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98, and 2.43, respectively, P less then 0.021), as was BMI in the upper quartile (HR = 2.59, 2.91, and 2.29, respectively, P less then 0.013).Conclusion BMI in the lower and upper quartiles at diagnosis and during follow-up was associated with a more severe disease course in children with IBD.What is Known• Inflammatory bowel disease (IBD) has been associated with underweight and malnutrition.• The impacts of weight and body mass index (BMI) on the presentation and course of IBD have been mainly investigated in the adult population.What is