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P132 Vitamin D status and body composition in children and adolescents

D. Mager1, 2, M. Carroll2, E. Wine2, C. Kluthe2, 3, P. Medvedev2, m. chen3, J. Wu3, J. Turner2, K. Macdonald1, K. Siminoski4, H. Huynh*2

1University of Alberta, Department of Agricultural, Food & Nutritional Science, Edmonton, Canada, 2University of Alberta, Department of Paediatrics, Edmonton, Canada, 3Stollery Chidlren’s Hospital, Department of Paediatrics, Edmonton, Canada, 4University of Alberta, Department of Medicine, Edmonton, Canada

Background

Suboptimal vitamin D status and undernutrition is highly prevalent in paediatric Crohn’s disease (CD). However, little is known about whether children with CD experience significant rates of sarcopenia (reduced muscle mass). The study objective was to determine the prevalence of sarcopenia in children at the time of diagnosis, as well as the associations between vitamin D status and body composition in paediatric CD.

Methods

We prospectively recruited consecutive children newly diagnosed with CD from January 2014 until December 2015 (n = 35 CD). Outcome variables measured at the time of diagnosis included major symptoms, inflammatory markers, anthropometric (weight, weight-z, height, and height-z), and body composition (absolute/regional/percent fat mass [FM] and fat-free mass [FFM], lean soft tissue/total mass, skeletal muscle mass [SMM], appendicular lean mass [ALM]) as measured by Dual-X-ray absorptiometry (DXA) vitamin D status (25-hydroxy vitamin D:25(OH)D). Disease activity was measured using the paediatric CD activity index (PCDAI), and disease phenotype and location were measured using the Paris Classifications for paediatric IBD. Endoscopy findings were measured using simple endoscopic score for CD (SEC-CD). Sarcopenia was defined as SSM-z scores < -2. We excluded children who had no DXA or DXA performed outside of the Edmonton zone.

Results

In total, 35 children with CD between the ages of 4 and 17 years were included. All DXA were done with 2.3 ± 2.9 months of CD diagnosis. Twenty-one percent (n = 10) of children with CD had reduced weight (weight-z < -1.5) with height-z scores within normal ranges at time of diagnosis. Sarcopenia was found in 26% (n = 9) of children with CD. Suboptimal 25 (OH) D levels (< 50 nmol/L) were present in 31% (n = 11) of children, with teenagers older than 13 years having significantly lower 25 (OH) D concentrations (50.5 ± 22.2 nmol/L) compared with younger children (65.2 ± 20.7) (p = 0.03). Moreover, 25 (OH) D was not affected by disease activity /extent /severity, site of disease (ileal vs colonic vs ileocolonic ), FM, or gender (p > 0.05) but was inversely related to reduced SMM (p = 0.03), SSM-z (p = 0.09), and ESR (p = 0.008).

Conclusion

Sarcopenia was found in 26% of children with CD. Suboptimal vitamin D status in children with CD was related to reduced lean body mass, but not to fat mass. Optimising vitamin D status is an important goal in the treatment of children with CD.