REVERSAL OF GROWTH ARREST IN CROHN'S DISEASE(CD): A NEW APPROACH

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.

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