P0275 The Impact of Sarcopenia on Clinical Outcomes in Pediatric Crohn’s Disease
G D’Arcangelo, D De Mitri, L Busato, A Verrino, L Bottino, F Maccioni, M AloiAbstract
Background
Sarcopenia, the age-related progressive loss of muscle mass and strength, affects up to 50% of adults with Crohn’s Disease (CD) and is related to major clinical outcomes. However, data on children is scarce. We investigated whether sarcopenia at the diagnosis impacts the outcomes of children with CD.
Methods
Retrospective, single-center, case-control study of newly diagnosed children with CD undergoing magnetic resonance (MR) within one month from the diagnosis, from 2011 to 2022. Sarcopenia was assessed by measuring total psoas muscle area (tPMA) at L3-L4 level on the MR and defined as z-score values ≤2 standard deviations. Sarcopenic and nonsarcopenic children were compared for the risk of disease flares, IBD-related hospitalization, complications, need for step-up treatment, and courses of steroids over a 2-year follow-up.
Results
Seventy-eight children were included (mean age 11.7 years, 41% females), 46 (59%) sarcopenic and 32 (41%) nonsarcopenic. Sarcopenic children presented at the diagnosis with higher serum levels of total cholesterol (140 ± 28 mg/dL vs. 105.6 ± 27 mg/dL, p=0.009) as well as LDL and HDL cholesterol (77 ± 26 vs. 57.7 ± 24. 4 mg/dL, p=0.03 and 42.8 ± 9.2 vs 36 ± 8 mg/dL, p=0.02, respectively). The risk of clinical relapse was higher in sarcopenic vs nonsarcopenic patients at 6 [21.7% vs. 0%, OR 8.6 (95% CI 1.2-96.2), p=0.004] and 12 months [34.7% vs. 6.6%, OR 7.4 (95% 1.6-34.4), p=0.005]. Additionally, the risk of steroid use was higher in sarcopenic vs. nonsarcopenic children at 12 months [34.7% vs. 13.3%, OR 3.4 (95% CI 1.1-10.3), p=0.06]. Kaplan Meier analysis showed lower survival free from relapses in sarcopenic vs nonsarcopenic patients [Log Rank p=0.004, HR 2.8 (95%CI 1.3-5.7)]. Multivariate logistic regression analysis identified sarcopenia as an independent predictor of relapse risk [OR (95%CI)142 (2.1-470), p=0.051].
Conclusion
The presence of sarcopenia at the diagnosis seems to increase the risk of unfavorable outcomes, specifically clinical relapses in the first year of diagnosis. An altered lipid profile may indicate an increased risk of reduced muscle mass children, highlighting the need for targeted nutritional and therapeutic interventions