Division of Gastroenterology, Hepatology and Nutrition, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA.
Division of Biostatistics, Children's Hospital of Philadelphia, University of Pennsylvania, Philadelphia, Pennsylvania, USA.
J Pediatr Gastroenterol Nutr. 2024 Jan;78(1):85-94. doi: 10.1002/jpn3.12063. Epub 2023 Dec 10.
There is increasing recognition that children with Crohn's Disease (CD) can develop obesity.
Using the RISK Study, an inception cohort of pediatric CD participants, and Bone Mineral Density in Childhood Study (BMDCS), a longitudinal cohort of healthy children, multivariable linear mixed effects, generalized linear mixed effects, and logistic regression models were used to evaluate factors associated with change in body mass index z-score (BMIZ), obesity, and excessive weight gain, respectively.
1029 CD participants (625 exposed to antitumor necrosis factor (anti-TNF) therapy) and 1880 healthy children were included. Change in BMIZ was higher in CD exposed to anti-TNF as compared to CD unexposed to anti-TNF and the healthy reference group. Sex, age, baseline BMIZ, C-reactive protein, anti-TNF, and steroids were associated with changes in BMIZ in CD. CD exposed (odds ratio [OR] 4.81, confidence interval [CI] 4.00-5.78) and unexposed (OR 3.14, CI 2.62-3.76) had a greater likelihood of becoming obese versus the healthy reference group. While the prevalence of obesity was higher at baseline in the healthy reference group (21.3%) versus CD participants (8.5% exposed vs. 11.1% unexposed), rates of obesity were similar by the end of follow-up (21.4% healthy vs. 20.3% exposed vs. 22.5% unexposed). Anti-TNF therapy was an independent risk factor for the development of obesity and excessive weight gain in CD participants.
Patients with CD have dynamic changes in BMIZ over time, and while for most, this is restorative, for some, this can lead to obesity and excessive weight gain. It is important to understand the factors that may lead to these changes, including anti-TNF therapy. Counseling of patients and early lifestyle intervention may be necessary.
越来越多的人认识到，患有克罗恩病（CD）的儿童可能会肥胖。
使用 RISK 研究，这是一项儿科 CD 参与者的入组队列研究，以及儿童期骨密度研究（BMDCS），这是一项健康儿童的纵向队列研究，使用多变量线性混合效应、广义线性混合效应和逻辑回归模型来评估与体重指数 z 分数（BMIZ）变化、肥胖和体重过度增加相关的因素。
纳入 1029 名 CD 参与者（625 名暴露于抗肿瘤坏死因子（anti-TNF）治疗）和 1880 名健康儿童。与未暴露于 anti-TNF 的 CD 患者和健康参考组相比，暴露于 anti-TNF 的 CD 患者的 BMIZ 变化更高。性别、年龄、基线 BMIZ、C 反应蛋白、anti-TNF 和类固醇与 CD 患者的 BMIZ 变化相关。与健康参考组相比，暴露（比值比 [OR] 4.81，置信区间 [CI] 4.00-5.78）和未暴露（OR 3.14，CI 2.62-3.76）的 CD 患者更有可能肥胖。虽然健康参考组的肥胖患病率基线较高（21.3%），但与 CD 患者相比（暴露者为 8.5%，未暴露者为 11.1%），随访结束时肥胖的患病率相似（健康者为 21.4%，暴露者为 20.3%，未暴露者为 22.5%）。anti-TNF 治疗是 CD 患者肥胖和体重过度增加的独立危险因素。
CD 患者的 BMIZ 随时间发生动态变化，尽管对大多数患者来说，这是恢复性的，但对一些患者来说，这可能导致肥胖和体重过度增加。了解可能导致这些变化的因素很重要，包括 anti-TNF 治疗。可能需要对患者进行咨询和早期生活方式干预。
