Short, not skinny: The distinct sarcopenia phenotype of pediatric primary sclerosing cholangitis-inflammatory bowel disease

Ghaida Dahlwi; Toshifumi Yodoshi; Jonathan E. M. O'Donnell; Fatemeh Hadian; Anne M. Griffiths; Peter C. Church; Amanda Ricciuto

doi:10.1002/jpn3.70499

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Short, not skinny: The distinct sarcopenia phenotype of pediatric primary sclerosing cholangitis-inflammatory bowel disease

Journal article

Peer reviewed

Short, not skinny: The distinct sarcopenia phenotype of pediatric primary sclerosing cholangitis-inflammatory bowel disease

Ghaida Dahlwi, Toshifumi Yodoshi, Jonathan E. M. O'Donnell, Fatemeh Hadian, Anne M. Griffiths, Peter C. Church and Amanda Ricciuto

Journal of pediatric gastroenterology and nutrition

07/08/2026

DOI: 10.1002/jpn3.70499

PMID: 42415658

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Abstract

Objectives: Sarcopenia is prevalent in pediatric liver disease and inflammatory bowel disease (IBD) and predicts adverse outcomes. We aimed to compare sarcopenia prevalence in pediatric primary sclerosing cholangitis (PSC)-colitis versus non-PSC colitis, characterize longitudinal anthropometric trajectories, and examine the association between sarcopenia and liver outcomes. Methods: This retrospective study compared children with PSC-colitis to matched non-PSC colitis controls. Total psoas muscle area (tPMA) was measured on magnetic resonance enterography. Sarcopenia was defined as tPMA <3rd percentile. Logistic regression examined the PSC-sarcopenia association adjusting for IBD factors. Anthropometric and gamma-glutamyl transferase (GGT) trajectories were analyzed using linear mixed-effects models. Results: Of 85 patients (31 PSC-colitis, 54 non-PSC colitis), sarcopenia prevalence was 42% versus 26%. After adjustment, PSC-colitis patients had nearly fivefold higher odds of sarcopenia (adjusted odds ratio [aOR] 4.81, 95% confidence interval [CI] 1.33-17.36, p = 0.016). However, height-corrected tPMA was similar between groups (p = 0.97), and the PSC-sarcopenia association attenuated when adjusting for height (aOR 3.16, p = 0.085). Sarcopenic PSC-colitis patients demonstrated weight recovery yet persistent height deficits. Sarcopenic non-PSC colitis patients had persistent weight deficits without height impairment. GGT trajectories in PSC-colitis did not differ by sarcopenia status. Conclusions: Sarcopenia in PSC-colitis may reflect proportionate growth impairment, "short but not skinny," rather than catabolic wasting. This phenotype, characterized by persistent height deficits despite weight recovery and mild colitis, may suggest hepatobiliary or other mechanisms distinct from the gut inflammation-driven sarcopenia in non-PSC colitis and the cachexia of end-stage liver disease.

Pediatrics

Gastroenterology & Hepatology

Life Sciences & Biomedicine

Nutrition & Dietetics

Science & Technology

Details

Title: Subtitle: Short, not skinny: The distinct sarcopenia phenotype of pediatric primary sclerosing cholangitis-inflammatory bowel disease
Creators: Ghaida Dahlwi - King Abdulaziz University
Toshifumi Yodoshi - University of Toronto
Jonathan E. M. O'Donnell - University of Toronto
Fatemeh Hadian - Hospital for Sick Children
Anne M. Griffiths - University of Toronto
Peter C. Church - University of Toronto
Amanda Ricciuto - University of Toronto
Resource Type: Journal article
Publication Details: Journal of pediatric gastroenterology and nutrition
DOI: 10.1002/jpn3.70499
PMID: 42415658
NLM abbreviation: J Pediatr Gastroenterol Nutr
ISSN: 0277-2116
eISSN: 1536-4801
Publisher: Wiley
Number of pages: 10
Grant note: MIGA Doctors in Training Grants Program and Avant Foundation Member Grant Program
Language: English
Electronic publication date: 07/08/2026
Academic Unit: Stead Family Department of Pediatrics; Gastroenterology, Hepatology, Pancreatology, and Nutrition
Record Identifier: 9985214171602771

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