A.A. KAMALOVA^1, 2, E.R. SAFINA¹, A.R. GAIFUTDINOVA^1, 2

 ¹Kazan State Medical University, Kazan

²Children’s Republican Clinical Hospital, Ministry of Health of Republic of Tatarstan, Kazan

 Contact details:

Kamalova A.A. — MD, Professor of the Department of Hospital Pediatrics

Address: 49 Butlerov St., Kazan, Russian Federation, 420012, tel.: +7 (843) 237-30-37, e-mail: aelitakamalova@gmail.com

Underweight and growth retardation are the main extraintestinal manifestations of inflammatory bowel disease (IBD) in children and are especially common among patients with Crohn’s disease (CD). Anthropometry and laboratory parameters cannot always reveal hidden violations of the nutritional status of patients. In this regard, the method of bioelectrical impedance is being actively introduced into clinical practice to assess the component composition of the body. There are few publications in the literature, according to which children with IBD have a disturbed body component composition; mainly it is the indicators of fat and muscle mass that change. However, a number of questions remain regarding the effect of therapy, duration, stage and activity of the disease on the nutritional status of children with IBD, including body composition, which require further study.

The purpose was to evaluate the body composition in children with inflammatory bowel diseases.

Material and methods. We observed 63 children aged 5 to 18 years with IBD: with CD — 23 children, with ulcerative colitis (UC) — 40 children. Body composition was determined using bioelectrical impedance analysis.

Results. Body composition differed in children with IBD depending on the disease. Children with CD were more likely to be fat deficient than children with UC (p = 0.014), and children with UC were more likely to have excess fat mass (p = 0.038). The content of fat and active cell mass was lower in CD compared with UC. Lower rates of fat mass were observed both at the onset and during remission of CD. A decrease in the phase angle was observed more often in children with CD during the disease exacerbation (p = 0.029). A third of children with UC with normal physical development have deviations in the indicators of the body component composition according to the results of bioelectrical impedance analysis.

Conclusions. Further prospective studies of body composition and phase angle in children with IBD are needed to analyze the effect of therapy, duration and period of the disease.

Key words: children, inflammatory bowel diseases, ulcerative colitis, Crohn’s disease, body composition, fat mass, lean mass, active cell mass.

REFERENCES

1. Cederholm T., Bosaeus I., Barazzoni R. et al. Diagnostic criteria for malnutrition — An ESPEN Consensus Statement. Clin Nutr, 2015, vol. 34, pp. 335–340. DOI: 10.1016/j.clnu.2015.03.001
2. Forbes A., Escher J., Hebuterne X. et al. ESPEN practical guideline: Clinical Nutrition in inflammatory bowel disease. Clinical Nutrition, 2017, vol. 36, p. 321e347.
3. Hartman C., Eliakim R., Shamir R. Nutritional status and nutritional therapy in inflammatory bowel diseases. World J Gastroenterol, 2009, vol. 15 (21), pp. 2570–2578. DOI:10.3748/wjg.15.2570
4. Thangarajah D., Hyde M.J., Konteti V.K. et al. Systematic review: Body composition in children with inflammatory bowel disease. Alimentary Pharmacology & Therapeutics, 2015, vol. 42, rr. 142–157.
5. Klinicheskie rekomendatsii Yazvennyy kolit 2021 [Clinical guidelines Ulcerative colitis 2021], available at: https://cr.minzdrav.gov.ru/schema/391_2
6. Klinicheskie rekomendatsii Bolezn’ Krona 2021 [Clinical guidelines Crohn’s disease 2021], available at: https://cr.minzdrav.gov.ru/recomend/682_1
7. Programma VOZ Anthro dlya personal’nykh komp’yuterov, versiya 3, 2009 g.: programmnoe sredstvo dlya otsenki rosta i razvitiya detey vo vsem mire [WHO Anthro for personal computers, version 3, 2009: a software tool for assessing the growth and development of children worldwide]. Zheneva: VOZ, 2009, avaialble at: http://who.int/childgrowth/software/en/
8. Rocha R., Santana G.O., Almeida N. et al. Analysis of fat and muscle mass in patients with inflammatory bowel disease during remission and active phase. ACBr J Nutr., 2009, Mar,vol. 101 (5), pp. 676–679.
9. Pituch-Zdanowska A., Banaszkiewicz A., Dziekiewicz M. et al. Overweight and obesity in children with newly diagnosed inflammatory bowel disease. Adv Med Sci, 2016, vol. 61, pp. 28–31.
10. Chandrakumar A., Wang A., Grover K., El-Matary W. Obesity is more common in children newly diagnosed with ulcerative colitis as compared to those with Crohn disease. J Pediatr Gastroenterol Nutr, 2020, vol. 70, pp. 593–597.
11. Thayu M., Shults J., Burnham J.M. et al. Gender differences in body composition deficits at diagnosis in children and adolescents with Crohn’s disease. Inflamm Bowel Dis, 2007, vol. 13, pp. 1121–1128.
12. Wiskin A.E., Wootton S.A., Hunt T.M. et al. Body composition in childhood inflammatory bowel disease. Clin Nutr, 2011, vol. 30, pp. 112–115.
13. Hill R.J. Update on nutritional status, body composition and growth in pediatric inflammatory bowel disease. World J Gastroenterol, 2014, vol. 20, pp. 3191–3197.
14. Gerasimidis K., McGrogan P., Edwards C.A. The etiology and impact of malnutrition in paediatric inflammatory bowel disease. J Hum Nutr Diet, 2011, vol. 24, pp. 313–326.
15. Azcue M., Rashid M., Griffiths A. et al. Energy expenditure and body composition in children with Crohn’s disease: effect of enteral nutrition and treatment with prednisolone. Gut, 1997, vol. 41, pp. 203–208.
16. Burnham J.M., Shults J., Semeao E. et al. Body-composition alterations consistent with cachexia in children and young adults with Crohn disease. Am J Clin Nutr, 2005, vol. 82, pp. 413–420.
17. Więch P., Dąbrowski M., Bazaliński D. et al. Bioelectrical Impedance Phase Angle as an Indicator of Malnutrition in Hospitalized Children with Diagnosed Inflammatory Bowel Diseases-A Case Control Study. Nutrients, 2018, vol. 10 (4), p. 499. DOI: 10.3390/nu10040499
18. Więch P., Binkowska-Bury M., Korczowski B. Body composition as an indicator of the nutritional status in children with newly diagnosed ulcerative colitis and Crohn’s disease — a prospective study. Gastroenterology Rev, 2017, vol. 12 (1), pp. 55–59 DOI: 10.5114/pg.2016.64601
19. Hill R.J., Davies P.S.W. You look all right to me: compromised nutritional status in paediatric patients with ulcerative colitis. J Pediatr Gastroenterol Nutr, 2013, vol. 56, pp. 385–389.
20. Cederholm T., Barazzoni R., Austin P. et al. ESPEN guidelines on definitions and terminology of clinical nutrition. Clin. Nutr, 2017, vol. 36, P. 49–64.
21. Nikolaev D.V., Shchelykalina S.P. Lektsii po bioimpedansnomu analizu sostava tela cheloveka [Lectures on bioimpedance analysis of human body composition]. Moscow: RIO TsNIIOIZ MZ RF, 2016. 152 p.
22. Werkstetter K.J., Ullrich J., Schatz S.B. at al. Lean body mass, physical activity and quality of life in paediatric patients with inflammatory bowel disease and in healthy controls. J Crohns Colitis, 2012, Jul, vol. 6 (6), pp. 665–673.
23. Więch P., Dąbrowski M., Bazaliński D. at al. Bioelectrical Impedance Phase Angle as an Indicator of Malnutrition in Hospitalized Children with Diagnosed Inflammatory Bowel Diseases — A Case Control Study. Nutrients, 2018, Apr, vol. 10 (4), p. 499. doi: 10.3390/nu10040499
24. James J. Ashton, Luise V. Marino, Mark J. Johnson et al. Bioelectrical spectroscopy impedance phase angle is not associated with nutritional status in a stable cohort of pediatric inflammatory bowel disease patients. Clinical Nutrition ESPEN, 2021, vol. 44, pp. 276–281. DOI: 10.1016/j.clnesp.2021.06.003