Issue 22

Clinical Question

Does obesity affect outcomes of pediatric patients with newly-diagnosed Crohn’s disease (CD)?

Editor’s Bottom Line

Body mass index does not affect the course of pediatric CD. Treatment decisions should not differ for children who are overweight or obese.

Reference

Jain A, Bricker J, Kappelman MD, Dotson. Obesity Does Not Affect Early Outcomes in Children With Newly Diagnosed Crohn [sic] Disease. J Pediatr Gastroenterol Nutrition. 2018;67(5):622–25; https://journals.lww.com/jpgn/Abstract/2018/11000/.

Synopsis

Existing data examining the impact of obesity on IBD outcomes have yielded conflicting results, with some findings showing obesity is linked with increased rates of disease relapses and complications and others showing no impact. In this study, investigators used data from the ImproveCareNow registry, the world’s largest pediatric IBD registry. They retrospectively examined data from 898 children with Crohn’s disease, including 87 overweight and 43 obese children. Patients had been diagnosed with Crohn’s disease within 90 days of the start of data collection and had 12–18 months of follow-up.

The researchers found that children with obesity were diagnosed significantly younger than non-obese patients (11.4 years vs. 12.9 years; P=0.016). All other demographic and clinical characteristics were similar at baseline.

The total number of healthcare visits and the number of patients in steroid-free remission during the study period were similar among obese and non-obese patients. Additionally, there were no differences in nutritional status, growth status, and short Pediatric Crohn’s Disease Activity Index (sPCDAI) scores at follow-up. Medication use was also similar between weight groups.

Although not statistically significant, the authors found that more children with obesity had moderate-to-severe disease (20.0% vs. 11.0%), and inactive disease was less common among obese patients (60.0% vs. 72.0%). Serum hematocrit values were significantly higher among obese patients at 1 year, compared with normal-weight patients (39.5% vs. 37.8%; P=0.021). All other laboratory values were similar between groups.

Details

Study Design: Retrospective, observational
Funding: Not reported
Allocation: Not applicable
Setting: Multi-center registry
Level of Evidence: 2b (Oxford Levels of Evidence)

The summary and conclusion in this issue of E-mentoring in IBD pertains to the manuscript(s) being reviewed, and should be considered in the context of what is already known surrounding the topic and incorporated into practice as deemed appropriate by the individual learner.