Reversal of growth arrest in crohn's disease(cd): a new approach

Reversal of growth arrest in crohn's disease(cd): a new approach

Play all audios:

Loading...

ABSTRACT Severe impairment of linear growth without evidence of endocrine dysfunction frequently complicates CD in childhood. The impact of nutritional intervention was studied in 7 patients(pts) (5 boys, 2 girls, ages 9-17 yrs)with CD and linear growth arrest for at least 1 yr prior to study. 6/7 were less than 3rd%; height and bone ages ranged 5-11 and 6-13 yrs respectively. All were in clinical remission; 3 were maintained on a constant dose of steroid. Fasting somatomedin (3/3) and stimulated growth hormone levels (5/5) were normal. On metabolic balances prior to therapy, 5 pts demonstrated inadequate caloric intake (50±20 kcal/kg;normal for height 75-85 kcal/kg); none had positive nitrogen balance; 1 had steatorrhea. Oral feeding was supplemented with intravenous hyperalimentation to total daily intake of 77±8 kcalAg for 6-8 wks. During treatment, lean body mass(40K) increased 2.2-7.3 kg in 5 pts studied. All pts exhibited weight gain (range 2.4-7.4 kg), linear growth (range 1.0-2.3cm), and a significant increase in growth velocity (0.7±0.2cm/month, p<.001). Linear growth persisted following therapy and averaged 0.4±.3cm/month(p<.02) for 3-6 months. Subsequent growth in the 4 pts with long-term followup has totalled 2.5, 9, 10 and 20 cm respectively at 1.5-2.5 yr. The lowest growth increment occurred in the only pubertal pt. Conclusions: 1. Inadequate caloric intake explains the growth arrest in these children with CD; 2. caloric supplementation via intravenous hyperalimentation produces improvement in anthropometric values and a dramatic linear growth spurt that continues after therapy is terminated. ARTICLE PDF AUTHOR INFORMATION AUTHORS AND AFFILIATIONS * Children's Hosp Med Ctr, Boston, MA R J Grand, G Shen, S L Werlin, D G Kelts & C Boehme Authors * R J Grand View author publications You can also search for this author inPubMed Google Scholar * G Shen View author publications You can also search for this author inPubMed Google Scholar * S L Werlin View author publications You can also search for this author inPubMed Google Scholar * D G Kelts View author publications You can also search for this author inPubMed Google Scholar * C Boehme View author publications You can also search for this author inPubMed Google Scholar RIGHTS AND PERMISSIONS Reprints and permissions ABOUT THIS ARTICLE CITE THIS ARTICLE Grand, R., Shen, G., Werlin, S. _et al._ REVERSAL OF GROWTH ARREST IN CROHN'S DISEASE(CD): A NEW APPROACH. _Pediatr Res_ 11, 444 (1977). https://doi.org/10.1203/00006450-197704000-00445 Download citation * Issue Date: 01 April 1977 * DOI: https://doi.org/10.1203/00006450-197704000-00445 SHARE THIS ARTICLE Anyone you share the following link with will be able to read this content: Get shareable link Sorry, a shareable link is not currently available for this article. Copy to clipboard Provided by the Springer Nature SharedIt content-sharing initiative

ABSTRACT Severe impairment of linear growth without evidence of endocrine dysfunction frequently complicates CD in childhood. The impact of nutritional intervention was studied in 7


patients(pts) (5 boys, 2 girls, ages 9-17 yrs)with CD and linear growth arrest for at least 1 yr prior to study. 6/7 were less than 3rd%; height and bone ages ranged 5-11 and 6-13 yrs


respectively. All were in clinical remission; 3 were maintained on a constant dose of steroid. Fasting somatomedin (3/3) and stimulated growth hormone levels (5/5) were normal. On metabolic


balances prior to therapy, 5 pts demonstrated inadequate caloric intake (50±20 kcal/kg;normal for height 75-85 kcal/kg); none had positive nitrogen balance; 1 had steatorrhea. Oral feeding


was supplemented with intravenous hyperalimentation to total daily intake of 77±8 kcalAg for 6-8 wks. During treatment, lean body mass(40K) increased 2.2-7.3 kg in 5 pts studied. All pts


exhibited weight gain (range 2.4-7.4 kg), linear growth (range 1.0-2.3cm), and a significant increase in growth velocity (0.7±0.2cm/month, p<.001). Linear growth persisted following


therapy and averaged 0.4±.3cm/month(p<.02) for 3-6 months. Subsequent growth in the 4 pts with long-term followup has totalled 2.5, 9, 10 and 20 cm respectively at 1.5-2.5 yr. The lowest


growth increment occurred in the only pubertal pt. Conclusions: 1. Inadequate caloric intake explains the growth arrest in these children with CD; 2. caloric supplementation via intravenous


hyperalimentation produces improvement in anthropometric values and a dramatic linear growth spurt that continues after therapy is terminated. ARTICLE PDF AUTHOR INFORMATION AUTHORS AND


AFFILIATIONS * Children's Hosp Med Ctr, Boston, MA R J Grand, G Shen, S L Werlin, D G Kelts & C Boehme Authors * R J Grand View author publications You can also search for this


author inPubMed Google Scholar * G Shen View author publications You can also search for this author inPubMed Google Scholar * S L Werlin View author publications You can also search for


this author inPubMed Google Scholar * D G Kelts View author publications You can also search for this author inPubMed Google Scholar * C Boehme View author publications You can also search


for this author inPubMed Google Scholar RIGHTS AND PERMISSIONS Reprints and permissions ABOUT THIS ARTICLE CITE THIS ARTICLE Grand, R., Shen, G., Werlin, S. _et al._ REVERSAL OF GROWTH


ARREST IN CROHN'S DISEASE(CD): A NEW APPROACH. _Pediatr Res_ 11, 444 (1977). https://doi.org/10.1203/00006450-197704000-00445 Download citation * Issue Date: 01 April 1977 * DOI:


https://doi.org/10.1203/00006450-197704000-00445 SHARE THIS ARTICLE Anyone you share the following link with will be able to read this content: Get shareable link Sorry, a shareable link is


not currently available for this article. Copy to clipboard Provided by the Springer Nature SharedIt content-sharing initiative