Sarcopenia in Pediatric Crohn's: 30% Higher Relapse Risk

1. In children with Crohn’s disease (CD), sarcopenia at diagnosis was associated with a greater chance of relapse in the first year of diagnosis.

Evidence Rating Level: 2 (Good)

Study Rundown: CD can cause nutrient malabsorption through several mechanisms, which may lead to the development of sarcopenia. The impact of sarcopenia on outcomes in various disorders in adults, including inflammatory bowel disease (IBD), has been previously investigated. However, there is a paucity of data on the impact of sarcopenia in pediatric CD. This retrospective cohort study therefore sought to investigate the impact of sarcopenia at the diagnosis of pediatric CD on outcomes of children with CD.

78 children with CD from a single centre in Italy were included in the study. Data on outcomes, including disease relapse and disease complications, were collected at 6, 12 and 24 months following diagnosis. Based on evaluation using magnetic resonance (MR), approximately 59% of patients were diagnosed with sarcopenia at baseline. Compared to children without baseline sarcopenia at CD diagnosis, children with sarcopenia were at significantly higher risk of disease relapse at 6 and 12 months. Additionally, survival free from clinical relapse was significantly lower among children with baseline sarcopenia compared to those without.

Overall, this study found that among children with CD, having sarcopenia at the diagnosis of CD was associated with a greater chance of relapse in the first year of diagnosis compared to those without sarcopenia.

Click to read the study in Inflammatory Bowel Diseases

Relevant Reading: Sarcopenia is a Predictor for Adverse Clinical Outcome in Pediatric Inflammatory Bowel Disease

In-Depth [retrospective cohort study]:

CD in children can cause nutrient malabsorption through several mechanisms, leading to weight loss in up to 70% of cases with the potential of ultimately leading to sarcopenia. Several methods exist to assess body composition, with MR being a promising modality in pediatric CD due to its pre-existing role in routine CD follow-up. The association of sarcopenia and clinical outcomes in various chronic illnesses in adults has previously been investigated. However, the impact of sarcopenia on pediatric CD has not been well studied. As such, this retrospective cohort study sought to investigate the impact of sarcopenia at CD diagnosis on the clinical outcomes of children with CD.

78 children with CD (median age[IQR], 12[9-15] years) from a single centre in Italy were included in the study. Data on various clinical outcomes, including disease relapse and disease complications, were collected at 6, 12 and 24 months following diagnosis. To evaluate disease activity, the weighted Pediatric Crohn’s Disease Activity Index (wPCDAI) was used. At baseline, 59% (46/78) of patients were diagnosed with sarcopenia and 41% (32/78) without. Patients with sarcopenia at baseline more often received anti-TNF agents at induction compared to those without sarcopenia (52% vs 31%, P = .1). Children with sarcopenia were at significantly higher risk of disease relapse compared to children without sarcopenia at 6 months [19.5% vs 3%, odds ratio (OR) 7.5 (95% CI, 1.5-85), P = .04] and 12 months [28% vs 6%, OR 5.9 (95% CI, 1.2-27), P = .01]. Compared to children without sarcopenia, children with sarcopenia had lower survival free from clinical relapse (log rank P = .01, HR 2.7, 95% CI 1.4-4.5). Sarcopenia was an independent predictor of disease relapse under both univariate (OR 4.6, 95% CI, 1.7-13.2, P = .002) and multivariate analysis (OR 1.7, 95% CI, 1-3.1, P = .04).