Yerushalmy-Feler Anat, Ben-Tov Amir, Weintraub Yael, Amir Achiya, Galai Tut, Moran-Lev Hadar, Cohen Shlomi
a Pediatric Gastroenterology Unit , ' Dana-Dwek' Children's Hospital, Tel Aviv Sourasky Medical Center, Sackler Faculty of Medicine, Tel Aviv University , Tel Aviv , Israel.
Scand J Gastroenterol. 2018 Jun;53(6):708-713. doi: 10.1080/00365521.2018.1464595. Epub 2018 Apr 24.
Inflammatory bowel disease (IBD) has been historically associated with underweight and malnutrition. The impact of both underweight and obesity on the clinical course of IBD in adults is controversial. This study described the association between body mass index (BMI) at diagnosis to disease course in children with IBD.
We reviewed the medical records of children with IBD from the database of the 'Dana-Dwek' Children's Hospital between 2010 and 2016. Demographic and anthropometric data were collected as were disease characteristics, course and therapy. Patients were categorized in quartiles according to BMI percentiles at diagnosis (Q1-Q4).
Of 100 children who were identified, 62 had Crohn's disease (CD) and 38 had ulcerative colitis (UC). The median age (interquartile range, IQR) at diagnosis was 13.7 (range 11.9-15.2) years. The median (IQR) follow-up was 2.1 (1.2-3.8) years. At diagnosis, 46 children (46%) were in Q1, 20 (20%) in Q2, 19 (19%) in Q3 and 15 (15%) in Q4. Prolonged time to diagnosis was associated with BMI in Q1 and Q4, as well as high disease activity at diagnosis (p < .001). In a multivariate analysis, BMI in the lower and upper quartiles was associated with disease exacerbation (HR 3.212 and 4.651, respectively, p = .016) and anti-tumor necrosis factor (TNF) therapy (HR 4.489 and 3.972, respectively, p = .021).
BMI in the lower and upper quartiles was associated with more severe disease course in children with IBD. BMI may serve as a simple and highly accessible predictor of pediatric IBD course and prognosis.
炎症性肠病（IBD）在历史上一直与体重不足和营养不良相关。体重不足和肥胖对成人IBD临床病程的影响存在争议。本研究描述了IBD患儿诊断时的体重指数（BMI）与疾病病程之间的关联。
我们回顾了2010年至2016年间“达纳 - 德维克”儿童医院数据库中IBD患儿的病历。收集了人口统计学和人体测量数据以及疾病特征、病程和治疗情况。根据诊断时的BMI百分位数将患者分为四分位数（Q1 - Q4）。
在确诊的100名儿童中，62例患有克罗恩病（CD），38例患有溃疡性结肠炎（UC）。诊断时的中位年龄（四分位间距，IQR）为13.7岁（范围11.9 - 15.2岁）。中位（IQR）随访时间为2.1年（1.2 - 3.8年）。诊断时，46名儿童（46%）处于Q1，20名（20%）处于Q2，19名（19%）处于Q3，15名（15%）处于Q4。诊断时间延长与Q1和Q4的BMI以及诊断时的高疾病活动度相关（p < 0.001）。在多变量分析中，较低和较高四分位数的BMI与疾病加重相关（风险比分别为3.212和4.651，p = 0.016）以及抗肿瘤坏死因子（TNF）治疗相关（风险比分别为4.489和3.972，p = 0.021）。
较低和较高四分位数的BMI与IBD患儿更严重的疾病病程相关。BMI可作为小儿IBD病程和预后的简单且易于获取的预测指标。
