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Papadimitriou K, Detopoulou P, Soufleris K, Voulgaridou G, Tsoumana D, Ntopromireskou P, Giaginis C, Chatziprodromidou IP, Spanoudaki M, Papadopoulou SK. Nutritional Risk and Sarcopenia Features in Patients with Crohn's Disease: Relation to Body Composition, Physical Performance, Nutritional Questionnaires and Biomarkers. Nutrients 2023; 15:3615. [PMID: 37630805 PMCID: PMC10458234 DOI: 10.3390/nu15163615] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2023] [Revised: 08/10/2023] [Accepted: 08/15/2023] [Indexed: 08/27/2023] Open
Abstract
Patients with Crohn's disease (CD) face malnutrition risk, which, combined with inflammation, can lead to sarcopenia, associated with a worse prognosis. The purpose of the present study was to assess malnutrition and sarcopenia in patients with CD. Fifty-three patients (26 women) participated (38.1 ± 10.9 years, 79% in remission). Body composition, physical performance, nutritional questionnaires, and biomarkers were performed. Malnutrition was screened with the Mini Nutritional Assessment (MNA) and the Malnutrition Inflammation Risk Tool (MIRT) and was assessed with the Global Leadership Initiative on Malnutrition (GLIM) tool using etiologic along with three different phenotypic criteria: low Body Mass Index (BMI), low Calf Circumference (CC), and low Fat-Free Mass Index (FFMI). To find cases and evaluate sarcopenia, the Sarcopenia Questionnaire (SARC-F) and European Working Group on Sarcopenia2 (EWGSOP2) criteria were used. Malnutrition rates were 11.3% (n = 6), 7.5% (n = 4), and 5.6% (n = 3) based on low FFMI, CC, and BMI, correspondingly. Four (7%) patients had low Hand-Grip Strength (HGS), n = 8 (14.8%) had low Appendicular Lean Mass (ALM), and n = 3 (5.6%) had low gait speed. No-one had sarcopenia. A high albumin and triceps skinfold pattern, identified by principal component analysis, was related to reduced C-Reactive Protein (CRP) levels (B = -0.180, SE = 0.085, p = 0.045). In conclusion, based on the studied anthropometric, nutritional, and functional variables, CD patients were not diagnosed with sarcopenia in the present study. Body composition patterns were related to the inflammatory burden, underlying the interplay of inflammation and malnutrition, even in remission states. Further studies on older populations and during disease exacerbation are necessary to explore the potential link between CD, inflammation, and sarcopenia.
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Affiliation(s)
- Konstantinos Papadimitriou
- Faculty of Health and Rehabilitation Sciences, Metropolitan College of Thessaloniki, University of East London, 546 24 Thessaloniki, Greece
| | - Paraskevi Detopoulou
- Department of Clinical Nutrition, General Hospital Korgialenio Benakio, 115 26 Athens, Greece;
| | - Konstantinos Soufleris
- Gastroenterology-Oncology Department, Theageneio Anticancer Hospital of Thessaloniki, 546 39 Thessaloniki, Greece;
| | - Gavriela Voulgaridou
- Department of Nutritional Sciences and Dietetics, School of Health Sciences, International Hellenic University, 570 01 Thessaloniki, Greece; (G.V.); (D.T.); (M.S.)
| | - Despoina Tsoumana
- Department of Nutritional Sciences and Dietetics, School of Health Sciences, International Hellenic University, 570 01 Thessaloniki, Greece; (G.V.); (D.T.); (M.S.)
| | - Panagiotis Ntopromireskou
- Department of Food Science and Nutrition, School of Environment, University of Aegean, 811 00 Myrina, Greece; (P.N.); (C.G.)
| | - Constantinos Giaginis
- Department of Food Science and Nutrition, School of Environment, University of Aegean, 811 00 Myrina, Greece; (P.N.); (C.G.)
| | | | - Maria Spanoudaki
- Department of Nutritional Sciences and Dietetics, School of Health Sciences, International Hellenic University, 570 01 Thessaloniki, Greece; (G.V.); (D.T.); (M.S.)
| | - Sousana K. Papadopoulou
- Department of Nutritional Sciences and Dietetics, School of Health Sciences, International Hellenic University, 570 01 Thessaloniki, Greece; (G.V.); (D.T.); (M.S.)
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Jabłońska B, Mrowiec S. Nutritional Status and Its Detection in Patients with Inflammatory Bowel Diseases. Nutrients 2023; 15:nu15081991. [PMID: 37111210 PMCID: PMC10143611 DOI: 10.3390/nu15081991] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2023] [Revised: 04/15/2023] [Accepted: 04/19/2023] [Indexed: 04/29/2023] Open
Abstract
Malnutrition is an important issue in patients with inflammatory bowel diseases (IBDs) including Crohn's disease (CD) and ulcerative colitis (UC). It is caused by altered digestion and absorption within the small bowel, inadequate food intake, and drug-nutrient interactions in patients. Malnutrition is an essential problem because it is related to an increased risk of infections and poor prognosis in patients. It is known that malnutrition is also related to an increased risk of postsurgery complications in IBD patients. Basic nutritional screening involves anthropometric parameters with body mass index (BMI) and others (fat mass, waist-to-hip ratio, muscle strength), medical history concerning weight loss, and biochemical parameters (including the Prognostic Nutritional Index). Besides standard nutritional screening tools, including the Subjective Global Assessment (SGA), Nutritional Risk Score 2002 (NRS 2002), and Malnutrition Universal Screening Tool (MUST), specific nutritional screening tools are used in IBD patients, such as the Saskatchewan Inflammatory Bowel Disease-Nutrition Risk Tool (SaskIBD-NR Tool and IBD-specific Nutritional Screening Tool). There is a higher risk of nutrient deficiencies (including iron, zinc, magnesium) and vitamin deficiencies (including folic acid, vitamin B12 and D) in IBD patients. Therefore, regular evaluation of nutritional status is important in IBD patients because many of them are undernourished. An association between plasma ghrelin and leptin and nutritional status in IBD patients has been observed. According to some authors, anti-tumor necrosis factor (anti-TNFα) therapy (infliximab) can improve nutritional status in IBD patients. On the other hand, improvement in nutritional status may increase the response rate to infliximab therapy in CD patients. Optimization of nutritional parameters is necessary to improve results of conservative and surgical treatment and to prevent postoperative complications in patients with IBDs. This review presents basic nutritional screening tools, anthropometric and laboratory parameters, dietary risk factors for IBDs, common nutrient deficiencies, associations between anti-TNFα therapy and nutritional status, selected features regarding the influence of nutritional status, and surgical outcome in IBD patients.
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Affiliation(s)
- Beata Jabłońska
- Department of Digestive Tract Surgery, Medical University of Silesia, 40-752 Katowice, Poland
| | - Sławomir Mrowiec
- Department of Digestive Tract Surgery, Medical University of Silesia, 40-752 Katowice, Poland
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Barnes A, Spizzo P, Bampton P, Andrews JM, Fraser RJ, Mukherjee S, Mountifield R. Examining the influence of inflammatory bowel disease medications on sleep quality. JGH OPEN 2023; 7:190-196. [PMID: 36968569 PMCID: PMC10037038 DOI: 10.1002/jgh3.12871] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/30/2022] [Revised: 12/25/2022] [Accepted: 01/16/2023] [Indexed: 02/05/2023]
Abstract
Background and Aim Inflammatory bowel disease (IBD) can disrupt sleep, leading to poor sleep quality. This may in part be due to the symptoms of IBD and the influence of pro-inflammatory cytokines on sleep. This study aimed to investigate the potential influence of IBD medications on sleep quality. Methods An online survey of adults with IBD was conducted, which included measures of sleep quality, IBD activity, anxiety, depression, and physical activity. Logistic regression was used to investigate possible associations between IBD medications (corticosteroids, immunomodulators, biologics, aminosalicyate) and outcome of poor sleep. A generalized linear model was built for outcome of sleep quality score. Results There were 544 participants included in the final analysis, median age of 42, and 61% with Crohn's disease. Increased odds of poor sleep were seen in those taking opioids, medications for anxiety or depression, corticosteroids, vitamin D, methotrexate, and infliximab. A multivariate model was built incorporating demographic and IBD variables with opioids present in the final model and associated with increased odds of poor sleep. This was in addition to medications for sleep, depression, anxiety, IBD activity, and body weight. In a multivariate generalized linear model, opioids and methotrexate were associated with worse sleep quality scores. Conclusions Opioids were associated with increased odds of poor sleep independent of other factors. This provides further support for avoiding these medications in people with IBD. Infliximab was associated with increased body weight and consequently increased odds of poor sleep.
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Affiliation(s)
- Alex Barnes
- Department of Gastroenterology Southern Adelaide Local Health Network (SALHN) Flinders Medical Centre Bedford Park South Australia Australia
- College of Medicine and Public Health Flinders University Bedford Park South Australia Australia
| | - Paul Spizzo
- Department of Gastroenterology Southern Adelaide Local Health Network (SALHN) Flinders Medical Centre Bedford Park South Australia Australia
| | - Peter Bampton
- College of Medicine and Public Health Flinders University Bedford Park South Australia Australia
| | - Jane M Andrews
- Inflammatory Bowel Disease Service, Department of Gastroenterology and Hepatology (CAHLN) Royal Adelaide Hospital Adelaide South Australia Australia
- School of Medicine, Faculty of Health & Medical Sciences University of Adelaide Adelaide South Australia Australia
| | - Robert J Fraser
- Department of Gastroenterology Southern Adelaide Local Health Network (SALHN) Flinders Medical Centre Bedford Park South Australia Australia
- College of Medicine and Public Health Flinders University Bedford Park South Australia Australia
| | - Sutapa Mukherjee
- College of Medicine and Public Health Flinders University Bedford Park South Australia Australia
- Department of Respiratory and Sleep Medicine Southern Adelaide Local Health Network (SALHN) Flinders Medical Centre Bedford Park South Australia Australia
| | - Réme Mountifield
- Department of Gastroenterology Southern Adelaide Local Health Network (SALHN) Flinders Medical Centre Bedford Park South Australia Australia
- College of Medicine and Public Health Flinders University Bedford Park South Australia Australia
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Lepp J, Höög C, Forsell A, Fyrhake U, Lördal M, Almer S. Rapid weight gain in infliximab treated Crohn's disease patients is sustained over time: real-life data over 12 months. Scand J Gastroenterol 2020; 55:1411-1418. [PMID: 33108226 DOI: 10.1080/00365521.2020.1837929] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
BACKGROUND Infliximab (IFX) is used in active Crohn's disease for induction and maintenance of remission. There are scanty data on weight gain in IBD-patients under anti-TNF treatment. We investigated changes in weight and blood chemistry in anti-TNF-naïve Crohn's disease patients during their first course of IFX. METHODS Retrospective analysis of 110 patients (77 men, 33 women) aged 34 years (range 14-73), 54 with luminal and 56 with fistulising disease, given at least 3 infusions of IFX (range 3-11). Data regarding body weight, height, C-reactive protein (CRP), haemoglobin and S-albumin at baseline, before the third infusion, at three months and at 12 months were collected. RESULTS At 6 weeks, 65 (59%) increased in weight, 73% and 76% at three and 12 months, respectively. There was an increase in median weight (1.7 kg, IQR = 3.1 kg) and BMI (0.5 kg/m2, IQR = 1.2 kg/m2) at 6 weeks, which persisted at three and 12 months (all p < .001). There was no difference between men and women. Young patients, patients with underweight or fistulising disease increased most in weight. Disease activity assessed by PGA and SES-CD decreased at all time points (p < .05). Increases in weight and BMI correlated with an increase in serum albumin and a decrease in CRP. CONCLUSION Approximately 60% of Crohn's disease patients experience weight gain within the first six weeks of infliximab treatment. The weight increment correlates with improvements in inflammatory markers and disease activity. The causes of weight gain may be related to treatment induced metabolic changes and reduced inflammatory burden.
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Affiliation(s)
- Johanna Lepp
- Department of Medicine, Karolinska Institutet, Solna, Sweden
| | - Charlotte Höög
- Department of Medicine, Karolinska Institutet, Huddinge, Sweden.,GHP Stockholm Gastro Center, Stockholm, Sweden
| | - Anette Forsell
- Department of Medicine, Ersta Hospital, Stockholm, Sweden
| | - Ulrika Fyrhake
- Division of Gastroenterology, Karolinska University Hospital, Stockholm, Sweden
| | - Mikael Lördal
- GI-unit, Department of Medicine, Danderyd Hospital, Danderyd, Sweden
| | - Sven Almer
- Department of Medicine, Karolinska Institutet, Solna, Sweden.,Division of Gastroenterology, Karolinska University Hospital, Stockholm, Sweden
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Shafiee NH, Manaf ZA, Mokhtar NM, Raja Ali RA. An assessment of dietary intake, food avoidance and food beliefs in patients with ulcerative colitis of different disease status. Intest Res 2020; 18:447-458. [PMID: 32475103 PMCID: PMC7609392 DOI: 10.5217/ir.2019.00042] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/15/2019] [Accepted: 03/28/2020] [Indexed: 12/20/2022] Open
Abstract
Background/Aims Ulcerative colitis (UC) is a chronic, relapsing and remitting inflammation of the gastrointestinal tract. Little is known about the link between dietary intake, food avoidance, and beliefs among UC patients of different disease severity. Therefore, this study aimed to assess the dietary intake, food avoidance, and beliefs among active and inactive UC patients. Methods A cross-sectional study was conducted among UC patients from a tertiary medical center in Kuala Lumpur, Malaysia. Demographic, anthropometric, dietary intake, food avoidance and beliefs were assessed. Disease activity of UC patients was evaluated using the Powell Tuck Index. Results UC patients were recruited (64.1% inactive UC and 35.9% active UC). As compared to inactive UC patients, active UC patients were likely to lose weight (75.0% vs. 0%), possess certain food beliefs (95.7% vs. 39.0%), and frequently practiced dietary avoidance (95.7% vs. 43.9%). The dietary intake among inactive UC patients was higher than active UC patients. However, neither of them met the standard nutrients recommendation for protein, calcium, iron, folate, zinc, vitamin D, vitamin B12, and vitamin E. Conclusions Active UC patients had poorer dietary intake, were more prone to practicing food avoidance and exhibited certain food beliefs as compared to inactive UC patients. Both macro- and micronutrients intakes were inadequate regardless of patient’s disease status. These findings emphasized the importance for patients to be provided with the nutrition-related knowledge as part of strategies to avoid nutritional inadequacies.
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Affiliation(s)
- Nor Hamizah Shafiee
- Dietetic Unit & Centre of Healthy Ageing and Wellness, Faculty of Health Sciences, National University of Malaysia, Kuala Lumpur, Malaysia
| | - Zahara Abdul Manaf
- Dietetic Unit & Centre of Healthy Ageing and Wellness, Faculty of Health Sciences, National University of Malaysia, Kuala Lumpur, Malaysia
| | - Norfilza M Mokhtar
- Department of Physiology, Faculty of Medicine, National University of Malaysia, Kuala Lumpur, Malaysia.,GUT Research Group, Faculty of Medicine, National University of Malaysia, Kuala Lumpur, Malaysia
| | - Raja Affendi Raja Ali
- GUT Research Group, Faculty of Medicine, National University of Malaysia, Kuala Lumpur, Malaysia.,Gastroenterology Unit, Department of Medicine, UKM Medical Centre, Kuala Lumpur, Malaysia
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Cabalzar AL, Azevedo FMD, Lucca FDA, Reboredo MDM, Malaguti C, Chebli JMF. PHYSICAL ACTIVITY IN DAILY LIFE, EXERCISE CAPACITY AND QUALITY OF LIFE IN PATIENTS WITH CROHN'S DISEASE ON INFLIXIMAB-INDUCED REMISSION: A PRELIMINARY STUDY. ARQUIVOS DE GASTROENTEROLOGIA 2020; 56:351-356. [PMID: 31618395 DOI: 10.1590/s0004-2803.201900000-65] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/06/2019] [Accepted: 07/23/2019] [Indexed: 12/21/2022]
Abstract
BACKGROUND Physical activity in daily life and exercise capacity have not been assessed in patients with Crohn's disease to date. OBJECTIVE To evaluate the physical activity in daily life, exercise capacity, quality of life, and prevalence of mood disorders in patients with moderate-to-severe Crohn's disease on infliximab-induced remission and the possible associations among variables. METHODS A cross-sectional preliminary study was conducted. Twenty-six patients with Crohn's disease and 20 controls were selected. Participants underwent evaluation of physical activity in daily life (triaxial accelerometer), exercise capacity (shuttle walk test), handgrip strength, quality of life, and presence of mood disorders. RESULTS The number of steps taken (7446±3081 vs 7898±2487), active time (80.6±42 vs 89.7±24.3min), shuttle walk test distance [665 (405) vs 710 (409) m] and handgrip strength [31 (15) vs 29 (20) kgf did not show any difference between the patients with Crohn's disease and the controls. The time spent lying down [95.8 (68.8) vs 60.9 (74.7) min] was greater and some domains of the quality of life were superior in the patients with Crohn's disease. No correlation was observed between the physical activity in daily life and quality of life or presence of mood disorders in patients with Crohn's disease. CONCLUSION Patients with Crohn's disease on infliximab-induced remission, despite to more time spent lying down, they have the same level of physical activity in daily life and exercise capacity min compared with the controls.
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Affiliation(s)
- Andrea Lemos Cabalzar
- Universidade Federal de Juiz de Fora, Faculdade de Medicina, Departamento de Gastroenterologia, Hospital Universitário, Centro de Doenças Inflamatórias Intestinais, Juiz de Fora, MG, Brasil
| | - Felipe Meirelles de Azevedo
- Universidade Federal de Juiz de Fora, Faculdade de Fisioterapia, Programa de Pós-Graduação Ciências da Reabilitação e Desempenho Físico-Funcional, Juiz de Fora, MG, Brasil
| | - Fernando de Azevedo Lucca
- Universidade Federal de Juiz de Fora, Faculdade de Medicina, Departamento de Gastroenterologia, Hospital Universitário, Centro de Doenças Inflamatórias Intestinais, Juiz de Fora, MG, Brasil
| | - Maycon de Moura Reboredo
- Universidade Federal de Juiz de Fora, Faculdade de Fisioterapia, Programa de Pós-Graduação Ciências da Reabilitação e Desempenho Físico-Funcional, Juiz de Fora, MG, Brasil
| | - Carla Malaguti
- Universidade Federal de Juiz de Fora, Faculdade de Fisioterapia, Programa de Pós-Graduação Ciências da Reabilitação e Desempenho Físico-Funcional, Juiz de Fora, MG, Brasil
| | - Júlio Maria Fonseca Chebli
- Universidade Federal de Juiz de Fora, Faculdade de Medicina, Departamento de Gastroenterologia, Hospital Universitário, Centro de Doenças Inflamatórias Intestinais, Juiz de Fora, MG, Brasil
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Rodin I, Chan J, Meleady L, Hii C, Lawrence S, Jacobson K. High body mass index is not associated with increased treatment failure in infliximab treated pediatric patients with inflammatory bowel disease. JGH OPEN 2019; 4:446-453. [PMID: 32514452 PMCID: PMC7273726 DOI: 10.1002/jgh3.12277] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/08/2019] [Revised: 10/16/2019] [Accepted: 10/22/2019] [Indexed: 12/18/2022]
Abstract
Background and Aim While weight gain during infliximab therapy in inflammatory bowel disease (IBD) is common, there has been limited research evaluating its impact on infliximab efficacy. Methods Primary aims of this study were to determine the frequency of excess weight gain (body mass index [BMI] > 25 kg/m2) in children with IBD on maintenance infliximab and evaluate the impact on infliximab dosing, serum trough levels, and treatment failure. Secondary aims were to determine differences in weight gain, treatment characteristics, and clinical/biochemical variables between patients with therapeutic and subtherapeutic maintenance therapy trough levels. We performed a retrospective study of 253 pediatric IBD (75.1% Crohn's disease, 23.3% ulcerative colitis, 1.6% IBD-unclassified) patients on infliximab followed at BC Children's Hospital between January 2013 and January 2018. Results Median age at infliximab initiation was 13.9 years, median length of follow up was 56.9 months, and 55.7% were males; 10.3% of the cohort demonstrated excess weight gain (7.5% overweight, 2.8% obese). Average mg/kg dosing was not statistically different between groups (normal, overweight, and obese: 6.7, 6.4, and 6.7 mg/kg, respectively, P = 0.52). Median BMI of patients with therapeutic and subtherapeutic trough levels was similar at 19.9 kg/m2 (interquartile range [IQR], 17.3-23.8) and 19.7 kg/m2 (IQR, 17.4-21.9), respectively. BMI had no effect on secondary loss of response to infliximab, with no significant difference between normal and high BMI subgroups (13.4 vs. 16.7%, P = 0.9). Conclusions In a subgroup of pediatric IBD patients on maintenance infliximab, excess weight gain was not associated with higher weight-based dosing, lower serum trough levels, or increased risk of treatment failure.
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Affiliation(s)
- Isaac Rodin
- MD Undergraduate Program University of British Columbia Vancouver Canada
| | - Justin Chan
- Division of Gastroenterology, Hepatology and Nutrition, Department of Pediatrics, Faculty of Medicine University of British Columbia Vancouver Canada.,British Columbia Children Hospital Research Institute, University of British Columbia Vancouver Canada
| | - Laura Meleady
- Division of Gastroenterology, Hepatology and Nutrition, Department of Pediatrics, Faculty of Medicine University of British Columbia Vancouver Canada.,British Columbia Children Hospital Research Institute, University of British Columbia Vancouver Canada
| | - Clare Hii
- Division of Gastroenterology, Hepatology and Nutrition, Department of Pediatrics, Faculty of Medicine University of British Columbia Vancouver Canada.,British Columbia Children Hospital Research Institute, University of British Columbia Vancouver Canada
| | - Sally Lawrence
- Division of Gastroenterology, Hepatology and Nutrition, Department of Pediatrics, Faculty of Medicine University of British Columbia Vancouver Canada.,British Columbia Children Hospital Research Institute, University of British Columbia Vancouver Canada
| | - Kevan Jacobson
- Division of Gastroenterology, Hepatology and Nutrition, Department of Pediatrics, Faculty of Medicine University of British Columbia Vancouver Canada.,British Columbia Children Hospital Research Institute, University of British Columbia Vancouver Canada.,Department of Cellular and Physiological Sciences University of British Columbia Vancouver Canada
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Brown P, Clark T, Dowson G, Warren L, Hamlin J, Hull M, Subramanian V. Relationship of Body Mass Index to Clinical Outcomes after Infliximab Therapy in Patients with Crohn's Disease. J Crohns Colitis 2016; 10:1144-50. [PMID: 26995185 DOI: 10.1093/ecco-jcc/jjw079] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/26/2015] [Accepted: 02/29/2016] [Indexed: 02/08/2023]
Abstract
BACKGROUND & AIMS There are conflicting data for the role of obesity in Crohn's disease (CD) and the effect on long-term clinical outcomes is poorly studied. Some evidence suggests obesity is associated with diminished responsiveness to biological agents, especially anti-tumour necrosis factor antibodies. METHODS We aimed to examine the influence of body mass index (BMI) on the response to infliximab in CD in a retrospective analysis. The outcomes of interest within 12 months were: (1) Composite loss of response (CD-related flare or surgery; LOR); (2) any CD-related surgery (CDRS); and (3) CD-related intestinal resectional surgery (CDRIS). RESULTS A total of 388 patients were included. The mean BMI was 24.2kg/m(2) [± standard deviation (SD) 5.1]. Of the 388 patients, 137 (35.4%) were overweight (BMI: 25-29.9kg/m(2)) or obese (BMI: ≥30kg/m(2))-160 (41.6%) patients had LOR during the 12 months follow-up; 121 (31.4%) required CDRS, and 109 (28.2%) required CDRIS. Multivariate analysis showed that increasing BMI (per unit, kg/m(2) increase) reduced the risk of LOR [odds ratio (OR): 0.98], CDRS (OR: 0.95), and CDRIS (OR: 0.95). Rates for all outcomes were higher, but not significantly so, in the extreme categories (underweight and obese) and lower in the underweight categories compared with normal BMI. Exclusion of the obese category of patients strengthened this relationship. CONCLUSIONS Body mass index at first infusion of infliximab has a non-linear relationship with outcomes at 12 months. The worst outcomes are at the extremes of weight (underweight and obese categories). Increasing BMI is associated with a modest reduction in risk of LOR, CDRS, and CDRIS within 12 months, increasing with the exclusion of the obese category.
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Affiliation(s)
- Peter Brown
- Molecular Gastroenterology, Leeds Institute of Biomedical and Clinical Sciences, St James University Hospital, University of Leeds, Leeds, UK
| | - Tanya Clark
- Gastroenterology, St James University Hospital, Leeds Teaching Hospital NHS Trust, Leeds, UK
| | - Grace Dowson
- Gastroenterology, St James University Hospital, Leeds Teaching Hospital NHS Trust, Leeds, UK
| | - Lisa Warren
- Gastroenterology, St James University Hospital, Leeds Teaching Hospital NHS Trust, Leeds, UK
| | - John Hamlin
- Gastroenterology, St James University Hospital, Leeds Teaching Hospital NHS Trust, Leeds, UK
| | - Mark Hull
- Molecular Gastroenterology, Leeds Institute of Biomedical and Clinical Sciences, St James University Hospital, University of Leeds, Leeds, UK Gastroenterology, St James University Hospital, Leeds Teaching Hospital NHS Trust, Leeds, UK
| | - Venkataraman Subramanian
- Molecular Gastroenterology, Leeds Institute of Biomedical and Clinical Sciences, St James University Hospital, University of Leeds, Leeds, UK Gastroenterology, St James University Hospital, Leeds Teaching Hospital NHS Trust, Leeds, UK
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9
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Kotze PG, Bremer-Nones R, Kotze LM. Is there any relation between gastric bypass for morbid obesity and the development of Crohn's disease? J Crohns Colitis 2014; 8:712-3. [PMID: 24378833 DOI: 10.1016/j.crohns.2013.12.003] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/07/2013] [Accepted: 12/08/2013] [Indexed: 02/08/2023]
Affiliation(s)
- Paulo G Kotze
- ColorectalSurgery Unit, Cajuru University Hospital, Catholic University of Paraná, Curitiba, PR, Brazil.
| | | | - Lorete M Kotze
- Gastroenterology Unit, Cajuru University Hospital, Catholic University of Paraná, Curitiba, PR, Brazil
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10
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Postoperative infliximab and elemental diet combination in a case with diffuse, extensive jejunoileal Crohn's disease. Int J Colorectal Dis 2014; 29:265-6. [PMID: 24150229 DOI: 10.1007/s00384-013-1777-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 09/27/2013] [Indexed: 02/04/2023]
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11
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Bryant RV, Trott MJ, Bartholomeusz FD, Andrews JM. Systematic review: body composition in adults with inflammatory bowel disease. Aliment Pharmacol Ther 2013; 38:213-25. [PMID: 23763279 DOI: 10.1111/apt.12372] [Citation(s) in RCA: 122] [Impact Index Per Article: 11.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/24/2013] [Revised: 03/19/2013] [Accepted: 05/26/2013] [Indexed: 12/15/2022]
Abstract
BACKGROUND There is a paucity of data on body composition in patients with inflammatory bowel disease (IBD). Alterations of fat and muscle may affect bone health, muscle performance, quality of life (QoL) and overall morbidity. AIMS To systematically review the literature on body composition in adults with IBD, and to discuss potential contributory factors and associations. METHODS A systematic search was performed in July 2012 of OVID SP MEDLINE, OVID EMBASE and National Library of Medicine's PubMed Central Medline (Limitations: English, humans, from 1992). A total of 19 articles comparing body composition in patients with IBD with healthy age- and sex-matched control populations were included in the primary analysis. RESULTS A total of 631 patients with Crohn's disease (CD) and 295 with ulcerative colitis (UC), mean age 37.1 (s.d. ± 9.2) years; 485 (52%) female, were reported upon. Data were heterogeneous and methodology varied. Compared with controls, a statistically significant reduction in body mass index (BMI) was reported in 37% of CD and 20% of UC patients; reduced fat-free mass in 28% CD and 13% UC patients, and reduced fat mass in 31% CD and 13% UC patients. There was no consistent association between body composition and disease activity, duration, extent or therapies. BMI did not accurately predict body composition. CONCLUSIONS Current data, although heterogeneous, suggest that many patients with IBD are affected by aberrations in fat and lean mass, which may not be detected during routine clinical assessment. The prevalence and impact of altered body composition amongst this population warrant further investigation.
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Affiliation(s)
- R V Bryant
- IBD Service & Department of Nuclear Medicine, Royal Adelaide Hospital, Adelaide, Australia.
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Yamamoto T, Shiraki M. Prevalence of overweight and obesity in patients with Crohn's disease in Western countries and Japan. J Crohns Colitis 2013; 7:e192. [PMID: 23138132 DOI: 10.1016/j.crohns.2012.10.010] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/17/2012] [Accepted: 10/17/2012] [Indexed: 02/08/2023]
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Abstract
PURPOSE OF REVIEW Diet is known to have a major role in the expression of inflammatory bowel disease (IBD). The role of dietary interventions and enteral nutrition in the management of IBD remains unelucidated. This study was to review the current evidence for dietary risk factors for the development of IBD and the efficacies of dietary and enteral interventions. RECENT FINDINGS High dietary intakes of total fats, polyunsaturated fatty acids, omega-6 fatty acids, and meat are associated with an increased risk of Crohn's disease and ulcerative colitis. Further prospective studies are required to confirm these observations. Among various dietary interventions, none has shown striking efficacy. Meta-analyses have shown enteral nutrition to be inferior to corticosteroids in adults with active Crohn's disease. However, in children, a meta-analysis has shown no significant difference in the remission rates between enteral nutrition and corticosteroid therapy. Although the evidence level is not striking, enteral nutrition may be useful for maintaining remission in patients with quiescent Crohn's disease. SUMMARY Dietary risk factors for IBD and the therapeutic benefit of dietary and enteral interventions need to be confirmed by further well designed studies in large cohorts of patients.
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Ottaviani S, Allanore Y, Tubach F, Forien M, Gardette A, Pasquet B, Palazzo E, Meunier M, Hayem G, Job-Deslandre C, Kahan A, Meyer O, Dieudé P. Body mass index influences the response to infliximab in ankylosing spondylitis. Arthritis Res Ther 2012; 14:R115. [PMID: 22584116 PMCID: PMC3446492 DOI: 10.1186/ar3841] [Citation(s) in RCA: 81] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2012] [Accepted: 05/14/2012] [Indexed: 12/14/2022] Open
Abstract
INTRODUCTION The excess of adipose tissue in obese individuals may have immunomodulating properties and pharmacokinetic consequences. The aim of this study was to determine whether body mass index (BMI) affects response to infliximab (IFX) in ankylosing spondylitis (AS) patients. METHODS In 155 patients retrospectively included with active AS, the BMI was calculated before initiation of IFX treatment (5 mg/kg intravenously). After 6 months of treatment, changes from baseline in BASDAI, Visual Analogue Scale (VAS) pain, C-reactive protein (CRP) level, and total dose of nonsteroidal antiinflammatory drug (NSAID) were dichotomized with a threshold corresponding to a decrease of 50% of initial level of the measure, into binary variables assessing response to IFX (BASDAI50, VAS50, CRP50, NSAID50). Whether the BMI was predictive of the response to IFX therapy according to these definitions was assessed with logistic regression. RESULTS Multivariate analysis found that a higher BMI was associated with a lower response for BASDAI50 (P = 0.0003; OR, 0.87; 95% CI (0.81 to 0.94)), VAS50 (P < 0.0001; OR, 0.87; 95% CI (0.80 to 0.93)); CRP50 (P = 0.0279; OR, 0.93; 95% CI (0.88 to 0.99)), and NSAID50 (P = 0.0077; OR, 0.91; 95% CI (0.85 to 0.97)), criteria. According to the three WHO BMI categories, similar results were found for BASDAI50 (77.6%, 48.9%, and 26.5%; P < 0.0001), VAS50 (72.6%, 40.4%, and 16.7%; P < 0.0001); CRP50 (87.5%, 65.7%, and 38.5%; P = 0.0001), and NSAID50 (63.2%, 51.5%, and 34.6%; P = 0.06). CONCLUSIONS This study provides the first evidence that a high BMI negatively influences the response to IFX in AS. Further prospective studies, including assessment of the fat mass, pharmacokinetics, and adipokines dosages are mandatory to elucidate the role of obesity in AS IFX response.
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Affiliation(s)
- Sébastien Ottaviani
- Rheumatology Department, AP-HP, Paris Diderot, Sorbonne Paris Cité University, Bichat Claude Bernard Hospital, 46 rue Henri Huchard, Paris, 75018, France
| | - Yannick Allanore
- Rheumatology A Department, AP-HP, Paris Descartes University, Cochin Hospital, 27 rue du Faubourg Saint-Jacques, Paris, 75014, France
- INSERM U1016, Paris Descartes University, Cochin Hospital, 27 rue du Faubourg Saint-Jacques, Paris, 75014, France
| | - Florence Tubach
- Epidemiology Biostatistics and Clinical Research Department, AP-HP, INSERM, CIE801, Paris Diderot, Sorbonne Paris Cité University, Bichat Claude Bernard Hospital, 46 rue Henri Huchard, Paris, 75018, France
| | - Marine Forien
- Rheumatology Department, AP-HP, Paris Diderot, Sorbonne Paris Cité University, Bichat Claude Bernard Hospital, 46 rue Henri Huchard, Paris, 75018, France
| | - Anaïs Gardette
- Rheumatology Department, AP-HP, Paris Diderot, Sorbonne Paris Cité University, Bichat Claude Bernard Hospital, 46 rue Henri Huchard, Paris, 75018, France
| | - Blandine Pasquet
- INSERM U1016, Paris Descartes University, Cochin Hospital, 27 rue du Faubourg Saint-Jacques, Paris, 75014, France
| | - Elisabeth Palazzo
- Rheumatology Department, AP-HP, Paris Diderot, Sorbonne Paris Cité University, Bichat Claude Bernard Hospital, 46 rue Henri Huchard, Paris, 75018, France
| | - Marine Meunier
- Rheumatology A Department, AP-HP, Paris Descartes University, Cochin Hospital, 27 rue du Faubourg Saint-Jacques, Paris, 75014, France
| | - Gilles Hayem
- Rheumatology Department, AP-HP, Paris Diderot, Sorbonne Paris Cité University, Bichat Claude Bernard Hospital, 46 rue Henri Huchard, Paris, 75018, France
| | - Chantal Job-Deslandre
- Rheumatology A Department, AP-HP, Paris Descartes University, Cochin Hospital, 27 rue du Faubourg Saint-Jacques, Paris, 75014, France
| | - André Kahan
- Rheumatology A Department, AP-HP, Paris Descartes University, Cochin Hospital, 27 rue du Faubourg Saint-Jacques, Paris, 75014, France
| | - Olivier Meyer
- Rheumatology Department, AP-HP, Paris Diderot, Sorbonne Paris Cité University, Bichat Claude Bernard Hospital, 46 rue Henri Huchard, Paris, 75018, France
| | - Philippe Dieudé
- Rheumatology Department, AP-HP, Paris Diderot, Sorbonne Paris Cité University, Bichat Claude Bernard Hospital, 46 rue Henri Huchard, Paris, 75018, France
- INSERM U699, Paris Diderot, Sorbonne Paris Cité University, Faculté de Médecine Xavier Bichat, 16 rue Henri Huchard, Paris, 75018, France
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