Nutritional Status, Body Composition and Growth in Paediatric-Onset Ulcerative Colitis: A Systematic Review.

Fifteen studies with 1575 patients with UC met inclusion criteria for this systematic review on growth, nutritional status, and body composition in pediatric UC.

• The review included 5 prospective, 5 cross-sectional, and 5 retrospective study designs.
• Studies were included if patients were aged 5-22 years with confirmed UC.
• The systematic literature search was performed up to August 2025.
• Although included studies were conducted in broader IBD cohorts, only UC-specific outcomes were reported.
• Data were limited by sample size, heterogeneity in patient characteristics, outcome definitions, and assessment methods.

Growth failure prevalence in pediatric UC ranged from 7% to 36% across included studies.

• Weight deficits were more common than height deficits.
• The majority of patients had prolonged disease with remission or mild activity.
• Growth impairment was identified as a recognized complication of pediatric IBD, yet data specific to UC were described as limited.

Undernutrition affected up to 25% of pediatric UC patients, with variability across studies.

• Variability in undernutrition prevalence was noted across the included studies.
• Overweight and obesity were also observed in pediatric UC patients.
• Most studies showed no significant differences between UC patients and controls regarding overweight and obesity.
• The heterogeneity in outcome definitions and assessment methods contributed to variability in nutritional status findings.

Only five very small studies assessed body composition in pediatric UC, reporting inconsistent findings regarding reductions in lean body mass.

• The five studies assessing body composition were described as 'very small.'
• Findings regarding reductions in lean body mass were inconsistent across these studies.
• The authors concluded that body composition assessment needs essential integration into future studies.
• The limited number and size of body composition studies was identified as a major gap in the evidence base.

Larger, standardized, high-quality studies focused specifically on UC are needed to better characterize its impact on growth and nutritional status.

• Current data were limited by sample size, heterogeneity in patient characteristics, outcome definitions, and assessment methods.
• The authors called for essential integration of body composition assessment in future studies.
• Existing studies were conducted in broader IBD cohorts rather than being UC-specific.
• The review identified growth impairment and poor nutritional status as occurring in children and adolescents with UC but noted the evidence base is insufficient to fully characterize these complications.