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Nutritional status and food intake in pediatric patients with inflammatory bowel disease at diagnosis significantly differs from healthy controls

Abstract

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.

Conclusion: Food intake of newly diagnosed pediatric patients with inflammatory bowel disease significantly differed from healthy controls. Altered anthropometry and body composition are present already at the time of diagnosis.

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.

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Fig. 1

Abbreviations

CD:

Crohn’s disease

IBD:

Inflammatory bowel disease

UC:

Ulcerative colitis

PCDAI:

Pediatric Crohn’s disease activity index

PUCAI:

Pediatric ulcerative colitis activity index

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Acknowledgments

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.

Funding

This study was part of a research project IP-2014-09-3788 funded by the Croatian Science Foundation.

Author information

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.

Correspondence to Iva Hojsak.

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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.

Ethical approval

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

Informed consent was obtained from all individual participants and at least one of their parents included in the study.

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Sila, S., Trivić, I., Pavić, A.M. et al. Nutritional status and food intake in pediatric patients with inflammatory bowel disease at diagnosis significantly differs from healthy controls. Eur J Pediatr 178, 1519–1527 (2019). https://doi.org/10.1007/s00431-019-03443-3

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Keywords

  • Inflammatory bowel disease
  • Children
  • Adolescents
  • Diet
  • Anthropometry