Malnutrition in Adults and Children with IBD: Is There a Difference?

Abstract

Purpose: Malnutrition is associated with increased morbidity and mortality and is commonly observed in patients with IBD. It is attributed to multiple factors, including inadequate dietary intake, malabsorption, and disease activity. The added energy costs of growth in the child and adolescent with IBD are an additional risk factor. Few data have compared the prevalence of malnutrition in pediatric with adult onset disease. The aim of the present study was to perform a comparative analysis of nutritional parameters between adult and pediatric subjects with IBD. Methods: A cross sectional comparison of nutritional status in pediatric and adult patients with IBD, grouped as Crohn's disease (CD), ulcerative (UC) or unclassified colitis (IBDU), according to the Montreal classification. The McGill IBD database was used to collect clinical and biochemical parameters at 4 tertiary centers. Nutritional parameters included BMI and blood concentrations of hemoglobin, Fe, vitamin B12, and folate. Malnutrition was defined by BMI Z-score for age below 2 standard deviations in pediatric patients and a BMI below 18.5 in adults. Abnormal micronutrient results were defined by age adjusted values below normal cut-offs. Disease activity was determined at each clinical visit by the HBI (CD) or Lichtiger Index (UC, IBDU). Results: Complete data were available for 195 adults 110 pediatric cases (mean age ±SD: 29.7 ± 13.9 y and 13.6 ± 2.8 y respectively). CD was more frequent in both age groups (74.9% in adults; 88.2% in children). UC and IBDU were more common in the adult compared to the pediatric population (25.1% vs 11.8%, p <0.02). Surprisingly, malnutrition was not more frequent in pediatric, compared to adult patients (6.4% vs 7.8%), nor were there differences observed between CD, UC ad IBDU groups. Anemia was common in both populations, but significantly more often in children, compared to adults (38.2 vs 24.4%, p = 0.01). No significant differences were observed between pediatric and adult populations for low levels of serum Fe (3.6 vs 8.7%), or folate (2.7 vs 1.5%). Deficiency of B12 in CD was similar in pediatric and adult groups (9.3 vs 9.6%). BMI was not correlated with disease activity scores for adult or pediatric age groups (CD, UC or IBDU). Conclusion: Malnutrition is seen in adult IBD patients as often as in children. Moreover, malnutrition was seen irrespective of disease activity. Children with IBD were more likely than adults to present with anemia.