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Body-composition alterations consistent with cachexia in children and young adults with Crohn disease^1,2,3

¹ From the Department of Pediatrics, Division of Rheumatology (JMB), Nephrology (BJF and MBL), Gastroenterology and Nutrition (ES, BSZ, and VAS), The Children's Hospital of Philadelphia, University of Pennsylvania School of Medicine, Philadelphia, PA, and the Department of Epidemiology and Biostatistics, University of Pennsylvania School of Medicine, Philadelphia, PA (JMB, JS, BJF, and MBL)

Background: Crohn disease (CD) in children is associated with low body mass index (BMI), poor growth, and delayed maturation; alterations in lean and fat mass, however, are poorly characterized.

Objective: The objective was to quantify lean and fat mass in children and young adults with CD and in healthy control subjects, relative to height and pubertal maturation.

Design: This cross-sectional study assessed whole-body lean and fat mass by using dual-energy X-ray absorptiometry in 104 subjects with CD and in 233 healthy control subjects aged 4–25 y. Linear regression was used to determine the effect of CD on body composition and to generate sex-specific SD scores (z scores) for lean and fat mass relative to height.

Results: Subjects with CD had lower height-for-age and BMI-for-age z scores (P < 0.001 for both) than did control subjects. CD was associated with significant deficits in lean mass after adjustment for height, age, race, and Tanner stage (P = 0.003); deficits in fat mass were not observed. The mean (±SD) lean mass–for-height and fat mass–for-height z scores in the subjects with CD were –0.61 ± 0.92 and –0.04 ± 0.86, respectively. Within the control group, fat mass–for-height was positively correlated with lean mass–for height (r = 0.41, P < 0.0001); this association was absent in the subjects with CD.

Conclusions: Children and young adults with CD had significant deficits in lean mass but preserved fat mass, which is consistent with cachexia. Further research is needed to identify physical activity, nutritional, and antiinflammatory interventions to improve body composition in persons with CD.

Key Words: Crohn disease • body composition • cachexia • lean mass • fat mass

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