Nutrition and Growth in Chronic Disease.

Growth failure (wasting and stunting) is common in many children with chronic disorders. These include, but are not limited to, inflammatory bowel disease (IBD), especially those with Crohn’s disease (CD), cystic fibrosis (CF), chronic kidney diseases (CKD), and juvenile idiopathic arthritis (JIA). Poor growth may lead to short stature and a reduction in adult height as seen in a subset of these patients. Suboptimal nutrition, prolonged use of glucocorticoids (GC), metabolic derangements, and chronic inflammation contribute to the underlying pathophysiology of growth failure. All these factors lead to a continuum of abnormalities in the systemic growth hormone (GH)/insulin-like growth factor 1 (IGF-1) axis, including relative GH insufficiency, GH/IGF-1 resistance due to impairment of IGF-binding proteins, downregulation of GH/IGF receptors, and/or impairment of local GH and IGF-1 signaling pathways. Targeting the inflammatory process aggressively using immunomodulators (e.g., azathioprine and methotrexate) and biologic therapy (e.g., anti-TNF drugs), minimizing the use of systemic GC, and optimizing nutrition may be associated with improvement in markers of the GH-IGF axis and are essential for ensuring normal growth and pubertal development. However, in spite of the advances in contemporary care of these diseases, many children with these conditions continue to grow slowly, and improvement in disease activity does not seem to normalize linear growth completely. Nutrition and Growth in Chronic Disease Corina Hartman 1 Raanan Shamir 2, 3 1 Pediatric Gastroenterology Unit, Lady Davis Carmel Medical Center, Haifa , Israel; 2 Institute of Gastroenterology, Nutrition and Liver Diseases, Schneider Children’s Medical Center of Israel, Clalit Health Services, Petach Tikva , Israel; 3 Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv , Israel