Growth after intestinal resection for Crohn's disease in children, adolescents, and young adults.

OBJECTIVE: Growth before and after intestinal resection for Crohn's disease (CD) was examined in a group of children, adolescents, and young adults. METHODS: Retrospective chart review of patients who had intestinal resections as clinical management of complications of CD between 1985 and 1996. Pre- and postoperative measurements of weight and height were reviewed. Z-scores were computed for weight-forage (WAZ), height-for-age (HAZ), and weight-for-height (WHZ). Two tailed t tests were used to compare postoperative growth patterns. Significance was defined as p < 0.05. RESULTS: Twenty-five subjects (8 females, mean age 16.2+/-2.8 years with one operation, and 3 males, mean age 15.7 years with multiple operations) were identified. There were significant improvements in the postoperative growth patterns of subjects who had one operation: HAZ (-1.28+/-1.45 versus -0.98+/-1.37, p = 0.041), WAZ (-1.35+/-1.02 versus -0.74+/-0.93, p = 0.0006) and WHZ (-0.64+/-0.95 versus -0.23+/-0.81, p = 0.036). Furthermore, the magnitude of postoperative weight gain directly correlated with the age at CD diagnosis, R2 = 0.16, p = 0.046. Trends towards improved postoperative WAZ (-0.83 versus -0.49) and HAZ (-0.47 versus -0.27) were also observed in the three subjects who had multiple operations. CONCLUSION: The pattern of weight and height growth was improved after intestinal resection for CD. Nonetheless, close monitoring of postoperative growth is necessary especially in children diagnosed with CD at a young age.

Association between steatorrhea, growth, and immunologic status in children with perinatally acquired HIV infection.

OBJECTIVE: To examine the prevalence of steatorrhea and exocrine pancreatic insufficiency (EPI) and their association with growth and immune status variables in children with perinatally acquired human immunodeficiency virus (HIV) infection. DESIGN: Cross-sectional study. SETTING: Tertiary care HIV subspecialty practice. PARTICIPANTS: Children with perinatally acquired HIV infection. Exclusion criteria included being younger than 1 year and receiving mineral oil as a medication. METHODS: Weight, height, and upper arm anthropometric variables were measured. Spot stool samples were analyzed for steatorrhea using the Sudan III qualitative test and for EPI using fecal elastase-1 enzyme assay. Hormone-stimulated pancreatic function testing and 72-hour stool and dietary fat sample collection were performed when fecal elastase-1 enzyme was in the range of EPI, defined as less than 200 microgram/g. HIV RNA viral load, CD4 status, type of antiretroviral therapy, and biochemical evidence of hepatobiliary disease were measured within 3 months of stool sample collection. z Scores were computed for height, weight, triceps skinfold, and upper arm muscle area. RESULTS: We enrolled 44 patients (23 girls [52%]) with a mean +/- SD age of 7.4 +/- 3.1 years. None had hepatobiliary disease. The prevalence of steatorrhea was 39% (95% confidence interval, 23%-56%). The prevalence of EPI was 0% (95% confidence interval, 0%-9%). There were no associations between steatorrhea and EPI, growth, HIV RNA viral load, CD4 status, or type of antiretroviral therapy. Older children had decreased z scores for height (r = -0.42; P =.006). CONCLUSIONS: The clinical significance of steatorrhea in children with HIV infection is unclear. Furthermore, its evaluation should focus on nonpancreas-based conditions. Continual close monitoring of growth is essential in children with HIV infection.

Growth, body composition, and nutritional status in children and adolescents with Crohn's disease.

OBJECTIVE: To examine growth, body composition, and nutritional status in a large sample of children, adolescents, and young adults with Crohn's disease (CD). METHODS: One hundred thirty-two subjects (48 females) with CD, aged 5 to 25 years, and 66 healthy control subjects (37 females) of similar age. Growth, nutritional status, and body composition were measured by anthropometry and dual-energy x-ray absorptiometry. Genetic potential of linear growth was predicted using the adjusted heights of Himes et al. Pubertal status and skeletal age were assessed. Average Pediatric Crohn's Disease Activity Index (PCDAI) and lifetime steroid exposure (in milligrams per day) were obtained from medical charts. The variables were examined in relation to gender and measures of disease activity. RESULTS: Males and females with CD did not differ by age, disease duration, or PCDAI. Males with CD had significantly lower values for growth and nutritional status than control subjects (z-scores for weight: -0.66 +/- 1.18 vs. 0.26 +/- 0.95, P = 0.00002; height -0.81 +/- 1.14 vs. 0.28 +/- 0.93, P = 0.00001; adjusted height -1.05 +/- 1.03 vs. 0.40 +/- 1.03, P = 0.00001) and delayed skeletal age of 0.9 +/- 1.6 years. Impaired linear growth in the males was present regardless of pubertal stage. Associations between disease severity indicators and growth parameters were more consistent for females. CONCLUSIONS: Crohn's disease is associated with impaired growth. Despite similarities in disease duration, activity, and lifetime steroid exposure, growth in males was more impaired. Gender may confer risk for impaired growth in CD.

Resting energy expenditure and prediction equations in young children with failure to thrive.

OBJECTIVE: To compare predicted and measured resting energy expenditure (REE) in young children (birth to 3 years) with failure to thrive (FTT). METHODS: REE (kcal/d) was measured by indirect calorimetry and compared with predicted REE from 3 sex and age group equations: World Health Organization (WHO), Schofield weight-based (SCH-WT), and Schofield weight- and height-based (SCH-WT-HT). The clinical characteristics associated with inaccuracy of predicted REE were examined. RESULTS: Forty-five subjects (47% female) were evaluated. Their clinical characteristics (mean +/- SD) included age 1.2 +/- 0.7 years, length/height z score -2.1 +/- 1.3, weight z score -2.7 +/- 1.0, and measured REE 438 +/- 111 kcal/d. All prediction equations were within 10% accuracy <50% of the time. However, SCH-WT-HT did not significantly differ from measured REE (450 +/- 138 vs 438 +/- 111 kcal/d, P =.2) and was least likely to underestimate REE. Younger age and more severe growth failure (based on weight, length/height, or both) were associated with underestimation of REE by prediction equations. CONCLUSION: REE should be measured in young infants and children with moderate to severe FTT when knowledge of caloric needs is required for optimal clinical care. The SCH-WT-HT equation was least likely to underestimate REE and is therefore preferred when REE cannot be measured in this group of children.