Association between body mass index and age of disease onset with clinical outcomes in paediatric-onset Crohn’s Disease (CD): a UK nation-wide analyses using the NIHR-IBD BioResource

Abstract

Background

The evidence on the relationship between adiposity and disease outcomes in paediatric Crohn’s disease (CD) is limited and lacks consensus.

Aim

To investigate the relationship between (a) body mass index (BMI) and clinical CD outcomes (hospitalisation, surgery, disease behaviour, biologic use, extra-intestinal manifestations (EIMs)) and (b) the age of CD onset with clinical outcomes.

Design

Clinical outcomes were examined in CD patients diagnosed at age <17 years and enroled in the National Institute for Health Research IBD-UK BioResource at a median age of 24 years. All outcomes and BMI were recorded at the time of enrolment. Participants were categorised into normal (<25 kg/m ²) and high (≥25 kg/m ²) BMI. Age at disease diagnosis was categorised into pre-puberty/early puberty (<11 years), puberty (11–14 years) and post-puberty (15–17 years). Spearman rank correlation was used to test the associations between continuous variables and chi-square test to compare categorical variables.

Results

848 participants with CD were included (51.8% males) and median age at diagnosis was 14 years. Participants with high BMI experienced a greater frequency of EIMs ( P = 0.05) than those with low BMI (1 type of EIM: 18.5% vs. 13.2%, respectively; ≥2 types of EIMs: 7.8% vs. 5.6%, respectively). Age at diagnosis and BMI showed weak correlations with corticosteroid use ( ρ = 0.08, P = 0.03 and ρ = −0.09, P = 0.01; respectively). An early diagnosis (<11 years) was associated with higher occurrence of stenosing and penetrating disease behaviour ( P = 0.01) and hospitalisations ( P < 0.001).

Conclusions

A higher BMI and an earlier age of disease onset are associated with worse CD clinical presentation.