BACKGROUND: This study aimed to evaluate the effect of overweight and obesity at the start of anti-TNF therapy on treatment response and relapse rate in children with inflammatory bowel disease (IBD). METHODS: This multicenter, retrospective cohort study included 22 IBD centers in 14 countries. Children diagnosed with IBD in whom antitumor necrosis factor (anti-TNF) was introduced were included; those who were overweight/obese were compared with children who were well/undernourished. RESULTS: Six hundred thirty-seven children (370 [58%] males; mean age 11.5 ± 3.5 years) were included; 140 (22%) were in the overweight/obese group (OG) and 497 (78%) had BMI ≤1 SD (CG). The mean follow-up time was 141 ± 78 weeks (median 117 weeks). There was no difference in the loss of response (LOR) to anti-TNF between groups throughout the follow-up. However, children in OG had more dose escalations than controls. Male sex and lack of concomitant immunomodulators at the start of anti-TNF were risk factors associated with the LOR. There was no difference in the relapse rate in the first year after anti-TNF introduction; however, at the end of the follow-up, the relapse rate was significantly higher in the OG compared with CG (89 [64%] vs 218 [44%], respectively, P < .001). Univariate and multivariate analysis revealed that being overweight/obese, having UC, or being of male sex were factors associated with a higher risk for relapse. CONCLUSIONS: Overweight/obese children with IBD were not at a higher risk of LOR to anti-TNF. Relapse in the first year after anti-TNF was introduced, but risk for relapse was increased at the end of follow-up.

Overweight and obese children with inflammatory bowel disease required more frequent dose escalations, but overall loss of response to anti-TNF therapy was not increased. Furthermore, in the long term, they tend to have a higher risk for relapse.

Children's Hospital Zagreb University of Zagreb Medical School Zagreb Croatia

Department of Gastroenterology Hepatology and Nutrition Royal Hospital for Children and Young People Edinburgh UK

Department of Paediatrics 2nd Faculty of Medicine Charles University and University Hospital Motol Prague Czech Republic

Department of Pediatrics Gastroenterology and Nutrition Jagiellonian University Medical College Kracow Poland

Department of Pediatrics School of Medicine Kyungpook National University Daegu Korea

DOCHAS Group Children's Health Ireland University College Dublin Dublin Ireland

Gastroenterology and Nutrition Unit Hospital Infantil Universitario Niño Jesús Madrid Spain

Gastroenterology and Nutrition Unit Meyer Children Hospital IRCCS Florence Italy

Heim Pal National Pediatric Institute Budapest Hungary

Institute for Maternal and Child Health IRCCS Burlo Garofolo Trieste Italy

Institute of Gastroenterology Nutrition and Liver Diseases Schneider Children's Medical Centre Petach Tikva Sackler Faculty of Medicine Tel Aviv University Tel Aviv Israel

Juliet Keidan Institute of Pediatric Gastroenterology Hepatology and Nutrition Shaare Zedek Medical Center the Hebrew University of Jerusalem Jerusalem Israel

Justus Liebig University Giessen Childrens Hospital Giessen Germany

Pediatric Department Children's Hospital Vittore Buzzi University of Milan Milan Italy

Pediatric Gastroenterology and Cystic Fibrosis Unit Department of Human Pathology in Adulthood and Childhood University of Messina Italy

Pediatric Gastroenterology and Hepatology Research Center Children's Medical Center Tehran University of Medical Sciences Tehran Iran

Pediatric Gastroenterology and Liver Unit University Children's Hospital of the University Medical Centre Ljubljana Ljubljana Slovenia

Pediatric Gastroenterology and Nutrition Unit Sheba Medical Center Tel HaShomer The Faculty of Medicine Tel Aviv University Tel Aviv Israel

Pediatric gastroenterology clinic Meir Medical Center Kfar Saba and School of Medicine Tel Aviv University Tel Aviv Israel

Pediatric Gastroenterology Institute Tel Aviv Sourasky Medical Center and the Faculty of Medicine Tel Aviv University Tel Aviv Israel

Pediatric Gastroenterology Unit Sapienza University Umberto 1 Hospital Rome Italy

Pediatric Hepatology Gastroenterology and Transplantation Department ASST Papa Giovanni XXIII Bergamo Italy

University of Helsinki and Children´s Hospital HUS HelsinkiFinland

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