Racial and ethnic differences in diagnosis age and blood biomarkers in a pediatric inflammatory bowel disease cohort.

OBJECTIVE: Prompt diagnosis of pediatric-onset inflammatory bowel disease (IBD) is crucial for preventing a complicated disease course; however, it is not well understood how social determinants of health might affect pediatric IBD diagnosis. This study examined differences in diagnosis age, biomarkers of disease severity, and anthropometrics with sociodemographic factors in a pediatric IBD cohort. METHODS: Pediatric IBD patients (n = 114) and their parents/caregivers were enrolled from the Children's of Alabama Pediatric IBD Clinic in Birmingham, Alabama. Primary analyses examined associations of child race and ethnicity, parental income, parental education, single-parent household status, insurance type, and distance to a tertiary pediatric gastroenterology referral center with diagnosis age. Secondary analyses examined differences in biomarker levels, height, and body mass index at the time of diagnosis. RESULTS: Racial and ethnic minority children were diagnosed at an older age compared to Non-Hispanic White children (14.4 ± 0.40 vs. 11.7 ± 0.38 years; p < 0.001), and this trend was robust to adjustment with other sociodemographic variables. Parental attainment of a college education attenuated the link between minority race and ethnicity and the likelihood of older age at diagnosis, while other sociodemographic variables had no moderating effect. Racial and ethnic minority children were 5.7 times more likely to have clinically elevated erythrocyte sedimentation rate at diagnosis compared to Non-Hispanic White children (p = .024). CONCLUSIONS: These results suggest that child race and ethnicity may exert a primary effect on the age at diagnosis with pediatric-onset IBD. This study highlights the need for further research on racial and ethnic disparities to promote health equity in pediatric-onset IBD.

Screening and Referral Practices for Nonalcoholic Fatty Liver Disease by Race and Ethnicity in a Primary Care Clinic.

Nonalcoholic fatty liver disease (NAFLD) is the most common pediatric liver disease in the developed world, with primary care providers caring for many at-risk children. The prevalence of NAFLD varies widely by race and ethnicity. OBJECTIVE: To explore racial differences in screening and referral patterns for NAFLD among a high-risk pediatric population. METHODS: This retrospective cohort study studied primary care patients at Children's of Alabama aged 5-17 years with BMI ≥ 85th percentile from 2008 to 2018. The main outcomes of interest were screening for NAFLD with alanine aminotransferase (ALT) and aspartate aminotransferase (AST), and referral to Hepatology, Endocrinology, or Weight Management clinics. RESULTS: Of 666 children with BMI ≥ 85th percentile, 65% were screened at least once for NAFLD during the designated study period. Liver enzyme screening was performed in 54% of Hispanic Whites, 50% of non-Hispanic Whites, and 74% of African Americans (p-value < 0.001). African American patients had the lowest rate of abnormal liver enzymes (defined as ALT and/or AST > 1 × upper limit of normal). Among all patients with abnormal liver enzymes, 87% of non-Hispanic Whites, 92% of Hispanic Whites, and 17% of African Americans were referred (p-value < 0.0001). CONCLUSIONS: Significant differences exist in NAFLD screening and referral practices by race/ethnicity. African Americans were far less likely to be referred for abnormal screening labs than their counterparts of other races. Awareness of these differences may allow for more intentional efforts to standardize practices, ensuring all patients receive care according to established guidelines.

Relations between disease status and body composition in pediatric inflammatory bowel disease.

To evaluate the effect of remission status on physical activity and body composition in pediatric patients with inflammatory bowel disease (PIBD) and healthy peers. Single-center cohort study, including 54 PIBD patients and 33 healthy peers. During the initial study visit, a brief demographic questionnaire, physical activity questionnaire completed by participants, and instructions on recording dietary intake were given. Physicians completed the Physician Global Assessment (PGA) for disease severity. Medical chart abstraction was done to obtain disease variables of interest. DEXA scan completed 1 week later to obtain information on body composition. Variables of interest were compared between the three groups (IBD-Remission, IBD-Active, and healthy controls) using an ANOVA or Chi-square test as appropriate. IBD patients were older than controls, reported lower quality of life (73.9 vs. 80.9), and engaged in less MVPA (195.4 versus 361.1). The IBD-Active group had a significantly lower lean body mass, bone mineral density, and time spent in MVPA compared to the IBD-Remission group and healthy controls. IBD-Remission group had a significantly lower percentage of biologic use (55% vs. 87%) and comorbidities (26% vs. 44%) compared to IBD-active group. IBD-remission group also had a lower fat mass percentage. In this study, we report significantly favorable LBM, BMD, and time spent in MVPA in patients with IBD in remission compared to those not in remission with the former demonstrating a body composition resembling that of healthy peers.Conclusion: While an improvement in BMD was observed with remission, the scores were still lower than controls. What is Known: • Body composition deficits in pediatric inflammatory bowel disease are common and some persist despite achievement of remission leading to long term outcomes including osteopenia and osteoporosis. • Weight restoration in patients with pediatric IBD is primarily explained by gains in fat mass without similar gains in lean mass. What is New: • While an improvement in bone mineral density was observed, the achievement of remission significantly improves affects physical activity and body composition in pediatric inflammatory bowel disease. • However, some parameters of body composition do not reach levels comparable to healthy peers.