A.A. KAMALOVA, E.R. SAFINA

 Kazan State Medical University,  Kazan

Contact details:

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

Address: 49 Butlerov St., Russian Federation, Kazan, 420012, tel.: +7 (843) 237-30-37, e-mail: [email protected]

The article provides a literature review on the studies of nutritive status indicators in children with inflammatory bowel diseases — ulcerative colitis and Crohn’s disease. Features of anthropometry, body composition and actual nutrition are presented, as well as laboratory markers and the effects of drug therapy on the nutritional status of children with inflammatory bowel diseases. Patients with active inflammatory bowel disease are at high risk of developing protein-energy malnutrition with a prevalence of up to 75%. Up to 85% of patients with Crohn’s disease have protein-energy deficiency, one third of them are severely deficient, and 10% have stunted growth. In 30% of patients, especially those with a debut in childhood, indicators of physical development do not reach the standards in the future, despite remission. The literature review contains specific practical recommendations based on the Russian and international experience in treating patients with inflammatory bowel diseases. The authors put emphasis on the diagnosis of nutritional disorders, the regularity of the anthropometric and laboratory assessment, as well as the inadmissibility of strict unreasonable restrictive diets in the active phase of the disease and, especially, in the period of remission.

Key words: Inflammatory bowel disease, ulcerative colitis, Crohn’s disease, nutritive status.

REFERENCES

1. Kornienko E.A. Vospalitel’nye zabolevaniya kishechnika u detey [Inflammatory bowel disease in children]. Moscow: Prima Print, 2014. 280 p.
2. Baranov A.A., Potapov A.S., Gabruzskaya T.V., Gorelov A.V., Zakharova I.N., Kornienko E.A. Yazvennyy kolit u detey: klinicheskie rekomendatsii [Ulcerative colitis in children: clinical guidelines]. Minzdrav Rossii, Soyuz pediatrov Rossii, 2016. 53 p.
3. Ruemmele F.M., Veres G., Kolho K.L., Griffiths A., Levine A., Escher J.C. et al. JPGN, 2018, vol. 67, pp. 292–310; JPGN, 2018, vol. 67, pp. 257–291.
4. Heuschkel R., Salvestrini C., Beattie R.M. et al. Guidelines for the management of growth failure in childhood inflammatory bowel disease. Inflamm Bowel Dis., 2008, no. 14, rr. 839–849.
5. Forbes A., Escher J., Hebuterne X., Kłek S., Krznaric Z., Schneider S. ESPEN practical guideline: Clinical Nutrition in inflammatory bowel disease. Clinical Nutrition, 2017, vol. 36, pp. 321–347.
6. Thangarajah D. Body composition in children with inflammatory bowel disease. Alimentary Pharmacology & Therapeutics, 2015, vol. 42, rr. 142–157.
7. Prikaz Minzdrava RF ot 5.08.2003 no. 330 «O merakh po sovershenstvovaniyu lechebnogo pitaniya v lechebno-profilakticheskikh uchrezhdeniyakh RF» (s izmeneniyami i dopolneniyami) [Order of the Ministry of Health of the Russian Federation of 5.08.2003 No. 330 «On measures to improve medical nutrition in medical institutions of the Russian Federation» (with changes and additions)], avaialble at: http://base.garant.ru/12132439/
8. Lochs H., Dejong C., Hammarqvistc F., Hebuterned X., Leon-Sanze M., Schütza T., et al. ESPEN guidelines on enteral nutrition: gastroenterology. Clin Nutr, 2006, no. 25, rr. 260–270.
9. Kugathasan S., Nebel J., Skelton J.A., Markowitz J., Keljo D. et al. Body mass index in children with newly diagnosed inflammatory bowel disease: observations from two multicenter North American inception cohorts. J Pediatr, 2007, vol. 151, pp. 523–527.
10. El Mouzan M.I., Al Edreesi M.H., AlHussaini A.A., Saadah O.I., Al Qourain A.A., Al Mofarreh M.A., Al Saleem K.A. Nutritional status of children with inflammatory bowel disease in Saudi Arabia. World J Gastroenterol, 2016, vol. 22 (5), pp. 1854–1858.
11. Burnham J.M., Shults J., Semeao E., Foster B.J., Zemel B.S., Stallings V.A., Leonard MB. Body-composition alterations consistent with cachexia in children and young adults with Crohn disease. Am J Clin Nutr, 2005, vol. 82, pp. 413–420.
12. Briend A., Wojtyniak B., Rowland M.G. Arm circumference and other factors in children at high risk of death in rural Bangladesh. Lancet, 1987, vol. 2 (8561), pp. 725–728.
13. Seung Kim, Hong Koh. Nutritional aspect of pediatric inflammatory bowel disease: its clinical importance. Clin Exp Pediatr, 2015, vol. 58 (10), rr. 363–368.
14. Abraham B.P., Mehta S., El-Serag H.B. Natural history of pediatric-onset inflammatory bowel disease: a systematic review. J Clin Gastroenterol, 2012, vol. 46, pp. 581–589.
15. Rebecca J Hill. Update on nutritional status, body composition and growth in paediatric inflammatory bowel disease. World J Gastroenterol, 2014, vol. 20, pp. 3191–3197.
16. Miele E., Shamir R., Aloi M., Assa A., Braegger C., Bronsky J. et al. Nutrition in Pediatric Inflammatory Bowel Disease: A Position Paper on Behalf of the Porto Inflammatory Bowel Disease Group of the European Society of Pediatric Gastroenterology, Hepatology and Nutrition. J Pediatr Gastroenterol Nutr, 2018, Apr, vol. 66 (4), pp. 687–708.
17. Vagianos K., Bector S., McConnell J., Bernstein C.N. Nutrition assessment of patients with inflammatory bowel disease. JPEN J Parenter Enteral Nutr, 2007, vol. 31, rr. 311–319.
18. Sikora S.K., Spady D., Prosser C. Trace Elements and Vitamins at Diagnosis in Pediatric-Onset Inflammatory Bowel Disease. Journals sagepub, 2011, vol. 50, pp. 488–492.
19. Heyman M.B., Garnett E.A., Shaikh N. et al. Folate concentrations in pediatric patients with newly diagnosed inflammatory bowel disease. Am. J. Clin. Nutr, 2009, vol. 89, pp. 545–550.
20. Stochel-Gaudyn A., Fyderek K., Kościelniak P. Serum trace elements profile in the pediatric inflammatory bowel disease progress evaluation. Journal of Trace Elements in Medicine and Biology, 2019, vol. 55, pp. 121–126.
21. Gerasimidis K., Edwards C., Stefanowicz F., Galloway P., McGrogan P., Duncan A. et al. Micronutrient status in children with IBD: true deficiencies or epiphenomenon of the systemic inflammatory response. J Pediatr Gastroenterol Nutr, 2013, vol. 56, pp. 50–51.
22. Lim W.C., Hanauer S.B., Li Y.C. Mechanisms of disease: vitamin D and inflammatory bowel disease. Nat Clin Pract Gastroenterol Hepatol, 2005, vol. 2, pp. 308–315.
23. Loftus E.V. Jr, Sandborn W.J. Epidemiology of inflammatory bowel disease. Gastroenterol Clin North Am, 2002, vol. 31, pp. 1–20.
24. Cantorna M.T., McDaniel K., Bora S. et al. Vitamin D, immune regulation, the microbiota, and inflammatory bowel disease. Exp Biol Med (Maywood), 2014, vol. 239, pp. 1524–1530.
25. Mouli V.P., Ananthakrishnan A.N. Review article: vitamin D and inflammatory bowel diseases. Aliment Pharmacol Ther, 2014, vol. 39, pp. 125–136.
26. Van Etten E., Mathieu C. Immunoregulation by 1,25-dihydroxyvitamin D3: basic concepts. J Steroid Biochem Mol Biol, 2005, vol. 97, pp. 93–101.
27. Cantorna M.T., McDaniel K., Bora S. et al. Vitamin D, immune regulation, the microbiota, and inflammatory bowel disease. Exp Biol Med (Maywood), 2014, vol. 239, pp. 1524–1530.
28. Pappa H.M., Mitchell P.D., Jiang H., Kassiff S., Filip-Dhima R., Di Fabio D., Quinn N., Lawton R.C., Bronzwaer M.E., Koenen M., Gordon C.M. Maintenance of optimal vitamin D status in children and adolescents with inflammatory bowel disease: a randomized clinical trial comparing two regimens. J Clin Endocrinol Metab, 2014, vol. 9, pp. 3408–3417.
29. Turner D., Ruemmele F.M., Orlanski-Meyer E., Griffiths A.M., de Carpi J.M., Bronsky J. et al. Management of Paediatric Ulcerative Colitis, Part 1: Ambulatory Care — An Evidence-based Guideline From European Crohn’s and Colitis Organization and European Society of Paediatric Gastroenterology, Hepatology and Nutrition. JPGN, 2018, vol. 67, pp. 257–291.
30. Shepherd D., Day A.S., Leach S.T. et al. Single High-Dose Oral Vitamin D3 Therapy (Stoss): a solution to vitamin D deficiency in children with inflammatory bowel disease? J Pediatr Gastroenterol Nutr, 2015, vol. 61, pp. 411–414.
31. Filippi J., Al-Jaouni R., Wiroth J.B., Hébuterne X., Schneider S.M. Nutritional deficiencies in patients with Crohn’s disease in remission. Inflamm Bowel Dis, 2006, vol. 12, pp. 185–191.
32. Dignass A.U., Gasche C., Bettenworth D., Birgegård G. et al. European Crohn’s and Colitis Organisation [ECCO]. European consensus on the diagnosis and management of iron deficiency and anaemia in inflammatory bowel diseases. J Crohns Colitis, 2015, vol. 9, pp. 211–222.
33. Shamir R., Seidman E. Clinical dilemmas in inflammatory bowel disease, new challenges. 2nd ed. Wiley-Blackwell, 2011. Rr. 30–33.
34. Tutina O.A., Fedulova E.N., Kopeykin V.N., Fedorova O.V., Bogomolov A.R. Nutritional therapy for ulcerative colitis and Crohn’s disease in children. Pediatricheskaya farmakologiya, 2008, no. 5, pp. 110–115 (in Russ.).
35. Knight C., El-Matary W., Spray C., Sandhu B.K. Long-term outcome of nutritional therapy in paediatric Crohn’s disease. Clin Nutr, 2005, vol. 24, pp. 775–779.
36. Grover Z., Lewindon P. Two-year outcomes after exclusive enteral nutrition induction are superior to corticosteroids in pediatric Crohn’s disease treated early with Thiopurines. Dig Dis Sci, 2015, vol. 60, pp. 3069–3074.
37. Sousa Guerreiro C., Cravo M., Costa A.R. et al. A comprehensive approach to evaluate nutritional status in Crohn’s patients in the era of biologic therapy: a case-control study. Am J Gastroenterol, 2007, vol. 102, pp. 2551–2556.
38. Hartman C., Marderfeld L., Davidson K. et al. Food intake adequacy in children and adolescents with inflammatory bowel disease. J Pediatr Gastroenterol Nutr, 2016, vol. 63, pp. 437–444.
39. Pons R., Whitten K.E., Woodhead H. et al. Dietary intakes of children with Crohn’s disease. Br J Nutr, 2009, vol. 102, pp. 1052–1057.
40. Gordeeva I.G., Makarova S.G., Fisenko A.P., Pushkov A.A., Nikitin A.G., Surkov A.N. et al. Diagnostics of hypolactasia and assessment of the genotype of the rs182549 polymorphic marker of the mcm6 gene in children with inflammatory bowel diseases. Pediatriya. Zhurnal im. G.N. Speranskogo, 2019, no. 4, pp. 143–146 (in Russ.).
41. Sanderson I.R., Udeen S., Davies P.S., Savage M.O., Walker-Smith J.A. Remission induced by an elemental diet in small bowel Crohn’s disease. Arch Dis Child, 1987, vol. 2, pp. 123–127.
42. Newby E.A., Sawczenko A., Thomas A.G., Wilson D. Interventions for growth failure in childhood Crohn’s disease. Cochrane Database Syst Rev, 2005, vol. 36.
43. Markowitz J., Grancher K., Kohn N., Lesser M., Daum F. A multicenter trial of 6-mercaptopurine and prednisone in children with newly diagnosed Crohn’s disease. Gastroenterology, 2000, vol. 119, pp. 895–902.
44. Pichler J., Huber W.D., Aufricht C., Bidmon-Fliegenschnee B. Growth and bone health in paediatric patients with Crohn’s disease receiving subcutaneous tumor necrosis factor antibody. World J Gastroenterol, 2015, vol. 21, rr. 6613–6620.