ENERGY-EXPENDITURE AND BODY-COMPOSITION IN CHILDREN WITH CROHNS-DISEASE - EFFECT OF ENTERAL NUTRITION AND TREATMENT WITH PREDNISOLONE

Background-Malnutrition and growth retardation are common complication s of Crohn's disease in children. The contribution of resting energy e xpenditure (REE) to malnutrition is unclear. Aims-To characterise the REE and body composition in children with Crohn's disease and compare them with normal controls and patients with anorexia nervosa; to compa re the effects of prednisolone and enteral nutrition on energy expendi ture and body composition. Subjects-Twenty four children with Crohn's disease, 19 malnourished females with anorexia nervosa, and 22 healthy control subjects were studied. Methods-In children with Crohn's disea se measurements were done when the disease was acute and repeated at o ne and three months after treatment with either prednisolone or entera l nutrition. Resting energy expenditure was measured by indirect calor imetry and body composition by anthropometry, bioelectrical impedance analysis, total body potassium, (H2O)-O-18, and bromide space studies. Results-Body weight and ideal body weight were significantly lower in patients with Crohn's disease than in healthy controls. Lean tissue w as depleted and there was an increase in extracellular water. Per unit of lean body mass, there was no difference between REE in patients wi th Crohn's disease and controls, whereas patients with anorexia nervos a had significantly reduced REE. With enteral nutrition all body compa rtments and REE increased significantly (p<0.001). In a subgroup of ag e-matched men there was a significant increase in height after three m onths of enteral nutrition compared with prednisolone (p<0.01). Those treated with steroids did not show a significant change in height but did show an increase in all body compartments. However, intracellular water as well as lean body mass accretion were significantly higher in the enteral nutrition group than in the prednisolone group. Conclusio ns-Despite being malnourished, children with Crohn's disease fail to a dapt their REE per unit of lean body mass. This might be a factor cont ributing to their malnutrition. Lean tissue accretion is higher in pat ients treated with enteral nutrition than in those treated with predni solone.