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Background <p>Perianal disease (PD) is an aggressive phenotype in children with Crohn’s disease (CD), but its measurable impact on short-term nutritional recovery remains understudied. This study aimed to evaluate the independent effect of PD on the 6-month Body Mass Index Z-score (BMIZ) trajectory and to develop a practical nomogram for early risk stratification in pediatric CD.</p> Methods <p>A single-center retrospective cohort of 51 pediatric CD patients (29 with PD and 22 without PD) with at least 6&#xa0;months of follow-up was enrolled from a tertiary hospital in Fujian, southern China, between July 2017 and March 2025. BMIZ trajectories over time were estimated using linear mixed models (LMM). Predictors of 6-month ΔBMIZ were screened using univariate regression (<i>P</i> &lt; 0.20), followed by LASSO regression (tenfold cross-validation) to construct a nomogram. Model performance was internally validated using 1000 bootstrap resamples (<i>R</i><sup><i>2</i></sup><i>, MAE, RMSE</i>) and calibration plots. Decision curve analysis (DCA) was performed to evaluate clinical utility for predicting inadequate nutritional recovery (ΔBMIZ ≤ 0.40).</p> Results <p>LMM analysis showed that PD status significantly reduced the slope of BMIZ recovery after adjusting for age, sex, and biologic therapy (<i>β</i> = -0.085, 95% CI -0.147 to -0.023, <i>P</i> = 0.010). LASSO regression identified six core predictors: perianal disease, positive fecal occult blood test (FOBT), biologic therapy, erythrocyte sedimentation rate (ESR), hemoglobin (Hb), and 25-hydroxyvitamin D3 (25(OH)D3). The nomogram demonstrated satisfactory predictive performance (<i>R</i><sup><i>2</i></sup> = 0.51, <i>MAE</i> = 0.40, <i>RMSE</i> = 0.49), with calibration plots showing good agreement between predicted and observed ΔBMIZ. DCA confirmed a positive net benefit for predicting inadequate nutritional recovery (ΔBMIZ ≤ 0.40) across a threshold probability range of 5% to 85%.</p> Conclusion <p>Perianal disease was independently associated with suboptimal short-term nutritional recovery in children with CD. The proposed nomogram, integrating phenotypic, inflammatory, and nutritional markers, may help identify high-risk patients at diagnosis or early after diagnosis and support individualized nutritional monitoring and therapeutic planning in southern Chinese pediatric CD patients.</p>

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Nomogram for predicting 6-month BMIZ changes in children with Crohn’s disease: a single-center retrospective study

  • 期刊论文

  • 出版模式：

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  • 发表日期：

    2026年7月4日

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  • Yifei Zhang,
  • Peilin Wu,
  • Xilin Peng,
  • Bihong Ma,
  • Yueli Lin,
  • Xiaowei Zheng,
  • Suqing Chen

摘要

Background

Perianal disease (PD) is an aggressive phenotype in children with Crohn’s disease (CD), but its measurable impact on short-term nutritional recovery remains understudied. This study aimed to evaluate the independent effect of PD on the 6-month Body Mass Index Z-score (BMIZ) trajectory and to develop a practical nomogram for early risk stratification in pediatric CD.

Methods

A single-center retrospective cohort of 51 pediatric CD patients (29 with PD and 22 without PD) with at least 6 months of follow-up was enrolled from a tertiary hospital in Fujian, southern China, between July 2017 and March 2025. BMIZ trajectories over time were estimated using linear mixed models (LMM). Predictors of 6-month ΔBMIZ were screened using univariate regression (P < 0.20), followed by LASSO regression (tenfold cross-validation) to construct a nomogram. Model performance was internally validated using 1000 bootstrap resamples (R2, MAE, RMSE) and calibration plots. Decision curve analysis (DCA) was performed to evaluate clinical utility for predicting inadequate nutritional recovery (ΔBMIZ ≤ 0.40).

Results

LMM analysis showed that PD status significantly reduced the slope of BMIZ recovery after adjusting for age, sex, and biologic therapy (β = -0.085, 95% CI -0.147 to -0.023, P = 0.010). LASSO regression identified six core predictors: perianal disease, positive fecal occult blood test (FOBT), biologic therapy, erythrocyte sedimentation rate (ESR), hemoglobin (Hb), and 25-hydroxyvitamin D3 (25(OH)D3). The nomogram demonstrated satisfactory predictive performance (R2 = 0.51, MAE = 0.40, RMSE = 0.49), with calibration plots showing good agreement between predicted and observed ΔBMIZ. DCA confirmed a positive net benefit for predicting inadequate nutritional recovery (ΔBMIZ ≤ 0.40) across a threshold probability range of 5% to 85%.

Conclusion

Perianal disease was independently associated with suboptimal short-term nutritional recovery in children with CD. The proposed nomogram, integrating phenotypic, inflammatory, and nutritional markers, may help identify high-risk patients at diagnosis or early after diagnosis and support individualized nutritional monitoring and therapeutic planning in southern Chinese pediatric CD patients.