Juliet Keidan Institute of Pediatric Gastroenterology & Nutrition, Shaare Zedek Medical Center.
Hebrew University of Jerusalem, Jerusalem.
J Pediatr Gastroenterol Nutr. 2021 Jun 1;72(6):877-882. doi: 10.1097/MPG.0000000000003073.
Both the inflammatory burden of Crohn disease (CD) and corticosteroids have a negative effect on bone density. Exclusive enteral nutrition (EEN) avoids corticosteroids and promotes endoscopic healing. We aimed to explore the effect of nutritional therapy on bone health in pediatric CD.
This was a planned sub-study of a clinical trial enrolling children with new-onset mild-moderate CD. Children were randomized to either 6 weeks EEN followed by 6 weeks 25% partial enteral nutrition (PEN) or 6 weeks of 50% PEN with a CD exclusion diet followed by 6 weeks of 25% PEN with exclusion diet. Bone formation and resorption were measured at baseline, week 12 and week 24 by serum C-Propeptide of Type I Procollagen (CICP) and type I Collagen N-Telopeptide (NTX), respectively. Bone mineral density (BMD) was measured by dual energy X-ray absorptiometry (DXA) scan at baseline and week 24.
Median CICP improved from 130 ng/mL (106-189) at baseline to 223 (143-258) at week 12 and 193 (143-252) at week 24 (P = 0.016 for both, n = 29 children). Median NTX remained unchanged (P = 0.45 and P = 0.45). Thirty-six children had DXA scans performed at diagnosis; 81% and 33% had z scores of <-1 and <-2, respectively. DXA z scores did not improve from baseline (adjusted total body less head [TBLH] BMD -1.62 ± 0.87) to week 24 (-1.76 ± 0.75; P = 0.30, n = 21 with both scans).
Low bone density is common in new-onset mild-moderate pediatric CD. CICP, a sensitive marker of bone formation, improved following dietary intervention but this was not associated with improved BMD.
克罗恩病（CD）的炎症负担和皮质类固醇都对骨密度有负面影响。肠内营养（EEN）可避免皮质类固醇并促进内镜愈合。我们旨在探讨营养治疗对儿科 CD 患者骨健康的影响。
这是一项临床试验的计划子研究，招募了新诊断的轻度至中度 CD 儿童。儿童被随机分配至 6 周 EEN 后再进行 6 周 25%部分肠内营养（PEN），或 6 周 50%PEN 加排除饮食，然后再进行 6 周 25%PEN 加排除饮食。通过血清 I 型前胶原 C 端肽（CICP）和 I 型胶原 N 末端肽（NTX）分别在基线、第 12 周和第 24 周测量骨形成和骨吸收。通过双能 X 射线吸收法（DXA）扫描在基线和第 24 周测量骨矿物质密度（BMD）。
中位 CICP 从基线时的 130ng/ml（106-189）改善至第 12 周时的 223（143-258）和第 24 周时的 193（143-252）（均 P=0.016，n=29 名儿童）。中位 NTX 无变化（P=0.45 和 P=0.45）。36 名儿童在诊断时进行了 DXA 扫描；81%和 33%的儿童的 z 评分分别为<-1 和 <-2。DXA z 评分从基线时（调整后的全身除头部 [TBLH]BMD-1.62±0.87）到第 24 周时没有改善（-1.76±0.75；P=0.30，n=21 名儿童均有两次扫描）。
新诊断的轻度至中度儿科 CD 患者中骨密度低很常见。CICP 是骨形成的敏感标志物，在饮食干预后有所改善，但与 BMD 改善无关。
