Nutritional status and food intake in pediatric patients with inflammatory bowel disease at diagnosis significantly differs from healthy controls
Nutritional status and dietary intake in pediatric-onset inflammatory bowel disease are complex and need to be further explored. Therefore, we have assessed anthropometric measures, body composition, and dietary intake of newly diagnosed pediatric patients, and compared them with healthy controls. This was a prospective cross-sectional study including newly diagnosed patients with inflammatory bowel disease (n = 89) and healthy controls (n = 159). Mean energy intake was significantly lower in healthy controls compared to patients with ulcerative colitis, but not in patients with Crohn’s disease. Intake of all macronutrients, dietary fiber, and calcium was significantly lower in patients with ulcerative colitis, whereas the only intake of animal protein, fruit, and calcium differed significantly in patients with Crohn’s disease. There were no significant differences in the body fat percentage between patients with ulcerative colitis or Crohn’s disease vs. controls; however, lean mass-for-age z-scores were significantly lower in patients with both diseases in comparison to controls.
What is Known:
• Children with inflammatory bowel disease suffer from malnutrition, especially children with Crohn’s disease in whom linear growth failure often precedes gastrointestinal symptoms.
What is New:
• This study showed significantly lower intake of energy, macronutrients, and various micronutrients in patients with ulcerative colitis compared to healthy controls, while patients with Crohn’s disease have a lower intake of fruits, calcium, and animal protein at diagnosis.
• Altered body composition is present in both groups of patients at the time of diagnosis.
KeywordsInflammatory bowel disease Children Adolescents Diet Anthropometry
Inflammatory bowel disease
Pediatric Crohn’s disease activity index
Pediatric ulcerative colitis activity index
We thank Professor Mary Fewtrell for her kind help in the calculation of SD scores for lean mass in our patients and healthy controls, with the new UK reference data for pediatric body composition developed as a part of her research.
SS was responsible for writing the research protocol, conducting the research, extracting the data, interpreting the results, and writing the manuscript. IT was responsible for writing the protocol, conducting the research, extracting the data, interpreting the results, and writing the manuscript. AMP was responsible for writing the protocol, conducting the research, extracting the data, and reviewing the manuscript. TN was responsible for conducting the research, interpreting the results, and reviewing the manuscript. SK was responsible for designing the research protocol, interpreting the results, and reviewing the manuscript. IH was responsible for designing the research protocol, analyzing the data, interpreting the results and reviewing the manuscript.
This study was part of a research project IP-2014-09-3788 funded by the Croatian Science Foundation.
Compliance with ethical statements
Conflict of interest
Iva Hojsak received payment/honorarium for lectures or consultation from BioGaia, Nutricia, Nestle, GM pharma, and Chr Hansen. Sanja Kolaček received fees for lectures from Abbott, AbbVie, Fresenius, Mead and Johnson, Nestle, Nutricia, and Oktal Pharma. Tena Niseteo received a fee for lectures from 4U Pharma. Sara Sila, Ivana Trivić, and Ana Močić Pavić declare no conflict of interest.
All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional ethics committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards. This study was approved by the Ethics Committee Children’s Hospital Zagreb (IRB no. 21102014).
Informed consent was obtained from all individual participants and at least one of their parents included in the study.
- 2.Ng SC, Shi HY, Hamidi N, Underwood FE, Tang W, Benchimol EI, Panaccione R, Ghosh S, Wu JCY, Chan FKL, Sung JJY, Kaplan GG (2018) Worldwide incidence and prevalence of inflammatory bowel disease in the 21st century: a systematic review of population-based studies. Lancet 390(10114):2769–2778. https://doi.org/10.1016/S0140-6736(17)32448-0 CrossRefGoogle Scholar
- 3.Amre DK, D'Souza S, Morgan K, Seidman G, Lambrette P, Grimard G, Israel D, Mack D, Ghadirian P, Deslandres C, Chotard V, Budai B, Law L, Levy E, Seidman EG (2007) Imbalances in dietary consumption of fatty acids, vegetables, and fruits are associated with risk for Crohn’s disease in children. Am J Gastroenterol 102(9):2016–2025. https://doi.org/10.1111/j.1572-0241.2007.01411.x CrossRefGoogle Scholar
- 6.Jakobsen C, Paerregaard A, Munkholm P, Faerk J, Lange A, Andersen J, Jakobsen M, Kramer I, Czernia-Mazurkiewicz J, Wewer V (2011) Pediatric inflammatory bowel disease: increasing incidence, decreasing surgery rate, and compromised nutritional status: a prospective population-based cohort study 2007-2009. Inflamm Bowel Dis 17(12):2541–2550. https://doi.org/10.1002/ibd.21654 CrossRefGoogle Scholar
- 7.Filippi J, Al-Jaouni R, Wiroth JB, Hebuterne X, Schneider SM (2006) Nutritional deficiencies in patients with Crohn’s disease in remission. Inflamm Bowel Dis 12(3):185–191. https://doi.org/10.1097/01.MIB.0000206541.15963.c3 CrossRefGoogle Scholar
- 9.Kugathasan S, Nebel J, Skelton JA, Markowitz J, Keljo D, Rosh J, LeLeiko N, Mack D, Griffiths A, Bousvaros A, Evans J, Mezoff A, Moyer S, Oliva-Hemker M, Otley A, Pfefferkorn M, Crandall W, Wyllie R, Hyams J, Wisconsin Pediatric Inflammatory Bowel Disease A, Pediatric Inflammatory Bowel Disease Collaborative Research G (2007) Body mass index in children with newly diagnosed inflammatory bowel disease: observations from two multicenter North American inception cohorts. J Pediatr 151(5):523–527. https://doi.org/10.1016/j.jpeds.2007.04.004 CrossRefGoogle Scholar
- 10.Long MD, Crandall WV, Leibowitz IH, Duffy L, del Rosario F, Kim SC, Integlia MJ, Berman J, Grunow J, Colletti RB, Schoen BT, Patel AS, Baron H, Israel E, Russell G, Ali S, Herfarth HH, Martin C, Kappelman MD, ImproveCareNow Collaborative for Pediatric IBD (2011) Prevalence and epidemiology of overweight and obesity in children with inflammatory bowel disease. Inflamm Bowel Dis 17(10):2162–2168. https://doi.org/10.1002/ibd.21585 CrossRefGoogle Scholar
- 16.Tsiountsioura M, Wong JE, Upton J, McIntyre K, Dimakou D, Buchanan E, Cardigan T, Flynn D, Bishop J, Russell RK, Barclay A, McGrogan P, Edwards C, Gerasimidis K (2014) Detailed assessment of nutritional status and eating patterns in children with gastrointestinal diseases attending an outpatients clinic and contemporary healthy controls. Eur J Clin Nutr 68(6):700–706. https://doi.org/10.1038/ejcn.2013.286 CrossRefGoogle Scholar
- 17.Levine A, Koletzko S, Turner D, Escher JC, Cucchiara S, de Ridder L, Kolho KL, Veres G, Russell RK, Paerregaard A, Buderus S, Greer ML, Dias JA, Veereman-Wauters G, Lionetti P, Sladek M, Martin de Carpi J, Staiano A, Ruemmele FM, Wilson DC, European Society of Pediatric Gastroenterology H, Nutrition (2014) ESPGHAN revised porto criteria for the diagnosis of inflammatory bowel disease in children and adolescents. J Pediatr Gastroenterol Nutr 58(6):795–806. https://doi.org/10.1097/MPG.0000000000000239 Google Scholar
- 18.Levine A, Griffiths A, Markowitz J, Wilson DC, Turner D, Russell RK, Fell J, Ruemmele FM, Walters T, Sherlock M, Dubinsky M, Hyams JS (2011) Pediatric modification of the Montreal classification for inflammatory bowel disease: the Paris classification. Inflamm Bowel Dis 17(6):1314–1321. https://doi.org/10.1002/ibd.21493 CrossRefGoogle Scholar
- 20.Turner D, Otley AR, Mack D, Hyams J, de Bruijne J, Uusoue K, Walters TD, Zachos M, Mamula P, Beaton DE, Steinhart AH, Griffiths AM (2007) Development, validation, and evaluation of a pediatric ulcerative colitis activity index: a prospective multicenter study. Gastroenterology 133(2):423–432. https://doi.org/10.1053/j.gastro.2007.05.029 CrossRefGoogle Scholar
- 22.Wells JC, Williams JE, Chomtho S, Darch T, Grijalva-Eternod C, Kennedy K, Haroun D, Wilson C, Cole TJ, Fewtrell MS (2012) Body-composition reference data for simple and reference techniques and a 4-component model: a new UK reference child. Am J Clin Nutr 96(6):1316–1326. https://doi.org/10.3945/ajcn.112.036970 CrossRefGoogle Scholar
- 23.WHO Multicentre Growth Reference Study Group (2006) WHO child growth standards: length/height-for-age, weight-for-age, weight-for-length, weight-for-height and body mass index-for-age: methods and development. World Health Organization, Geneva (312 pages)Google Scholar
- 25.Mocic Pavic A, Detelic D, Hojsak I, Kolacek S (2015) Validation of a food frequency questionnaire for adolescents in Croatia. J Pediatr Gastroenterol Nutr 60:835–836Google Scholar
- 26.Nutrient Data Laboratory (U.S.), & Consumer and Food Economics Institute (U.S.) (1999) USDA nutrient database for standard reference. USDA, Nutrient Data Laboratory, Agricultural Research Service, Riverdale, MdGoogle Scholar
- 27.Kaic-Rak A, Antonic K (1990) Tablice o sastavu namirnica i pića. Zavod za zaštitu zdravlja R Hrvatske, ZagrebGoogle Scholar
- 29.Serrano-Montalban B, Arias A, Friginal-Ruiz AB, Lucendo AJ (2017) The use of the fracture risk assessment (FRAX(R)) tool in predicting risk of fractures in patients with inflammatory bowel disease: a systematic review. J Clin Densitom 20(2):180–187. https://doi.org/10.1016/j.jocd.2016.08.010 CrossRefGoogle Scholar
- 32.Veereman-Wauters G, de Ridder L, Veres G, Kolacek S, Fell J, Malmborg P, Koletzko S, Dias JA, Misak Z, Rahier JF, Escher JC, Group EIP (2012) Risk of infection and prevention in pediatric patients with IBD: ESPGHAN IBD Porto Group commentary. J Pediatr Gastroenterol Nutr 54(6):830–837. https://doi.org/10.1097/MPG.0b013e31824d1438 CrossRefGoogle Scholar
- 33.Vasseur F, Gower-Rousseau C, Vernier-Massouille G, Dupas JL, Merle V, Merlin B, Lerebours E, Savoye G, Salomez JL, Cortot A, Colombel JF, Turck D (2010) Nutritional status and growth in pediatric Crohn’s disease: a population-based study. Am J Gastroenterol 105(8):1893–1900. https://doi.org/10.1038/ajg.2010.20 CrossRefGoogle Scholar
- 35.Croatian Institute of Public Health. Health Behaviour in School-aged Children – HBSC 2013/2014Google Scholar