S40 The Impact of Nutritional Counseling on Growth Velocity in Pediatric IBD Patients

Abstract

Background: Approximately 1 in 4 patients with inflammatory bowel disease (IBD) will present with the disease during childhood. Pediatric IBD is linked to poor growth outcomes and pubertal delay in both Crohn’s disease (CD) and ulcerative colitis (UC). In up to 46% of pediatric CD patients, a decrease in height velocity is the first symptom to present, before any gastrointestinal. This decreased growth is likely multifactorial and related to decreased caloric intake, poor nutrient absorption, corticosteroid use, and chronic inflammation. In up to 17% of pediatric IBD patients with decreased growth velocity, these early delays can lead to permanent growth deficit. This study aimed to assess the effectiveness of nutritional counseling by a registered dietician on growth velocity in the pediatric IBD population at a major medical center. Methods: This study was conducted as a retrospective chart review. Charts of pediatric IBD patients that were seen at Golisano Children’s Hospital at the University of Rochester, Rochester, NY in the years 2020 and 2021 were collected using billing codes. In all, 140 total charts were reviewed, and 7 were excluded because they did not have an established IBD diagnosis. Demographic, growth velocity, and laboratory data were collected for each of the remaining 133 charts. Results: Of the pediatric IBD population sampled, 56% of patients were male, 44% were female, and the mean age of diagnosis was 11.2 years (SD = 3.74). 80.17% of patients had Crohn’s disease, 19.01% had ulcerative colitis, and 0.83% had an inconclusive IBD diagnosis. 40.60% of patients had at least one appointment or consultation with a dietician or a nutritionist, while 59.40% had not met with a dietician or a nutritionist. The mean height velocity* was 0.31 cm/month (SD = 0.35 cm/month), the mean weight velocity* was 0.63 kg/month (SD = 0.57 kg/month), and the mean BMI velocity* was 0.18 kg*month/m2 (SD = 0.22 kg*month/m2). In terms of height velocity*, there was no significant difference between those who had dietary consultations and those who did not (t(125) = 0.02, P = 0.99). Those who received a dietary consultation had a significantly higher weight velocity* (t(125) = 1.86, P = 0.03). The mean weight velocity for patients who received dietary consult was 0.7 kg/month (SD = 0.07) as compared to 0.54 kg/month (SD = 0.07) for patients who did not receive dietary consultation. Conclusion(s): These results suggest that consultation with a dietician or nutritionist has a significant effect on the growth potential, specifically the weight gain potential, of pediatric IBD patients. We did not see a significant increase in the height velocity, which may be due to the pre/early pubertal mean age of our data. Further multivariate analyses of the laboratory data that was collected are ongoing and may help to identify if any of the laboratory tests are strong predictors of growth or delay in growth. This could then allow physicians to identify patients that are at higher risk of poor growth outcomes and design more targeted interventions for these high-risk patients. Note: *in the 18 months following diagnosis.