5 Questions on Nutrition and Surgical Outcomes in Pediatric Crohn Disease

More than 500,000 individuals in the United States experience symptoms from Crohn disease (CD), according to the NIH. Of these, approximately 38,000 are children.

Mitchell Ladd, MD, PhD, and colleagues from The Johns Hopkins Hospital sought to better understand how malnutrition might affect surgical outcomes in children undergoing major bowel surgery. The researchers evaluated rate of wound infection, respiratory complications, reoperation, and readmission within 30 days of surgery.

The overall complication rate was 13.6%. However, results showed the more malnourished a child was, the more likely they were to experience complications.

Gastroenterology Consultant caught up with Dr. Ladd, a surgery resident at The Johns Hopkins Hospital and the study's first author, to talk about the research.

Gastroenterology Consultant: What prompted you to conduct your study? 

Mitchell Ladd: Most of the credit goes to the senior author Dr. Daniel Rhee. We knew that individuals with CD were often malnourished and that the ones that were chronically ill and malnourished seemed to have more complications after surgery. We also knew in the adult literature that malnutrition results in poor outcomes and made the hypothesis that this was true in children as well. To our surprise, there has not been much work directed towards looking at surgical outcomes in children based on nutrition status. Thus, we set out to see if our hypothesis was correct that pediatric patients with CD with poor nutrition had worse outcomes after surgery. An important part of our study was how we measured malnutrition, which can be difficult to assess in children compared to adults. We are fortunate to have great nutritionists as part of the children’s center and we asked them how they prefer to measure malnutrition. As surgeons, we often measure it using blood values like albumin, but our nutritionist, Courtney Haney, is the one that directed us towards the most recent ASPEN nutrition guidelines, which recommend using BMI-for-age z score. This worked great for us because we had those data available and so we could use this definition to categorize the nutritional status of the patients.

GASTRO CON: Why do you think research on malnutrition in children with CD been limited?

ML: I think the research on malnutrition in children with CD has been limited primarily in the surgical literature. There are numerous studies in the literature about how children with CD can become malnourished. However, no one has looked at how this affects surgical outcomes. I think the reason for this is that we were extrapolating the known data from the adult literature and applying it to children. Extrapolating is probably okay for older teenagers that are nearly adults, but for the younger patients with CD, this may not work as well, so we thought it was important to specifically look at malnutrition and its effects on surgical outcomes in the pediatric population.

Clinical implications >>

More than 500,000 individuals in the United States experience symptoms from Crohn disease (CD), according to the NIH. Of these, approximately 38,000 are children.

Mitchell Ladd, MD, PhD, and colleagues from The Johns Hopkins Hospital sought to better understand how malnutrition might affect surgical outcomes in children undergoing major bowel surgery. The researchers evaluated rate of wound infection, respiratory complications, reoperation, and readmission within 30 days of surgery.

The overall complication rate was 13.6%. However, results showed the more malnourished a child was, the more likely they were to experience complications.

Gastroenterology Consultant caught up with Dr. Ladd, a surgery resident at The Johns Hopkins Hospital and the study's first author, to talk about the research.

Gastroenterology Consultant: What prompted you to conduct your study? 

Mitchell Ladd: Most of the credit goes to the senior author Dr. Daniel Rhee. We knew that individuals with CD were often malnourished and that the ones that were chronically ill and malnourished seemed to have more complications after surgery. We also knew in the adult literature that malnutrition results in poor outcomes and made the hypothesis that this was true in children as well. To our surprise, there has not been much work directed towards looking at surgical outcomes in children based on nutrition status. Thus, we set out to see if our hypothesis was correct that pediatric patients with CD with poor nutrition had worse outcomes after surgery. An important part of our study was how we measured malnutrition, which can be difficult to assess in children compared to adults. We are fortunate to have great nutritionists as part of the children’s center and we asked them how they prefer to measure malnutrition. As surgeons, we often measure it using blood values like albumin, but our nutritionist, Courtney Haney, is the one that directed us towards the most recent ASPEN nutrition guidelines, which recommend using BMI-for-age z score. This worked great for us because we had those data available and so we could use this definition to categorize the nutritional status of the patients.

GASTRO CON: Why do you think research on malnutrition in children with CD been limited?

ML: I think the research on malnutrition in children with CD has been limited primarily in the surgical literature. There are numerous studies in the literature about how children with CD can become malnourished. However, no one has looked at how this affects surgical outcomes. I think the reason for this is that we were extrapolating the known data from the adult literature and applying it to children. Extrapolating is probably okay for older teenagers that are nearly adults, but for the younger patients with CD, this may not work as well, so we thought it was important to specifically look at malnutrition and its effects on surgical outcomes in the pediatric population.

Clinical implications >>