793 Persisting Malnutrition After Medical Therapy in Children With Crohn's Disease Is Associated With Increased Rates of Surgery and Complicated Disease Behavior
Bibliographic record
Abstract
INTRODUCTION: Although malnutrition in children diagnosed with Crohn's disease (CD) is common, the effect of malnutrition on clinical outcomes following diagnosis of CD has not been evaluated. METHODS: We used data from 948 CD subjects recruited from the RISK inception cohort to examine the impact of malnutrition on disease progression. Our primary exposures of interest were reported weight loss at diagnosis (reported as yes/no) as well as age specific body mass index (BMI) z-scores defined as the deviation of the value for an individual from the mean value of the reference population. Z-scores were stratified according 2015 guidelines of pediatric malnutrition to categorize the presence and severity of malnutrition over 3 years of follow-up. Our primary outcomes were development of complicated (stricturing or penetrating) disease, need for CD-related hospitalization, and surgery. Logistic regression models were used to define independent associations. RESULTS: Reported weight loss and malnutrition were present in 72.9% and 40.5% respectively of children diagnosed with Crohn's disease (Table 1). Following diagnosis at 6 months, BMI z-scores improved significantly such that only 13.2% remained malnourished and the rate of moderate/severe malnutrition declined from 17.6% to 2.2% (Figure 1). Failure to improve BMI z-score from 6 months was associated with increased risk of surgery (22% vs. 9%, P < 0.05) and B2/B2 phenotype (18% vs. 12%, P < 0.01) but not hospitalization (35% vs 28%, P > 0.05) at 3 years. The rate of overall malnutrition improved at 6 months but then remained stable until 3 years (range 13.9-15.9%, P > 0.05) and the association with increased rates of surgery and B2/B3 disease remained significant. CONCLUSION: Weight loss and malnutrition at diagnosis are common following diagnosis of CD in children. Failure to improve BMI z-score at 6 months and beyond correlates with increasing risk of surgery and complicated disease phenotype. We speculate that aggressive pharmacologic and nutritional management may improve/reverse the course in this narrow phenotype, and prospective studies are warranted to prove this concept.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.001 | 0.003 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.001 |
| Bibliometrics | 0.001 | 0.001 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.001 | 0.001 |
| Open science | 0.000 | 0.001 |
| Research integrity | 0.001 | 0.001 |
| Insufficient payload (model declined to judge) | 0.002 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".