Body height in paediatric inflammatory bowel diseases: A structural equation model analysis

Eur J Clin Invest. 2018 Aug;48(8):e12969. doi: 10.1111/eci.12969. Epub 2018 Jun 29.


Background: Linear growth restriction is a unique feature of paediatric inflammatory bowel diseases (IBD), and reduced insulin-like growth factor (IGF-1) is a major determinant of short stature. We aimed to assess factors influencing somatic height in children suffering from IBD.

Materials and methods: This was a retrospective, cross-sectional study conducted after approval by Institutional authorities. Anthropometric data, disease-related factors, biochemical and clinical indices of inflammation and endocrine parameters were recorded and considered as explanatory covariates. A structural equation model analysis was utilized. Somatic height was the outcome of interest, and possible associations of explanatory covariates directly or through the mediation effect of IGF-1 were assessed.

Results: Systemic inflammation, as expressed by high-sensitivity intereukin-6 (IL-6), and nutritional status described by body mass index (BMI) were the pathways that significantly affected stature through the mediation effect of IGF-1. Cortisol showed a direct, positive and independent of IGF-1 association with height.

Conclusions: Insulin-like growth factor-1 is a key player in the process that results in impaired linear growth. Malnutrition and systemic inflammation have a restrictive action on growth by reducing circulating IGF-1. The positive relation of serum cortisol to height could correspond to suppressed pituitary-adrenal axis due to long-term use of glucocorticoids.

Keywords: IGF-1; body height; inflammatory bowel diseases; mediation analysis; paediatrics.

MeSH terms

  • Body Height / physiology*
  • Body Mass Index
  • Child
  • Colitis, Ulcerative / etiology*
  • Crohn Disease / etiology*
  • Cross-Sectional Studies
  • Female
  • Humans
  • Hydrocortisone / metabolism
  • Insulin-Like Growth Factor I / deficiency*
  • Interleukin-6 / metabolism
  • Male
  • Nutritional Status
  • Retrospective Studies


  • IL6 protein, human
  • Interleukin-6
  • Insulin-Like Growth Factor I
  • Hydrocortisone