). First-year treatments included immunomodulators (60%), corticosteroids (77%), 5-aminosalicylates (61%), infliximab (15%), and enteral nutrition (10%). By 2 years, 86% had received immunomodulators and 36% infliximab. Mean height z scores at diagnosis, 1 year, and 2 years were-0.49 ± 1.2 standard deviations (SDs),-0.50 ± 1.2, and-0.46 ± 1.1, respectively. Of the subjects, 10%, 8%, and 6.5% had height z scores less than-2 SD at diagnosis, 1 year, and 2 years. A height velocity z score less than-1SD was seen in 45% of subjects at 1 year and 38% at 2 years. The mean height velocity z score, however, increased between 1 and 2 years from-0.71 to 0.26 (P < 0.03). Corticosteroid use greater than 6 months in the first year was associated with abnormal height velocity at 1 year (adjusted odds ratio = 4.5; 95% confidence interval [CI] = 2.2-9.6). No statistically significant effect on height velocity z scores was noted when comparing those receiving or not receiving infliximab. CONCLUSIONS:: Growth delay persists in many children with CD following diagnosis, despite improved disease activity and the frequent use of immunomodulators and biologics. Additional strategies to improve growth outcomes require development.

Original languageEnglish (US)
Pages (from-to)168-174
Number of pages7
JournalJournal of pediatric gastroenterology and nutrition
Volume48
Issue number2
DOIs
StatePublished - Feb 1 2009
Externally publishedYes

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Crohn Disease
Immunologic Factors
Growth
Adrenal Cortex Hormones
Therapeutics
Mesalamine
Enteral Nutrition
Biological Products
Odds Ratio
Confidence Intervals
Infliximab

All Science Journal Classification (ASJC) codes

  • Pediatrics, Perinatology, and Child Health
  • Gastroenterology

Cite this

Pfefferkorn, Marian ; Burke, Georgine ; Griffiths, Anne ; Markowitz, James ; Rosh, Joel ; MacK, David ; Otley, Anthony ; Kugathasan, Subra ; Evans, Jonathan ; Bousvaros, Athos ; Moyer, M. Susan ; Wyllie, Robert ; Oliva-Hemker, Maria ; Carvalho, Ryan ; Crandall, Wallace ; Keljo, David ; Walters, T. D. ; Leleiko, Neal ; Hyams, Jeffrey. / Growth abnormalities persist in newly diagnosed children with crohn disease despite current treatment paradigms. In: Journal of pediatric gastroenterology and nutrition. 2009 ; Vol. 48, No. 2. pp. 168-174.
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abstract = "OBJECTIVES:: We analyzed growth outcomes in children newly diagnosed with Crohn disease and determined whether growth abnormalities persist despite current therapies. PATIENTS AND METHODS:: Clinical and growth data were prospectively obtained on an inception cohort younger than 16 years old at diagnosis and Tanner I to III during the study. RESULTS:: In all, 176 children (mean age 10.1 years; 65{\%} male) with mild (33{\%}) or moderate/severe (67{\%}) disease at diagnosis were studied. Disease activity at 1 year was inactive/mild (89{\%}) or moderate/severe (11{\%}). First-year treatments included immunomodulators (60{\%}), corticosteroids (77{\%}), 5-aminosalicylates (61{\%}), infliximab (15{\%}), and enteral nutrition (10{\%}). By 2 years, 86{\%} had received immunomodulators and 36{\%} infliximab. Mean height z scores at diagnosis, 1 year, and 2 years were-0.49 ± 1.2 standard deviations (SDs),-0.50 ± 1.2, and-0.46 ± 1.1, respectively. Of the subjects, 10{\%}, 8{\%}, and 6.5{\%} had height z scores less than-2 SD at diagnosis, 1 year, and 2 years. A height velocity z score less than-1SD was seen in 45{\%} of subjects at 1 year and 38{\%} at 2 years. The mean height velocity z score, however, increased between 1 and 2 years from-0.71 to 0.26 (P < 0.03). Corticosteroid use greater than 6 months in the first year was associated with abnormal height velocity at 1 year (adjusted odds ratio = 4.5; 95{\%} confidence interval [CI] = 2.2-9.6). No statistically significant effect on height velocity z scores was noted when comparing those receiving or not receiving infliximab. CONCLUSIONS:: Growth delay persists in many children with CD following diagnosis, despite improved disease activity and the frequent use of immunomodulators and biologics. Additional strategies to improve growth outcomes require development.",
author = "Marian Pfefferkorn and Georgine Burke and Anne Griffiths and James Markowitz and Joel Rosh and David MacK and Anthony Otley and Subra Kugathasan and Jonathan Evans and Athos Bousvaros and Moyer, {M. Susan} and Robert Wyllie and Maria Oliva-Hemker and Ryan Carvalho and Wallace Crandall and David Keljo and Walters, {T. D.} and Neal Leleiko and Jeffrey Hyams",
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Pfefferkorn, M, Burke, G, Griffiths, A, Markowitz, J, Rosh, J, MacK, D, Otley, A, Kugathasan, S, Evans, J, Bousvaros, A, Moyer, MS, Wyllie, R, Oliva-Hemker, M, Carvalho, R, Crandall, W, Keljo, D, Walters, TD, Leleiko, N & Hyams, J 2009, 'Growth abnormalities persist in newly diagnosed children with crohn disease despite current treatment paradigms', Journal of pediatric gastroenterology and nutrition, vol. 48, no. 2, pp. 168-174. https://doi.org/10.1097/MPG.0b013e318175ca7f

Growth abnormalities persist in newly diagnosed children with crohn disease despite current treatment paradigms. / Pfefferkorn, Marian; Burke, Georgine; Griffiths, Anne; Markowitz, James; Rosh, Joel; MacK, David; Otley, Anthony; Kugathasan, Subra; Evans, Jonathan; Bousvaros, Athos; Moyer, M. Susan; Wyllie, Robert; Oliva-Hemker, Maria; Carvalho, Ryan; Crandall, Wallace; Keljo, David; Walters, T. D.; Leleiko, Neal; Hyams, Jeffrey.

In: Journal of pediatric gastroenterology and nutrition, Vol. 48, No. 2, 01.02.2009, p. 168-174.

Research output: Contribution to journalArticle

TY - JOUR

T1 - Growth abnormalities persist in newly diagnosed children with crohn disease despite current treatment paradigms

AU - Pfefferkorn, Marian

AU - Burke, Georgine

AU - Griffiths, Anne

AU - Markowitz, James

AU - Rosh, Joel

AU - MacK, David

AU - Otley, Anthony

AU - Kugathasan, Subra

AU - Evans, Jonathan

AU - Bousvaros, Athos

AU - Moyer, M. Susan

AU - Wyllie, Robert

AU - Oliva-Hemker, Maria

AU - Carvalho, Ryan

AU - Crandall, Wallace

AU - Keljo, David

AU - Walters, T. D.

AU - Leleiko, Neal

AU - Hyams, Jeffrey

PY - 2009/2/1

Y1 - 2009/2/1

N2 - OBJECTIVES:: We analyzed growth outcomes in children newly diagnosed with Crohn disease and determined whether growth abnormalities persist despite current therapies. PATIENTS AND METHODS:: Clinical and growth data were prospectively obtained on an inception cohort younger than 16 years old at diagnosis and Tanner I to III during the study. RESULTS:: In all, 176 children (mean age 10.1 years; 65% male) with mild (33%) or moderate/severe (67%) disease at diagnosis were studied. Disease activity at 1 year was inactive/mild (89%) or moderate/severe (11%). First-year treatments included immunomodulators (60%), corticosteroids (77%), 5-aminosalicylates (61%), infliximab (15%), and enteral nutrition (10%). By 2 years, 86% had received immunomodulators and 36% infliximab. Mean height z scores at diagnosis, 1 year, and 2 years were-0.49 ± 1.2 standard deviations (SDs),-0.50 ± 1.2, and-0.46 ± 1.1, respectively. Of the subjects, 10%, 8%, and 6.5% had height z scores less than-2 SD at diagnosis, 1 year, and 2 years. A height velocity z score less than-1SD was seen in 45% of subjects at 1 year and 38% at 2 years. The mean height velocity z score, however, increased between 1 and 2 years from-0.71 to 0.26 (P < 0.03). Corticosteroid use greater than 6 months in the first year was associated with abnormal height velocity at 1 year (adjusted odds ratio = 4.5; 95% confidence interval [CI] = 2.2-9.6). No statistically significant effect on height velocity z scores was noted when comparing those receiving or not receiving infliximab. CONCLUSIONS:: Growth delay persists in many children with CD following diagnosis, despite improved disease activity and the frequent use of immunomodulators and biologics. Additional strategies to improve growth outcomes require development.

AB - OBJECTIVES:: We analyzed growth outcomes in children newly diagnosed with Crohn disease and determined whether growth abnormalities persist despite current therapies. PATIENTS AND METHODS:: Clinical and growth data were prospectively obtained on an inception cohort younger than 16 years old at diagnosis and Tanner I to III during the study. RESULTS:: In all, 176 children (mean age 10.1 years; 65% male) with mild (33%) or moderate/severe (67%) disease at diagnosis were studied. Disease activity at 1 year was inactive/mild (89%) or moderate/severe (11%). First-year treatments included immunomodulators (60%), corticosteroids (77%), 5-aminosalicylates (61%), infliximab (15%), and enteral nutrition (10%). By 2 years, 86% had received immunomodulators and 36% infliximab. Mean height z scores at diagnosis, 1 year, and 2 years were-0.49 ± 1.2 standard deviations (SDs),-0.50 ± 1.2, and-0.46 ± 1.1, respectively. Of the subjects, 10%, 8%, and 6.5% had height z scores less than-2 SD at diagnosis, 1 year, and 2 years. A height velocity z score less than-1SD was seen in 45% of subjects at 1 year and 38% at 2 years. The mean height velocity z score, however, increased between 1 and 2 years from-0.71 to 0.26 (P < 0.03). Corticosteroid use greater than 6 months in the first year was associated with abnormal height velocity at 1 year (adjusted odds ratio = 4.5; 95% confidence interval [CI] = 2.2-9.6). No statistically significant effect on height velocity z scores was noted when comparing those receiving or not receiving infliximab. CONCLUSIONS:: Growth delay persists in many children with CD following diagnosis, despite improved disease activity and the frequent use of immunomodulators and biologics. Additional strategies to improve growth outcomes require development.

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