A new larger look to inflammatory bowel disease

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The current epidemic of childhood obesity and type 2 diabetes has generated a set of serious multi-systemic complications, heretofore not observed at this frequency in childhood. These have included obesity-related renal insufficiency, sleep apnea, steatohepatitis, and complicated orthopedic problems among others. Moreover, the obesity epidemic has spread beyond the wealthiest nations. Even in many developing countries, childhood obesity is now as common as malnutrition, changing the content of public health programs for optimal nutrition in children. In this issue of The Journal, Kugathasan et al uncover another alteration from the usual presentation of a classical childhood disease that is a direct result of the obesity epidemic. Weight loss and undernutrition are no longer the dominant nutritional presentation of Crohn’s disease and ulcerative colitis in North America. Rather, at presentation, <66% have normal body mass index (BMI) and obesity is twice as common as undernutriton in ulcerative colits and half as common in Crohn’s disease. Changing body habitus in American children in general may now be altering the BMI of children with a variety of chronic diseases, changing the clinical phenotypes, and requiring that we expand our diagnostic criteria.

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