Association of Nutritional Status at Diagnosis with Disease Course in Pediatric Inflammatory Bowel Disease
5 affiliations
- 1Digestive Diseases and Nutritional Rehabilitation Unit, Bambino Gesù Children’s Hospital, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), 00165 Rome, Italy
- 2Department of Medicine, Surgery and Dentistry “Scuola Medica Salernitana”, Pediatrics Section, University of Salerno, 84081 Baronissi, Italy
- 3Department of Pediatrics, Università Cattolica del Sacro Cuore, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), 00168 Rome, Italy
- 4Department of Pediatrics, University Federico II of Naples, Via Sergio Pansini 5, 80131 Naples, Italy
- 5Gastroenterology, Digestive Endoscopy and Nutrition Unit, Bambino Gesù Children’s Hospital, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), 00165 Rome, Italy
Abstract
Background: Growth impairment is a major component of pediatric inflammatory bowel disease (IBD), yet the prognostic role of baseline nutritional status remains debated. We assessed the impact of nutritional status at diagnosis on subsequent medical and surgical disease course. Methods: We retrospectively studied 183 children with IBD (84 Crohn’s disease, 99 ulcerative colitis) followed for at least 18 months. Patients were classified at diagnosis using BMI Z-scores as underweight (n = 35), normal weight (n = 123), or overweight/obese (n = 25). Multivariable regression models—adjusted for diagnosis, biological sex, age at diagnosis, and extraintestinal manifestations/comorbidities—evaluated relapse burden, surgical resection, and longitudinal anthropometric recovery at last follow-up. Results: Baseline underweight status was not independently associated with a higher relapse burden or time to first relapse. A sensitivity analysis excluding surgically resected patients showed higher estimated relapse rates for underweight patients, though these did not reach statistical significance. In exploratory analyses, baseline underweight showed a borderline, non-significant association with subsequent surgical resection (adjusted OR 2.68, 95% CI 0.97–7.27; p = 0.056), warranting validation in larger prospective cohorts. Exploratory VEO-IBD analyses were limited by small subgroup size; within UC, a higher crude resection frequency was observed in VEO-UC than in older-onset UC (15.0% vs. 1.3%), but this finding should be interpreted cautiously. At follow-up, 85.7% of initially underweight patients reached normal weight. Higher baseline BMI Z-score was independently associated with higher follow-up BMI Z-score, whereas therapeutic escalation and total relapse burden were not independently associated with follow-up BMI Z-score. Persistent stunting was very rare (1.9%), precluding multivariable analysis. Conclusions: Baseline underweight showed a suggestive but non-significant association with subsequent surgical resection, warranting confirmation in larger prospective cohorts, while it was not independently associated with medical disease instability. Substantial weight recovery occurred during pediatric IBD follow-up. Baseline BMI Z-score was associated with BMI Z-score at follow-up, although substantial between-patient variability remained unexplained.
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BibTeX
@article{morelli2026association,
title = {{Association of Nutritional Status at Diagnosis with Disease Course in Pediatric Inflammatory Bowel Disease}},
author = {Annalisa Morelli and Michela Caprarelli and Roberta Giusy Ruiz and Bianca Mazzoli and Alessia Salatto and Daniela Knafelz and Fiammetta Bracci and Sabrina Cardile and Giulia Bolasco and Chiara Maria Trovato and Paola De Angelis and Erminia Francesca Romeo and Antonella Diamanti},
journal = {Nutrients},
year = {2026},
month = oct,
doi = {10.3390/nu18193266},
url = {https://europepmc.org/article/PMC/PMC13667242},
note = {CC BY},
}
RIS
TY - JOUR
TI - Association of Nutritional Status at Diagnosis with Disease Course in Pediatric Inflammatory Bowel Disease
AU - Annalisa Morelli
AU - Michela Caprarelli
AU - Roberta Giusy Ruiz
AU - Bianca Mazzoli
AU - Alessia Salatto
AU - Daniela Knafelz
AU - Fiammetta Bracci
AU - Sabrina Cardile
AU - Giulia Bolasco
AU - Chiara Maria Trovato
AU - Paola De Angelis
AU - Erminia Francesca Romeo
AU - Antonella Diamanti
PY - 2026
DA - 2026/10/01
JO - Nutrients
DO - 10.3390/nu18193266
UR - https://europepmc.org/article/PMC/PMC13667242
AB - Background: Growth impairment is a major component of pediatric inflammatory bowel disease (IBD), yet the prognostic role of baseline nutritional status remains debated. We assessed the impact of nutritional status at diagnosis on subsequent medical and surgical disease course. Methods: We retrospectively studied 183 children with IBD (84 Crohn’s disease, 99 ulcerative colitis) followed for at least 18 months. Patients were classified at diagnosis using BMI Z-scores as underweight (n = 35), normal weight (n = 123), or overweight/obese (n = 25). Multivariable regression models—adjusted for diagnosis, biological sex, age at diagnosis, and extraintestinal manifestations/comorbidities—evaluated relapse burden, surgical resection, and longitudinal anthropometric recovery at last follow-up. Results: Baseline underweight status was not independently associated with a higher relapse burden or time to first relapse. A sensitivity analysis excluding surgically resected patients showed higher estimated relapse rates for underweight patients, though these did not reach statistical significance. In exploratory analyses, baseline underweight showed a borderline, non-significant association with subsequent surgical resection (adjusted OR 2.68, 95% CI 0.97–7.27; p = 0.056), warranting validation in larger prospective cohorts. Exploratory VEO-IBD analyses were limited by small subgroup size; within UC, a higher crude resection frequency was observed in VEO-UC than in older-onset UC (15.0% vs. 1.3%), but this finding should be interpreted cautiously. At follow-up, 85.7% of initially underweight patients reached normal weight. Higher baseline BMI Z-score was independently associated with higher follow-up BMI Z-score, whereas therapeutic escalation and total relapse burden were not independently associated with follow-up BMI Z-score. Persistent stunting was very rare (1.9%), precluding multivariable analysis. Conclusions: Baseline underweight showed a suggestive but non-significant association with subsequent surgical resection, warranting confirmation in larger prospective cohorts, while it was not independently associated with medical disease instability. Substantial weight recovery occurred during pediatric IBD follow-up. Baseline BMI Z-score was associated with BMI Z-score at follow-up, although substantial between-patient variability remained unexplained.
SN - 2072-6643
ER -