Malnutrition Ups Risk of Postop Issues in Pediatric Crohn Disease

For children with Crohn disease (CD), malnutrition is associated with increased risk of complications after bowel surgery, according to a study published in the November issue of the Journal of Pediatric Surgery.

Mitchell R. Ladd, M.D., Ph.D., from the Johns Hopkins University School of Medicine in Baltimore, and colleagues calculated body mass index (BMI)-for-age Z-scores based on U.S. Centers for Disease Control and Prevention growth charts and 2015 guidelines of pediatric malnutrition for children aged 5 to 18 years with CD who underwent bowel surgery. The effect of malnutrition on 30-day complications was examined for 516 patients: 67.6 percent without malnutrition and 18.8, 9.5, and 4.1 percent with mild, moderate, and severe malnutrition, respectively.

The researchers found that the overall complication rate was 13.6 percent, with increased rates in association with malnutrition: 9.7 percent for none versus 18.6, 20.4, and 28.6 percent for mild, moderate, and severe malnutrition, respectively. Malnutrition corresponded with elevated odds of complications in mild and severely malnourished patients in propensity-matched multivariable analysis (mild: odd ratio, 2.1; severe: odds ratio, 3.26).

"Further studies are needed to determine whether BMI-for-age Z-scores can be used to guide nutritional optimization before major surgery in this population," the authors write. "Regardless, this study suggests that malnourished pediatric CD patients should have their nutritional status optimized prior to surgery when possible."

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