Influence of the COVID-19 pandemic on changes in aerobic fitness and injury incidence in elite male soccer players.

BACKGROUND: The SARS-CoV-2 agent initiated a global pandemic. The initial response to the pandemic was severe disruption to the public and private sector including sports. The resultant was that soccer clubs had to prescribe that the players trained in isolation for a prolonged period of time in an attempt to maintain fitness. The aim of the present study was to evaluate the impact of a 10-week period of training in isolation on aerobic fitness, body composition and injury incidence on the return to preseason team-training in a group of elite, male soccer players. METHODS: Twenty-two professional soccer players (age: 25.2±4.4 years) who played for an English Championship first team participated in this study. A weekly training program was sent to each player at the start of each week. Prior to the start of the isolated training period, all players underwent a maximal aerobic speed test (MAS), and Body Mass Index data (BMI) were obtained. These measurements were repeated on the return to team training. RESULTS: There was a significant (P<0.05) increase in MAS pre-post isolated training (pre: 4.71±0.15 vs. post: 4.92±0.17 m/s), no change in BMI (pre: 24.3±1.3 vs. post: 24.1±1.1 kg/m2) and a low non-contact, soft-tissue injury incidence on the return to team training. CONCLUSIONS: The evidence from this study suggests that a more prolonged preseason schedule can enhance aerobic conditioning and mitigate the injury risk on the return to competitive match-play in elite soccer players.

Left Ventricular Responses during Exercise in Highly Trained Youth Athletes: Echocardiographic Insights on Function and Adaptation.

There is an increase in the prevalence of elite youth sports academies, whose sole aim is to develop future elite athletes. This involves the exposure of the child and adolescent athlete to high-volume training during a period of volatile growth. The large amount of data in this area has been garnered from the resting echocardiographic left ventricular (LV) evaluation of the youth athlete; while this can provide some insight on the functional adaptations to training, it is unable to elucidate a comprehensive overview of the function of the youth athletes' LV during exercise. Consequently, there is a need to interrogate the LV responses in-exercise. This review outlines the feasibility and functional insight of capturing global indices of LV function (Stroke Index-SVIndex and Cardiac Index-QIndex), systolic and diastolic markers, and cardiac strain during submaximal and maximal exercise. Larger SVI and QI were noted in these highly trained young athletes compared to recreationally active peers during submaximal and maximal exercise. The mechanistic insights suggest that there are minimal functional systolic adaptions during exercise compared to their recreationally active peers. Diastolic function was superior during exercise in these young athletes, and this appears to be underpinned by enhanced determinants of pre-load.

E. coli bacteraemia and antimicrobial resistance following antimicrobial prescribing for urinary tract infection in the community.

BACKGROUND: Urinary tract infections are one of the most common infections in primary and secondary care, with the majority of antimicrobial therapy initiated empirically before culture results are available. In some cases, however, over 40% of the bacteria that cause UTIs are resistant to some of the antimicrobials used, yet we do not know how the patient outcome is affected in terms of relapse, treatment failure, progression to more serious illness (bacteraemia) requiring hospitalization, and ultimately death. This study analyzed the current patterns of antimicrobial use for UTI in the community in Scotland, and factors for poor outcomes. OBJECTIVES: To explore antimicrobial use for UTI in the community in Scotland, and the relationship with patient characteristics and antimicrobial resistance in E. coli bloodstream infections and subsequent mortality. METHODS: We included all adult patients in Scotland with a positive blood culture with E. coli growth, receiving at least one UTI-related antimicrobial (amoxicillin, amoxicillin/clavulanic acid, ciprofloxacin, trimethoprim, and nitrofurantoin) between 1st January 2009 and 31st December 2012. Univariate and multivariate logistic regression analysis was performed to understand the impact of age, gender, socioeconomic status, previous community antimicrobial exposure (including long-term use), prior treatment failure, and multi-morbidity, on the occurrence of E. coli bacteraemia, trimethoprim and nitrofurantoin resistance, and mortality. RESULTS: There were 1,093,227 patients aged 16 to 100 years old identified as receiving at least one prescription for the 5 UTI-related antimicrobials during the study period. Antimicrobial use was particularly prevalent in the female elderly population, and 10% study population was on long-term antimicrobials. The greatest predictor for trimethoprim resistance in E. coli bacteraemia was increasing age (OR 7.18, 95% CI 5.70 to 9.04 for the 65 years old and over group), followed by multi-morbidity (OR 5.42, 95% CI 4.82 to 6.09 for Charlson Index 3+). Prior antimicrobial use, along with prior treatment failure, male gender, and higher deprivation were also associated with a greater likelihood of a resistant E. coli bacteraemia. Mortality was significantly associated with both having an E. coli bloodstream infection, and those with resistant growth. CONCLUSION: Increasing age, increasing co-morbidity, lower socioeconomic status, and prior community antibiotic exposure were significantly associated with a resistant E. coli bacteraemia, which leads to increased mortality.

The isometric horizontal push test correlates with jumping and sprinting performance among athletes and recreationally active controls.

The aim of this study was two-fold: (i) to examine the relationships between force outputs measured in the isometric horizontal push test (IHPT) and athletic performances; (ii) to compare IHPT outputs between football players and recreationally active controls. Thirty-two male subjects (football players, n = 16; university students, n = 16) completed the IHPT, countermovement jump (CMJ), standing long jump (SLJ), 5 m, 10 m and 20 m sprint tests, randomly across two testing sessions. Multivariate linear regression analysis was used to examine the relationships between IHPT outputs and athletic performances by accounting for the subjects' athletic background. An independent sample t-test was used to compare the IHPT outputs between groups. Moderate to very strong linear relationships (r2 range: 0.16-0.56) were found between the IHPT and all athletic performances (all p < .026). Percent variance explained by the IHPT outputs after accounting for groups difference was 16%, 56%, 54%, 48% and 40% for CMJ height, SLJ distance, 5 m, 10 m and 20 m sprint performances, respectively. Compared to controls (6.18 ± 0.89 N/kg), football players (10.09 ± 1.57 N/kg) achieved greater IHPT force outputs (p < .001, Hedges' g = 3.2, large ES). The IHPT is clearly correlated to horizontal and vertical athletic performances and can adequately distinguish between athletes and recreationally active controls based on their IHPT results. Future studies should examine the usefulness of the IHPT as a testing tool informing training prescription and performance monitoring practices.

The Effect of Different Types of Bariatric Surgery on Levothyroxine Requirement in Hypothyroid Bariatric Patients.

Background Bariatric surgeries are carried out to improve a patient's quality of life, and to reduce respiratory, cardiac, endocrine, and metabolic complications encountered by those with high body mass index (BMI). A complication associated with high hypothyroidism is weight gain, which may lead to obesity. Here, we explore the effect of different bariatric procedures on thyroid function and levothyroxine dosage.  Methods This is a retrospective review of 887 patients referred to a tertiary bariatric service between 2008 and 2020 and treated for hypothyroidism at the time of referral. The study identified 57 patients on thyroxine replacement. Of these, 22 underwent restrictive bariatric procedures, 16 underwent restrictive/malabsorptive procedures, and 19 did not undergo operative intervention. Comparisons were made among each group throughout the timeline of interest. Results Out of 57 patients, 50 (87.7%) were female. The average age for patients was 47.26+/- 8.89 years. The average BMI at baseline was 48.72+/- 8.68 kg/m2. The mean dose of levothyroxine in controls was 115.8+/- 53.5 mcg while that of surgical patients was 149.8+/- 68.4 mcg. There were no statistically significant differences in levothyroxine doses between surgical and control at T0 (baseline), T1 (one-year post-op in surgical patient, or two-year post referral in control patient), T2 (two-year post-op in surgical patient, or three-year post referral in control patient), and T3 (most recent result available). The surgical group was then categorized further into restrictive and restrictive/malabsorptive. When they were compared with the control group, there were no statistically significant differences in doses. A generalized linear mixed model was applied to assess differences in levothyroxine dose with time as a random variable. This was adjusted for age, sex, BMI, T4 level, and hypothyroid cause. Through this assessment, there were several statistically significant differences in levothyroxine dosage between the groups. Control group required on average 28.06 mcg less levothyroxine than the restrictive/malabsorptive group (p=0.015). Also, the restrictive group required on average 23.57 mcg less levothyroxine than the restrictive/malabsorptive group (p=0.033). There were no statistically significant differences observed between the control group and the restrictive group (p=0.67) Conclusion Patients who have bariatric surgery have changes to their anatomy and physiology which may affect both their thyroid hormone homeostasis and levothyroxine pharmacokinetics. Thus, hypothyroid bariatric patients requiring levothyroxine must have their thyroid function monitored regularly. In this study, it was found that hypothyroid patients who underwent restrictive surgery had an overall statistically significant lower levothyroxine requirement to remain euthyroid as compared to the restrictive/malabsorptive group (p=0.033). Additionally, the control group required statistically significantly less levothyroxine than the restrictive/malabsorptive group (p=0.015). These factors may determine the type of surgery chosen by hypothyroid bariatric patients. However, further studies that are randomized, controlled, and multi-center with a higher population are required.

Effect of long-term soccer training on changes in cardiac function during exercise in elite youth soccer players.

It is unclear what the effect of long-term, high-volume soccer training has on left ventricular (LV) function during exercise in youth soccer players. This study evaluated changes in LV function during submaximal exercise in a group of highly trained male soccer players (SP) as they transitioned over a three-year period from pre-adolescent to adolescent athletes. Data were compared to age- and sex-matched recreationally active controls (CON) over the same time period. Twenty-two SP from two professional English Premier League youth soccer academies (age: 12.0 ± 0.3 years at start of the study) and 15 CON (age: 11.7 ± 0.3 years) were recruited. Two-dimensional echocardiography was used to quantify LV function during exercise at the same submaximal metabolic load (approx. 45%VO2peak ) across the 3 years. After controlling for growth and maturation, there were training-induced changes and superiority (p < 0.001) in cardiac index (QIndex) from year 1 in the SP compared to CON. SP (year 1: 6.13 ± 0.76; year 2: 6.94 ± 1.31; and year 3: 7.20 ± 1.81 L/min/m2 ) compared to CON (year 1: 5.15 ± 1.12; year 2: 4.67 ± 1.04; and year 3: 5.49 ± 1.06 L/min/m2 ). Similar training-induced increases were noted for mitral inflow velocity (E): SP (year 1: 129 ± 12; year 2: 143 ± 16; and year 3: 135 ± 18 cm/s) compared to CON (year 1: 113 ± 10; year 2: 111 ± 12; and year 3: 121 ± 9 cm/s). This study indicated that there was evidence of yearly, training-induced increases in left ventricular function during submaximal exercise independent from the influence of growth and maturation in elite youth SP.

Impact of Bariatric Surgery on Renal Function.

Introduction Bariatric surgery offers superior benefits for weight loss, quality of life and a spectrum of metabolic diseases. Despite these benefits, studies so far have shown varying results on its effect on renal function. Aim In this study, we aim to look at bariatric surgery's effect on renal function at one, two and three year post operation (post-op). Methods This is a retrospective cross-sectional single-center study of patients who underwent bariatric surgery between 11/2008 and 06/2018. Renal function was calculated by using Cockroft-Gault equation, expressed as Creatinine Clearance (CrCl). Statistical analysis used was one-way ANOVA (Welch's) with Games-Howell Post-Hoc Test. Results From 307 patients who underwent bariatric surgery within the time period, 145 were studied. 30.3% (n=44) were male. The average age and body mass index (BMI) at referral were 48.1±8.6 years and 47.96±7.9 kgm-2 respectively, while the average age and BMI at surgery were 49.1±8.8 years and 40.62±4.2 kgm-2 respectively. Mean CrCl at surgery, year 1, year 2, and year 3 post-op were 172.35±53.29 mL/min, 179.20±57.87 mL/min, 142.35±46.05 mL/min, and 119.56±42.46 mL/min. Marginal improvement of CrCl at year one post-op (172.35±53.29mL/min to 179.20±57.87mL/min) was statistically insignificant (p=0.731). Meanwhile, there was statistically significant CrCl decline observed from year 1 to year 3 post-op (p<0.001). Conclusion Statistically insignificant marginal improvement in CrCl at year one post-op was noted. Beyond this, there was steady CrCl decline, albeit remained higher than the lower limit for respective gender. We recommend for further studies that take into account additional factors affecting renal function.

Preoperative Bariatric Surgery Predictors of Type 2 Diabetes Remission.

Obesity represents a significant proportion of the global public health burden, with the World Health Organization (WHO) estimating more than 600 million people are affected worldwide. Unfortunately, the epidemic of obesity is linked to the increased prevalence of associated metabolic diseases such as type 2 diabetes mellitus (T2DM). Bariatric surgery as an intervention has been shown to provide sustainable weight loss, and also leads to superior short- and long-term metabolic benefits including T2DM remission. Despite this added advantage conferred by bariatric surgery, emerging evidence has shown that not all patients with T2DM achieve remission postoperatively. As such, to improve patient selection and optimize preoperative counselling, research has focused on the preoperative predictors of T2DM remission following bariatric surgery. Herein, we provide a critical review of the current literature addressing preoperative predictors of T2DM remission and highlight the current gaps in the literature. The review comprised a multistage advanced electronic search of the Ovid/Medline, Embase, and Cochrane online libraries to identify available studies published over the last decade.

The influence of a soccer season on non-contact injury and isokinetic peak torque of the quadriceps and hamstrings in professional youth soccer players.

Isokinetic strength screening is utilized in professional soccer. However, there has been little research on the interaction between seasonal changes in players' peak torque (PT) and injury incidence. Twenty-five (age 16.5±0.68 years) professional youth soccer players participated in the study. Bilateral isokinetic concentric (CON) and eccentric (ECC) testing of Quadriceps (Q) and Hamstrings (H) were conducted at three time-points across the season. Absolute CON and ECC PT were measured at 60 degree/sec and in a supine 170-degree position. Testing data was normalized to body mass. A mixed design (2 by 3) repeated measures ANOVA with injury as a co-variate was conducted to evaluate the effect of season and/or limb dominance on PT and injury incidence. With regard to the seasonal variation and injury incidence, an interaction was identified with respect to non-dominant limb (NDL) QCON (p = 0.01) and to a lesser extent the dominant limb (DL) QCON (p = 0.05). The seasonal variation of the PT of the NDL QCON was different between the injured and non-injured individuals. Non-injured individuals, QCON strength increased over the course of the season. While for the Injured players, QCON declined from pre-season to mid-season then increased but never recovered to starting pre-season values.

Pre-specified Weight Loss Before Bariatric Surgery and Postoperative Outcomes.

Bariatric surgery is increasing exponentially to address the steep rise in the prevalence of severe obesity. Most centers require pre-specified preoperative weight loss before allowing patients to receive surgery. We examined the current evidence surrounding the potential benefits of this requirement on postoperative outcomes. We reviewed the current literature by conducting a multistage advance electronic search in Ovid®/MEDLINE® and PubMed for publications indexed after 2008 reporting preoperative weight loss and postoperative outcomes. Thirteen original publications, three randomized control trials (RCT), and five systematic reviews that met inclusion criteria were included. These were analyzed with regards to weight loss before surgery and postoperative outcomes. There were varied reports regarding the significant effect of preoperative weight loss. Six of the original articles (50%) did not identify a significant difference in the outcome while two of the RCT (essentially the same patient population, started in 2007 and reanalyzed in 2009) demonstrated some advantage. A later RCT (2012) did not show any advantage, albeit in the short term. The results of the systematic reviews, some with heterogenic designs, show no conclusive evidence that weight loss before surgery conferred improved postoperative outcomes. There is not enough high-quality evidence to back up the requirement of pre-specified preoperative weight loss before receiving surgery. Further validation of the possible benefits of pre-specified preoperative weight loss may need to be carried out.

Effectiveness of Community-Links Practitioners in Areas of High Socioeconomic Deprivation.

PURPOSE: To assess the effect of a primary care-based community-links practitioner (CLP) intervention on patients' quality of life and well-being. METHODS: Quasi-experimental cluster-randomized controlled trial in socioeconomically deprived areas of Glasgow, Scotland. Adult patients (aged 18 years or older) referred to CLPs in 7 intervention practices were compared with a random sample of adult patients from 8 comparison practices at baseline and 9 months. PRIMARY OUTCOME: health-related quality of life (EQ-5D-5L, a standardized measure of self-reported health-related quality of life that assesses 5 dimensions at 5 levels of severity). SECONDARY OUTCOMES: well-being (Investigating Choice Experiments for the Preferences of Older People Capability Measure for Adults [ICECAP-A]), depression (Hospital Anxiety and Depression Scale, Depression [HADS-D]), anxiety (Hospital Anxiety and Depression Scale, Anxiety [HADS-A]), and self-reported exercise. Multilevel, multiregression analyses adjusted for baseline differences. Patients were not blinded to the intervention, but outcome analysis was masked. RESULTS: Data were collected on 288 and 214 (74.3%) patients in the intervention practices at baseline and follow-up, respectively, and on 612 and 561 (92%) patients in the comparison practices. Intention-to-treat analysis found no differences between the 2 groups for any outcome. In subgroup analyses, patients who saw the CLP on 3 or more occasions (45% of those referred) had significant improvements in EQ-5D-5L, HADS-D, HADS-A, and exercise levels. There was a high positive correlation between CLP consultation rates and patient uptake of suggested community resources. CONCLUSIONS: We were unable to prove the effectiveness of referral to CLPs based in primary care in deprived areas for improving patient outcomes. Future efforts to boost uptake and engagement could improve overall outcomes, although the apparent improvements in those who regularly saw the CLPs may be due to reverse causality. Further research is needed before wide-scale deployment of this approach.

Multimorbidity and Socioeconomic Deprivation in Primary Care Consultations.

PURPOSE: The influence of multimorbidity on the clinical encounter is poorly understood, especially in areas of high socioeconomic deprivation where burdensome multimorbidity is concentrated. The aim of the current study was to examine the effect of multimorbidity on general practice consultations, in areas of high and low deprivation. METHODS: We conducted secondary analyses of 659 video-recorded routine consultations involving 25 general practitioners (GPs) in deprived areas and 22 in affluent areas of Scotland. Patients rated the GP's empathy using the Consultation and Relational Empathy (CARE) measure immediately after the consultation. Videos were analyzed using the Measure of Patient-Centered Communication. Multilevel, multi-regression analysis identified differences between the groups. RESULTS: In affluent areas, patients with multimorbidity received longer consultations than patients without multimorbidity (mean 12.8 minutes vs 9.3, respectively; P = .015), but this was not so in deprived areas (mean 9.9 minutes vs 10.0 respectively; P = .774). In affluent areas, patients with multimorbidity perceived their GP as more empathic (P = .009) than patients without multimorbidity; this difference was not found in deprived areas (P = .344). Video analysis showed that GPs in affluent areas were more attentive to the disease and illness experience in patients with multimorbidity (P < .031) compared with patients without multimorbidity. This was not the case in deprived areas (P = .727). CONCLUSIONS: In deprived areas, the greater need of patients with multimorbidity is not reflected in the longer consultation length, higher GP patient centeredness, and higher perceived GP empathy found in affluent areas. Action is required to redress this mismatch of need and service provision for patients with multimorbidity if health inequalities are to be narrowed rather than widened by primary care.

The Glasgow 'Deep End' Links Worker Study Protocol: a quasi-experimental evaluation of a social prescribing intervention for patients with complex needs in areas of high socioeconomic deprivation.

BACKGROUND: 'Social prescribing' can be used to link patients with complex needs to local (non-medical) community resources. The 'Deep End' Links Worker Programme is being tested in general practices serving deprived populations in Glasgow, Scotland. OBJECTIVES: To assess the implementation and impact of the intervention at patient and practice levels. METHODS: Study design: Quasi-experimental outcome evaluation with embedded theory-driven process evaluation in 15 practices randomized to receive the intervention or not. Complex intervention: Comprising a practice development fund, a practice-based community links practitioner (CLP), and management support. It aims to link patients to local community organizations and enhance practices' social prescribing capacity. Study population: For intervention practices, staff and adult patients involved in referral to a CLP, and a sample of community organization staff. For comparison practices, all staff and a random sample of adult patients. Sample size: 286 intervention and 484 comparator patients. Outcomes: Primary patient outcome is health-related quality of life (EQ-5D-5L). Secondary patient outcomes include capacity, depression/anxiety, self-esteem, and healthcare utilization. Practice outcome measures include team climate, job satisfaction, morale, and burnout. Outcomes measured at baseline and 9 months. Processes: Barriers and facilitators to implementation of the programme and possible mechanisms through which outcomes are achieved. Analysis plan: For outcome, intention-to-treat analysis with differences between groups tested using mixed-effects regression models. For process, case-study approach with thematic analysis. DISCUSSION: This evaluation will provide new evidence about the implementation and impact of social prescribing by general practices serving patients with complex needs living in areas of high deprivation.

Some issues in predicting patient recruitment in multi-centre clinical trials.

A key paper in modelling patient recruitment in multi-centre clinical trials is that of Anisimov and Fedorov. They assume that the distribution of the number of patients in a given centre in a completed trial follows a Poisson distribution. In a second stage, the unknown parameter is assumed to come from a Gamma distribution. As is well known, the overall Gamma-Poisson mixture is a negative binomial. For forecasting time to completion, however, it is not the frequency domain that is important, but the time domain and that of Anisimov and Fedorov have also illustrated clearly the links between the two and the way in which a negative binomial in one corresponds to a type VI Pearson distribution in the other. They have also shown how one may use this to forecast time to completion in a trial in progress. However, it is not just necessary to forecast time to completion for trials in progress but also for trials that have yet to start. This suggests that what would be useful would be to add a higher level of the hierarchy: over all trials. We present one possible approach to doing this using an orthogonal parameterization of the Gamma distribution with parameters on the real line. The two parameters are modelled separately. This is illustrated using data from 18 trials. We make suggestions as to how this method could be applied in practice.

Using quadratic inference functions to determine the factors associated with obesity: findings from the STEPS Survey in Iran.

PURPOSE: The last study that had a representative sample of the Iranian population and examined the association between sociodemographic and lifestyle factors with obesity used data from the 1999 to 2000 National Health Survey in Iran. Concern about the increased prevalence of obesity has heightened interest in the association between varieties of these factors with obesity among Iranian households. METHODS: Data (20,917 adults) were taken from the 2009 STEPwise approach to Surveillance survey in Iran that was conducted under the supervision of World Health Organization. Using quadratic inference function, we evaluated the relation of age, sex, physical activity, serving of fruit and vegetable, employment status, smoking, and place of residence with obesity. RESULTS: Using 20-30 years as the reference group, the obesity odds ratios (ORs) were 2.48, 3.79, 3.52, and 3.15 for ages 30-40, 40-50, 50-60, and 60+ years, respectively. Obesity OR for female was 2.63, compared with male. Obesity ORs for smokers and ex-smokers were 0.64 and 1.18, respectively, compared with nonsmokers. Among Iranian adult, obesity ORs for the moderate and vigorous physical activity were 0.99 and 0.90, respectively, compared with low level. The estimated odds of obesity were 46% higher for rural adults. Obesity ORs for public and private employed were 0.79 and 0.76, respectively, compared with unemployed. CONCLUSIONS: Our results may provide better insights of the factors associated with obesity and can be used as a basis to reinforce health programs to prevent obesity in Iran.

Growth in children receiving contemporary disease specific therapy for Crohn's disease.

INTRODUCTION: It is unclear whether recent therapeutic advances have improved the growth of children with Crohn's disease (CD). AIM: To assess the frequency of short stature and poor growth and their relationship to disease course and therapy in children with CD. WHAT IS ALREADY KNOWN ON THIS TOPIC: Growth retardation may occur in children with Crohn's disease (CD). Current therapy for CD in the UK is less likely than previously to involve the use of long-term glucocorticoids. WHAT THIS STUDY ADDS: Despite advances in therapy, short stature and slow growth continue to be encountered in children with CD. There is a need for simple and consistent definitions of growth that can identify poor growth in children with chronic disease. METHODS: The anthropometric and treatment details of 116 children (68 male) with a mean (range) age at diagnosis of 10.8 years (4.9-15.5) and a mean age at maximum follow-up (MF) of 15.4 years (9.4-19.3) were studied retrospectively at diagnosis (T0), at 1 (T1), 2 (T2) and 3 years (T3) after diagnosis and at MF. RESULTS: At T0, mean height SD score (HtSDS) was -0.5 (-3.3 to 2.6) compared to a mid-parental HtSDS of 0.2 (-2.0 to 01.4) (p=0.002). At T1, T2, T3 and MF, mean HtSDS was -0.6 (-4.8 to 7.8), -0.6 (-2.9 to 2.2), -0.7 (-3.6 to 2.5) and -0.5 (-3.5 to 2.9), respectively. Mean Ht velocity (HV) SDS at T1, T2, T3 and MF was -1.4 (-7.4 to 7.4), -0.6 (-7.5 to 6.1), -0.1 (-6.6 to 7.6) and 0.6 (-4.8 to 7.8), respectively (p<0.05). In final models, HtSDS was associated negatively with the use of prednisolone (p=0.0001), azathioprine (p=0.0001), methotrexate (p=0.0001) and weight SDS (WtSDS) (p=0.0001). HVSDS was associated positively with age (p=0.0001) and WtSDS (p=0.01). ΔHtSDS was associated negatively with use of prednisolone (p<0.02). CONCLUSION: Although current therapy for CD is associated with improved rate of growth for the first few years, a substantial proportion of children remain short. This study also highlights the need for consistency in describing growth in children with chronic diseases.