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Bellone F, Sardella A, Muscianisi M, Basile G. Fatigue, sarcopenia, and frailty in older adults with inflammatory bowel disease. Minerva Gastroenterol (Torino) 2024; 70:79-88. [PMID: 33988010 DOI: 10.23736/s2724-5985.21.02886-2] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Inflammatory bowel diseases (IBDs) are characterized by a multifactorial clinical picture, in which age-related physical, functional and psychological symptoms may coexist. The accurate evaluation and identification of such symptomatology acquires considerable importance in the context of older adults, since those core factors typical of IBD may also expose older patients to an increased risk for age-related negative outcomes, such as frailty and disability. The purpose of the present review was to provide an updated overview on the evaluation and management of IBD in the elderly population, with regard to fatigue, sarcopenia, and frailty. The assessment of fatigue might contribute to the identification of early symptoms of IBD, such as pain and mood disorders, which should be treated timely to offer elderly patient a better quality of life. Similarly, an accurate evaluation of sarcopenia might represent a useful Prognostic Index to identify those patients at risk of developing physical frailty. Frailty in IBD should be evaluated not only in relation to the occurrence of negative outcomes, but also should be considered itself as an outcome itself in IBD. A recommendation for future research on this topic might be the implementation of randomized trials, which include older adults and evaluate fatigue, sarcopenia, and frailty. Similarly, the development of tailored intervention programs, based on both physical and psychological outcomes, with the purpose of improving patients' adaptation to the disease, and monitoring the evolution of symptoms and the response to therapies over time, should be encouraged.
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Affiliation(s)
- Federica Bellone
- Department of Clinical and Experimental Medicine, University of Messina, Messina, Italy
| | - Alberto Sardella
- Department of Clinical and Experimental Medicine, University of Messina, Messina, Italy
| | - Marco Muscianisi
- Department of Clinical and Experimental Medicine, University of Messina, Messina, Italy
| | - Giorgio Basile
- Department of Clinical and Experimental Medicine, University of Messina, Messina, Italy -
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2
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Bertani L, D’Alessandro C, Fornili M, Coppini F, Zanzi F, Carmisciano L, Geri F, Svizzero GB, Rosi EM, De Bernardi A, Ceccarelli L, Mumolo MG, Baglietto L, Bellini M, De Bortoli N, Costa F. Response to Ustekinumab Therapy Is Associated with an Improvement of Nutritional Status in Patients with Crohn's Disease. J Clin Med 2023; 12:6118. [PMID: 37834762 PMCID: PMC10573723 DOI: 10.3390/jcm12196118] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2023] [Revised: 09/15/2023] [Accepted: 09/18/2023] [Indexed: 10/15/2023] Open
Abstract
The presence of sarcopenia has been associated with the worst outcome of Crohn's disease (CD). At present, no studies have evaluated the impact of ustekinumab (UST) in terms of its effects on body composition. The aim of this prospective study was to evaluate whether UST treatment could modify the parameters of body composition as assessed by bioelectrical impedance assay (BIA) in patients with CD. We prospectively enrolled consecutive patients with CD treated with UST, evaluating the therapeutic outcome at week 48 in terms of clinical remission and mucosal healing. BIA was performed at baseline and at week 48, assessing body cellular mass, total body water, phase angle, and body mass index. Out of 44 patients enrolled, 26 (59%) were in clinical remission and 22 (50%) achieved mucosal healing at the end of follow up. No significant differences were observed at baseline in all the BIA parameters between responders and non-responders. Phase angle increased over time in responders, while this was not observed in non-responders (test for the interaction between time and outcome, p-value = 0.009 and 0.007 for clinical remission and mucosal healing, respectively). The same differential increase was observed for body cellular mass (test for the interaction between time and outcome, p-value = 0.03 and 0.05 for clinical remission and mucosal healing, respectively). Total body water and BMI increased homogenously over time regardless of the outcomes (tests for the association with time, p-values of 0.01). To conclude, responsiveness to UST therapy seems to be associated with body composition modifications in patients with CD. In particular, the increase in phase angle in responders suggests that a significant improvement of nutritional status occurred in these patients.
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Affiliation(s)
- Lorenzo Bertani
- Department of Translational Research and New Technologies in Medicine and Surgery, University of Pisa, Via Roma, 67, 56100 Pisa, Italy; (C.D.); (F.C.); (F.Z.); (F.G.); (E.M.R.); (A.D.B.); (M.B.); (N.D.B.)
- Tuscany North West ASL, Department of General Surgery and Gastroenterology, Pontedera Hospital, Via Roma, 147, 56025 Pontedera, Italy
| | - Claudia D’Alessandro
- Department of Translational Research and New Technologies in Medicine and Surgery, University of Pisa, Via Roma, 67, 56100 Pisa, Italy; (C.D.); (F.C.); (F.Z.); (F.G.); (E.M.R.); (A.D.B.); (M.B.); (N.D.B.)
| | - Marco Fornili
- Department of Clinical and Experimental Medicine, University of Pisa, Via Roma, 67, 56100 Pisa, Italy; (M.F.); (L.C.); (L.B.)
| | - Francesca Coppini
- Department of Translational Research and New Technologies in Medicine and Surgery, University of Pisa, Via Roma, 67, 56100 Pisa, Italy; (C.D.); (F.C.); (F.Z.); (F.G.); (E.M.R.); (A.D.B.); (M.B.); (N.D.B.)
| | - Federico Zanzi
- Department of Translational Research and New Technologies in Medicine and Surgery, University of Pisa, Via Roma, 67, 56100 Pisa, Italy; (C.D.); (F.C.); (F.Z.); (F.G.); (E.M.R.); (A.D.B.); (M.B.); (N.D.B.)
| | - Luca Carmisciano
- Department of Clinical and Experimental Medicine, University of Pisa, Via Roma, 67, 56100 Pisa, Italy; (M.F.); (L.C.); (L.B.)
| | - Francesca Geri
- Department of Translational Research and New Technologies in Medicine and Surgery, University of Pisa, Via Roma, 67, 56100 Pisa, Italy; (C.D.); (F.C.); (F.Z.); (F.G.); (E.M.R.); (A.D.B.); (M.B.); (N.D.B.)
| | - Giovanni Baiano Svizzero
- Department of General Surgery and Gastroenterology, IBD Unit, Pisa University Hospital, Via Paradisa, 2, 56124 Pisa, Italy; (G.B.S.); (L.C.); (M.G.M.); (F.C.)
| | - Emma Maria Rosi
- Department of Translational Research and New Technologies in Medicine and Surgery, University of Pisa, Via Roma, 67, 56100 Pisa, Italy; (C.D.); (F.C.); (F.Z.); (F.G.); (E.M.R.); (A.D.B.); (M.B.); (N.D.B.)
| | - Alice De Bernardi
- Department of Translational Research and New Technologies in Medicine and Surgery, University of Pisa, Via Roma, 67, 56100 Pisa, Italy; (C.D.); (F.C.); (F.Z.); (F.G.); (E.M.R.); (A.D.B.); (M.B.); (N.D.B.)
| | - Linda Ceccarelli
- Department of General Surgery and Gastroenterology, IBD Unit, Pisa University Hospital, Via Paradisa, 2, 56124 Pisa, Italy; (G.B.S.); (L.C.); (M.G.M.); (F.C.)
| | - Maria Gloria Mumolo
- Department of General Surgery and Gastroenterology, IBD Unit, Pisa University Hospital, Via Paradisa, 2, 56124 Pisa, Italy; (G.B.S.); (L.C.); (M.G.M.); (F.C.)
| | - Laura Baglietto
- Department of Clinical and Experimental Medicine, University of Pisa, Via Roma, 67, 56100 Pisa, Italy; (M.F.); (L.C.); (L.B.)
| | - Massimo Bellini
- Department of Translational Research and New Technologies in Medicine and Surgery, University of Pisa, Via Roma, 67, 56100 Pisa, Italy; (C.D.); (F.C.); (F.Z.); (F.G.); (E.M.R.); (A.D.B.); (M.B.); (N.D.B.)
| | - Nicola De Bortoli
- Department of Translational Research and New Technologies in Medicine and Surgery, University of Pisa, Via Roma, 67, 56100 Pisa, Italy; (C.D.); (F.C.); (F.Z.); (F.G.); (E.M.R.); (A.D.B.); (M.B.); (N.D.B.)
| | - Francesco Costa
- Department of General Surgery and Gastroenterology, IBD Unit, Pisa University Hospital, Via Paradisa, 2, 56124 Pisa, Italy; (G.B.S.); (L.C.); (M.G.M.); (F.C.)
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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: 7] [Impact Index Per Article: 7.0] [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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Lian Z, Hu J, Cheng C, Liu Y, Zhu L, Shen H. Association with controlling nutritional status score and disease activity of ulcerative colitis. J Int Med Res 2023; 51:3000605231184046. [PMID: 37548189 PMCID: PMC10408351 DOI: 10.1177/03000605231184046] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2023] [Accepted: 06/06/2023] [Indexed: 08/08/2023] Open
Abstract
OBJECTIVE To explore the association between the controlling nutritional status (CONUT) score and disease activity in patients with ulcerative colitis (UC). METHODS This retrospective study enrolled patients with UC. Demographic, clinical and laboratory data were collected and compared. The CONUT score was obtained for each patient. The association between the CONUT score and laboratory parameters was analysed and the ability of the score to assess disease activity was evaluated. RESULTS A total of 182 patients with UC were enrolled. Patients with active disease showed significantly increased inflammatory biomarkers and decreased nutritional biomarkers compared with patients in remission. Malnourished individuals had significantly elevated inflammatory biomarkers and significantly reduced haemoglobin, prealbumin and retinol-binding protein. The CONUT score was inversely correlated with haemoglobin, prealbumin, retinol-binding protein and was positively correlated with faecal calprotectin, C-reactive protein, erythrocyte sedimentation rate, neutrophil/lymphocyte ratio and platelet/lymphocyte ratio. The area under the receiver operating characteristic curve was 0.655 (95% confidence interval, 0.557-0.752). The optimal cut-off value was 1.5 points, with a sensitivity of 75.7% and a specificity of 50.0%. CONCLUSION The CONUT score may evaluate the inflammatory response and nutritional status of UC patients, so it could be a potential biomarker to assess disease activity in UC.
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Affiliation(s)
- Ziyu Lian
- Department of Gastroenterology, Affiliated Hospital of Nanjing University of Chinese Medicine, Nanjing, Jiangsu Province, China
| | - Jingyi Hu
- Department of Gastroenterology, Affiliated Hospital of Nanjing University of Chinese Medicine, Nanjing, Jiangsu Province, China
| | - Cheng Cheng
- Department of Gastroenterology, Affiliated Hospital of Nanjing University of Chinese Medicine, Nanjing, Jiangsu Province, China
| | - Yajun Liu
- Department of Gastroenterology, Affiliated Hospital of Nanjing University of Chinese Medicine, Nanjing, Jiangsu Province, China
| | | | - Hong Shen
- Hong Shen, Department of Gastroenterology, Affiliated Hospital of Nanjing University of Chinese Medicine, 155 Hanzhong Road, Qinhuai District, Nanjing 210023, China.
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5
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Yu Y, Bian Y, Shi JX, Gu Y, Yuan DP, Yu B, Shi L, Dou DH. Geniposide promotes splenic Treg differentiation to alleviate colonic inflammation and intestinal barrier injury in ulcerative colitis mice. Bioengineered 2022; 13:14616-14631. [PMID: 36694912 PMCID: PMC9995132 DOI: 10.1080/21655979.2022.2092678] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023] Open
Abstract
Geniposide has been proven to have a therapeutic effect on ulcerative colitis (UC) in animals, but its potential mechanism in UC remains to be clarified. The purpose of this study was to confirm the efficacy of geniposide in UC and to investigate the possible mechanism of geniposide in UC treatment. In vivo, geniposide relieved weight loss and reduced intestinal tissue damage in UC mice. Geniposide decreased the levels of IL-1β and TNF-α and increased IL-10 levels in the colon and serum of UC mice. Geniposide increased FOXP3 expression in the colon and the number of CD4+ FOXP3+ cells in the spleen of UC mice. BD750 abolished the above regulatory effect of GE on UC mice. In vitro, geniposide increased the number of CD4+ FOXP3+ cells in spleen cells from normal mice, decreased the levels of IL-1β, CCL2 and TNF-α in the supernatant of LPS-treated Caco-2 cells, and decreased the protein expression of Beclin-1 and Occludin in cacO-2 cells. Epirubicin inhibited the effect of geniposide on increasing the number of CD4+ FOXP3+ cells in spleen cells, attenuated the inhibitory effect of geniposide on proinflammatory factors and attenuated the upregulation of geniposide on tight junction proteins in LPS-treated Caco-2 cells in the coculture system. In conclusion, geniposide has an effective therapeutic effect on UC. Increasing Treg differentiation of spleen cells is the mechanism by which geniposide alleviates intestinal inflammation and barrier injury in UC.
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Affiliation(s)
- Yun Yu
- School of Pharmacy, Nanjing University of Chinese Medicine, Nanjing, China
| | - Yong Bian
- Laboratory Animal Center, Nanjing University of Chinese Medicine, Nanjing, China
| | - Jian-Xin Shi
- Affiliated Hospital of Nanjing University of Chinese Medicine, Nanjing, China
| | - Yu Gu
- School of Medicine, Nanjing University of Chinese Medicine, Nanjing, China
| | - Dong-Ping Yuan
- School of Pharmacy, Nanjing University of Chinese Medicine, Nanjing, China
| | - Bin Yu
- School of Pharmacy, Nanjing University of Chinese Medicine, Nanjing, China
| | - Le Shi
- School of Pharmacy, Nanjing University of Chinese Medicine, Nanjing, China
| | - Da-Hai Dou
- Department of Pharmacy, Jiangsu Province Hospital, Nanjing, China
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Small and Large Intestine (II): Inflammatory Bowel Disease, Short Bowel Syndrome, and Malignant Tumors of the Digestive Tract. Nutrients 2021; 13:nu13072325. [PMID: 34371835 PMCID: PMC8308711 DOI: 10.3390/nu13072325] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2021] [Revised: 06/29/2021] [Accepted: 07/02/2021] [Indexed: 12/15/2022] Open
Abstract
The small intestine is key in the digestion and absorption of macro and micronutrients. The large intestine is essential for the absorption of water, to allow adequate defecation, and to harbor intestinal microbiota, for which their nutritional role is as important as it is unknown. This article will describe the causes and consequences of malnutrition in patients with inflammatory bowel diseases, the importance of screening and replacement of micronutrient deficits, and the main indications for enteral and parenteral nutrition in these patients. We will also discuss the causes of short bowel syndrome, a complex entity due to anatomical or functional loss of part of the small bowel, which can cause insufficient absorption of liquid, electrolytes, and nutrients and lead to complex management. Finally, we will review the causes, consequences, and management of malnutrition in patients with malignant and benign digestive tumors, including neuroendocrine tumors (present not only in the intestine but also in the pancreas).
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7
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Effects of olives and their constituents on the expression of ulcerative colitis: a systematic review of randomised controlled trials. Br J Nutr 2021; 127:1153-1171. [PMID: 34100354 DOI: 10.1017/s0007114521001999] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Extra virgin olive oil is often associated with anti-inflammatory and antioxidant properties. Its effects on inflammatory conditions such as ulcerative colitis (UC), however, have yet to be defined. As such, we aimed to conduct a systematic review and meta-analysis of studies investigating olive-based interventions in UC. A comprehensive database search for randomised controlled trials was performed between 9 July 2018 and 16 August 2018. Studies identified from search alerts were included up to 22 June 2020. Both individuals living with UC at any disease stage and murine models of UC were included in this review. No human trials meeting the eligibility criteria were identified, while nineteen animal studies comprised 849 murine models of UC were included in this review. Pooling of the data could not be performed due to heterogeneous outcomes; however, general trends favouring olive-based interventions were identified. Milder disease expression including weight maintenance, reduced rectal bleeding and well-formed stools favouring olive-based interventions was statistically significant in 16/19 studies, with moderate-to-large effect sizes (-0·66 (95 % CI -1·56, 0·24) to -12·70 (95 % CI -16·8, -8·7)). Olive-based interventions did not prevent the development of colitis-like pathologies in any study. In conclusion, effects of olive-based interventions on murine models of UC appear promising, with milder disease outcomes favouring the intervention in most trials and effect sizes suggesting potential clinical relevance. However, the lack of published randomised controlled human trials warrants further investigation to determine if these effects would translate to individuals living with UC.
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Balestrieri P, Ribolsi M, Guarino MPL, Emerenziani S, Altomare A, Cicala M. Nutritional Aspects in Inflammatory Bowel Diseases. Nutrients 2020; 12:nu12020372. [PMID: 32023881 PMCID: PMC7071234 DOI: 10.3390/nu12020372] [Citation(s) in RCA: 131] [Impact Index Per Article: 32.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2020] [Accepted: 01/28/2020] [Indexed: 12/16/2022] Open
Abstract
Crohn’s disease (CD) and ulcerative colitis (UC) are chronic, relapsing, inflammatory disorders of the digestive tract that characteristically develop in adolescence and early adulthood. The reported prevalence of malnutrition in inflammatory bowel disease (IBD) patients ranges between 20% and 85%. Several factors, including reduced oral food intake, malabsorption, chronic blood and proteins loss, and intestinal bacterial overgrowth, contribute to malnutrition in IBD patients. Poor nutritional status, as well as selective malnutrition or sarcopenia, is associated with poor clinical outcomes, response to therapy and, therefore, quality of life. The nutritional assessment should include a dietetic evaluation with the assessment of daily caloric intake and energy expenditure, radiological assessment, and measurement of functional capacity.
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Molendijk I, van der Marel S, Maljaars PWJ. Towards a Food Pharmacy: Immunologic Modulation through Diet. Nutrients 2019; 11:nu11061239. [PMID: 31159179 PMCID: PMC6627620 DOI: 10.3390/nu11061239] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2019] [Revised: 05/24/2019] [Accepted: 05/27/2019] [Indexed: 12/18/2022] Open
Abstract
Patients frequently wonder whether their dietary pattern influences the course of inflammatory bowel disease (IBD). Many patients even avoid certain foods that aggravate their symptoms. Although interest in nutritional interventions is rising among physicians, the current application of nutritional interventions in the IBD population is limited due to the lack of scientific evidence from clinical trials. Several studies, however, have identified associations between diet, gut microbiota, intestinal epithelial integrity, and mucosal immune responses. In patients consuming predominantly a Western diet high in n-6 poly-unsaturated fatty acids (PUFAs), sugars, and meat, and low in fruits and vegetables, an impaired gut epithelial barrier and disturbances in the intestinal microbiota have been observed, resulting in a chronic mucosal inflammation. An anti-inflammatory diet may restore this disbalance. In this review, we discuss the effects of diet on the composition of the microbiota, the gut epithelial barrier function, and the mucosal immune system.
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Affiliation(s)
- Ilse Molendijk
- Department of Gastroenterology and Hepatology, Leiden University Medical Center, 2313 ZA Leiden, The Netherlands.
| | - Sander van der Marel
- Department of Gastroenterology and Hepatology, Haaglanden Medical Center, 2512 VA The Hague, The Netherlands.
| | - P W Jeroen Maljaars
- Department of Gastroenterology and Hepatology, Leiden University Medical Center, 2313 ZA Leiden, The Netherlands.
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10
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Casanova MJ, Chaparro M, Molina B, Merino O, Batanero R, Dueñas-Sadornil C, Robledo P, Garcia-Albert AM, Gómez-Sánchez MB, Calvet X, Trallero MDR, Montoro M, Vázquez I, Charro M, Barragán A, Martínez-Cerezo F, Megias-Rangil I, Huguet JM, Marti-Bonmati E, Calvo M, Campderá M, Muñoz-Vicente M, Merchante A, Ávila AD, Serrano-Aguayo P, De Francisco R, Hervías D, Bujanda L, Rodriguez GE, Castro-Laria L, Barreiro-de Acosta M, Van Domselaar M, Ramirez de la Piscina P, Santos-Fernández J, Algaba A, Torra S, Pozzati L, López-Serrano P, Arribas MDR, Rincón ML, Peláez AC, Castro E, García-Herola A, Santander C, Hernández-Alonso M, Martín-Noguerol E, Gómez-Lozano M, Monedero T, Villoria A, Figuerola A, Castaño-García A, Banales JM, Díaz-Hernández L, Argüelles-Arias F, López-Díaz J, Pérez-Martínez I, García-Talavera N, Nuevo-Siguairo OK, Riestra S, Gisbert JP. Prevalence of Malnutrition and Nutritional Characteristics of Patients With Inflammatory Bowel Disease. J Crohns Colitis 2017; 11:1430-1439. [PMID: 28981652 DOI: 10.1093/ecco-jcc/jjx102] [Citation(s) in RCA: 108] [Impact Index Per Article: 15.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/25/2017] [Accepted: 07/20/2017] [Indexed: 12/13/2022]
Abstract
BACKGROUND AND AIMS This study sought to determine the prevalence of malnutrition in patients with inflammatory bowel disease, to analyse the dietary beliefs and behaviours of these patients, to study their body composition, to evaluate their muscular strength and to identify the factors associated with malnutrition in these patients. METHODS This was a prospective, multicentre study. Crohn's disease and ulcerative colitis patients from 30 Spanish centres, from the outpatient clinics, were included. A questionnaire of 11 items was applied to obtain data from patients' dietary behaviour and beliefs. Patients who accepted were evaluated to assess their nutritional status using Subjective Global Assessment and body mass index. Body composition was evaluated through bioelectrical impedance. RESULTS A total of 1271 patients were included [51% women, median age 45 years, 60% Crohn's disease]. Of these, 333 patients underwent the nutritional evaluation. A total of 77% of patients declared that they avoided some foods to prevent disease relapse. Eighty-six per cent of patients avoided some foods when they had disease activity because of fear of worsening the flare. Sixty-seven per cent of patients modified their dietary habits after disease diagnosis. The prevalence of malnutrition was 16% [95% confidence interval = 12-20%]. In the multivariate analysis, history of abdominal surgery, active disease and avoidance of some foods during flares were associated with higher risk of malnutrition. CONCLUSIONS The prevalence of malnutrition in inflammatory bowel disease patients was high. We identified some predictive factors of malnutrition. Most of the patients had self-imposed food restrictions, based on their beliefs.
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Affiliation(s)
- María José Casanova
- Hospital Universitario de La Princesa, Instituto de Investigación Sanitaria Princesa (IIS-IP) and Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBEREHD), Spain
| | - Maria Chaparro
- Hospital Universitario de La Princesa, Instituto de Investigación Sanitaria Princesa (IIS-IP) and Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBEREHD), Spain
| | - Begoña Molina
- Departments of Gastroenterology, Endocrinology and Nutrition.,Hospital Universitario de La Princesa, Instituto de Investigación Sanitaria Princesa (IIS-IP) and Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBEREHD), Spain
| | | | - Ricardo Batanero
- Departments of Gastroenterology, Endocrinology and Nutrition.,Hospital Universitario de Cruces, Spain
| | | | | | | | | | - Xavier Calvet
- Corporació Sanitària Universitària Parc Taulí, Sabadell, Universitat Autònoma de Barcelona, and CIBEREHD, Instituto de Salud Carlos III, Grupo de Investigación Consolidado (SGR01500), Spain
| | - Maria Del Roser Trallero
- Departments of Gastroenterology, Endocrinology and Nutrition.,Corporació Sanitària Universitària Parc Taulí, Sabadell, Universitat Autònoma de Barcelona, and CIBEREHD, Instituto de Salud Carlos III, Grupo de Investigación Consolidado (SGR01500), Spain
| | | | - Iria Vázquez
- Departments of Gastroenterology, Endocrinology and Nutrition.,Hospital San Jorge de Huesca, Spain
| | | | - Amaya Barragán
- Departments of Gastroenterology, Endocrinology and Nutrition.,Hospital Royo Villanova, Spain
| | | | - Isabel Megias-Rangil
- Departments of Gastroenterology, Endocrinology and Nutrition.,Hospital Universitario Sant Joan de Reus, Spain
| | | | | | - Marta Calvo
- Hospital Universitario Puerta de Hierro,Spain
| | - Mariana Campderá
- Departments of Gastroenterology, Endocrinology and Nutrition.,Hospital Universitario Puerta de Hierro,Spain
| | | | - Angel Merchante
- Departments of Gastroenterology, Endocrinology and Nutrition.,Hospital General Universitario de Castellón, Spain
| | | | - Pilar Serrano-Aguayo
- Departments of Gastroenterology, Endocrinology and Nutrition.,Hospital Universitario Virgen del Rocío, Spain
| | | | | | - Luis Bujanda
- Hospital de Donostia, Instituto Biodonostia, Universidad del País Vasco (UPV/EHU), and CIBEREHD, Spain
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | - Cecilio Santander
- Hospital Universitario de La Princesa, Instituto de Investigación Sanitaria Princesa (IIS-IP) and Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBEREHD), Spain
| | | | | | | | - Tamara Monedero
- Departments of Gastroenterology, Endocrinology and Nutrition.,Hospital Universitario Reina Sofía, Spain
| | - Albert Villoria
- Corporació Sanitària Universitària Parc Taulí, Sabadell, Universitat Autònoma de Barcelona, and CIBEREHD, Instituto de Salud Carlos III, Grupo de Investigación Consolidado (SGR01500), Spain
| | | | | | - Jesús M Banales
- Hospital de Donostia, Instituto Biodonostia, Universidad del País Vasco (UPV/EHU), and CIBEREHD, Spain
| | | | | | | | | | - Noelia García-Talavera
- Departments of Gastroenterology, Endocrinology and Nutrition.,Hospital Universitario Reina Sofía, Spain
| | | | | | - Javier P Gisbert
- Hospital Universitario de La Princesa, Instituto de Investigación Sanitaria Princesa (IIS-IP) and Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBEREHD), Spain
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11
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Santos JCD, Malaguti C, Lucca FDA, Cabalzar AL, Ribeiro TCDR, Gaburri PD, Chebli LA, Chebli JMF. Impact of biological therapy on body composition of patients with Chron's disease. Rev Assoc Med Bras (1992) 2017; 63:407-413. [PMID: 28724037 DOI: 10.1590/1806-9282.63.05.407] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2016] [Accepted: 11/20/2016] [Indexed: 12/18/2022] Open
Abstract
Introduction: Protein-energy malnutrition in Crohn's disease (CD) has been reported in 20 to 92% of patients, and is associated with increased morbidity and mortality and higher costs for the health system. Anti-TNF drugs are a landmark in the clinical management, promoting prolonged remission in patients with CD. It is believed that the remission of this disease leads to nutritional recovery. The effect of biological therapy on body composition and nutritional status is unclear. Method: Prospective study of body assessment by bioelectrical impedance method in patients with moderate to severe CD undergoing treatment with infliximab. The main outcome was the body composition before and after 6 months of anti-TNF therapy. Results: There was a predominance of females (52%) with a mean age of 42±12 years. Most patients were eutrophic at baseline and remained so. There was an increase in all parameters of body composition after anti-TNF treatment: BMI (22.9±3.2 versus 25±3.8; p=0.005), waist circumference (88.1±6.7 versus 93.9±7.7; p=0.002), lean mass index (17.5±2.2 versus 18.2±2.3; p=0.000) and fat mass index (5.5±2.3 versus 6.8±2.3; p=0.000). Phase angle remained unchanged (6.2 versus 6.8; p=0.94). Conclusion: After therapy with IFX, all components of body composition increased, except for phase angle. The substantial increase in fat mass index and waist circumference led to concern regarding cardiovascular risk and, thus, to the need for further studies.
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Affiliation(s)
- Julianne Campos Dos Santos
- Department of Internal Medicine, Faculdade de Medicina da Universidade Federal de Juiz de Fora, Juiz de Fora, MG, Brazil
| | - Carla Malaguti
- Department of Cardiorespiratory and Musculoskeletal Physiotherapy, Faculdade de Fisioterapia da Universidade Federal de Juiz de Fora, Juiz de Fora, MG, Brazil
| | - Fernando de Azevedo Lucca
- Department of Internal Medicine, Faculdade de Medicina da Universidade Federal de Juiz de Fora, Juiz de Fora, MG, Brazil
| | - Andrea Lemos Cabalzar
- Department of Internal Medicine, Faculdade de Medicina da Universidade Federal de Juiz de Fora, Juiz de Fora, MG, Brazil
| | | | - Pedro Duarte Gaburri
- Department of Internal Medicine, Faculdade de Medicina da Universidade Federal de Juiz de Fora, Juiz de Fora, MG, Brazil
| | - Liliana Andrade Chebli
- Department of Internal Medicine, Faculdade de Medicina da Universidade Federal de Juiz de Fora, Juiz de Fora, MG, Brazil
| | - Julio Maria Fonseca Chebli
- Department of Internal Medicine, Faculdade de Medicina da Universidade Federal de Juiz de Fora, Juiz de Fora, MG, Brazil
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12
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Liu X, Wu X, Zhou C, Hu T, Ke J, Chen Y, He X, Zheng X, He X, Hu J, Zhi M, Gao X, Hu P, Wu X, Lan P. Preoperative hypoalbuminemia is associated with an increased risk for intra-abdominal septic complications after primary anastomosis for Crohn's disease. Gastroenterol Rep (Oxf) 2017; 5:298-304. [PMID: 29230300 PMCID: PMC5691863 DOI: 10.1093/gastro/gox002] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/19/2016] [Revised: 12/11/2016] [Accepted: 12/21/2016] [Indexed: 12/18/2022] Open
Abstract
Objective The aim of this study was to evaluate the impact of preoperative hypoalbuminemia on the development of intra-abdominal septic complications (IASCs) after primary anastomosis for patients with Crohn’s disease (CD). Methods All CD patients undergoing bowel resection with a primary anastomosis during the study period from 2007 to 2015 were enrolled. The association of preoperative hypoalbuminemia (<30 g/L) with the risk for IASCs were assessed using both univariate and multivariate analyses. Results A total of 124 eligible patients were included, 117 (94.4%) of whom had available preoperative albumin level. Preoperative hypoalbuminemia occurred in 13 (11.7%) patients. The duration from diagnosis to surgery was longer for patients with preoperative hypoalbuminemia than those without (p = 0.012). Patients with preoperative hypoalbuminemia were more likely to have a history of preoperative use of 5-aminosalicylic acid (p = 0.013) and have an intraoperative finding of small bowel obstruction (p = 0.015). Of all patients, 24 (19.4%) developed postoperative IASCs. Univariate analysis showed that patients with preoperative hypoalbuminemia had an increased risk for IASCs (p = 0.012). Multivariate analysis confirmed the association between preoperative hypoalbuminemia and IASCs (odds ratio 4.67, 95% confidence interval: 1.28–17.04, p = 0.02). Similar findings were also obtained when preoperative albumin level was analysed as a continuous variable (p = 0.019). Conclusions Preoperative hypoalbuminemia is a significant predictor for the development of postoperative IASCs in CD patients after bowel resection with a primary anastomosis. Favorable preoperative nutrition status might lessen the risk for IASCs.
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Affiliation(s)
- Xuanhui Liu
- Department of Colorectal Surgery, The Sixth Affiliated Hospital of Sun Yat-sen University, Guangzhou, Guangdong, China.,Guangdong Provincial Key Laboratory of Colorectal and Pelvic Floor Diseases, The Sixth Affiliated Hospital of Sun Yat-sen University, Guangzhou, Guangdong, China
| | - Xianrui Wu
- Department of Colorectal Surgery, The Sixth Affiliated Hospital of Sun Yat-sen University, Guangzhou, Guangdong, China.,Guangdong Provincial Key Laboratory of Colorectal and Pelvic Floor Diseases, The Sixth Affiliated Hospital of Sun Yat-sen University, Guangzhou, Guangdong, China
| | - Chi Zhou
- Department of Colorectal Surgery, The Sixth Affiliated Hospital of Sun Yat-sen University, Guangzhou, Guangdong, China.,Guangdong Provincial Key Laboratory of Colorectal and Pelvic Floor Diseases, The Sixth Affiliated Hospital of Sun Yat-sen University, Guangzhou, Guangdong, China
| | - Tuo Hu
- Department of Colorectal Surgery, The Sixth Affiliated Hospital of Sun Yat-sen University, Guangzhou, Guangdong, China.,Guangdong Provincial Key Laboratory of Colorectal and Pelvic Floor Diseases, The Sixth Affiliated Hospital of Sun Yat-sen University, Guangzhou, Guangdong, China
| | - Jia Ke
- Department of Colorectal Surgery, The Sixth Affiliated Hospital of Sun Yat-sen University, Guangzhou, Guangdong, China.,Guangdong Provincial Key Laboratory of Colorectal and Pelvic Floor Diseases, The Sixth Affiliated Hospital of Sun Yat-sen University, Guangzhou, Guangdong, China
| | - Yufeng Chen
- Department of Colorectal Surgery, The Sixth Affiliated Hospital of Sun Yat-sen University, Guangzhou, Guangdong, China.,Guangdong Provincial Key Laboratory of Colorectal and Pelvic Floor Diseases, The Sixth Affiliated Hospital of Sun Yat-sen University, Guangzhou, Guangdong, China
| | - Xiaosheng He
- Department of Colorectal Surgery, The Sixth Affiliated Hospital of Sun Yat-sen University, Guangzhou, Guangdong, China.,Guangdong Provincial Key Laboratory of Colorectal and Pelvic Floor Diseases, The Sixth Affiliated Hospital of Sun Yat-sen University, Guangzhou, Guangdong, China
| | - Xiaobin Zheng
- Department of Colorectal Surgery, The Sixth Affiliated Hospital of Sun Yat-sen University, Guangzhou, Guangdong, China.,Guangdong Provincial Key Laboratory of Colorectal and Pelvic Floor Diseases, The Sixth Affiliated Hospital of Sun Yat-sen University, Guangzhou, Guangdong, China
| | - Xiaowen He
- Department of Colorectal Surgery, The Sixth Affiliated Hospital of Sun Yat-sen University, Guangzhou, Guangdong, China.,Guangdong Provincial Key Laboratory of Colorectal and Pelvic Floor Diseases, The Sixth Affiliated Hospital of Sun Yat-sen University, Guangzhou, Guangdong, China
| | - Jiancong Hu
- Department of Colorectal Surgery, The Sixth Affiliated Hospital of Sun Yat-sen University, Guangzhou, Guangdong, China.,Guangdong Provincial Key Laboratory of Colorectal and Pelvic Floor Diseases, The Sixth Affiliated Hospital of Sun Yat-sen University, Guangzhou, Guangdong, China
| | - Min Zhi
- Department of Gastroenterology, The Sixth Affiliated Hospital of Sun Yat-sen University, Guangzhou, Guangdong, China
| | - Xiang Gao
- Department of Gastroenterology, The Sixth Affiliated Hospital of Sun Yat-sen University, Guangzhou, Guangdong, China
| | - Pinjin Hu
- Department of Gastroenterology, The Sixth Affiliated Hospital of Sun Yat-sen University, Guangzhou, Guangdong, China
| | - Xiaojian Wu
- Department of Colorectal Surgery, The Sixth Affiliated Hospital of Sun Yat-sen University, Guangzhou, Guangdong, China.,Guangdong Provincial Key Laboratory of Colorectal and Pelvic Floor Diseases, The Sixth Affiliated Hospital of Sun Yat-sen University, Guangzhou, Guangdong, China
| | - Ping Lan
- Department of Colorectal Surgery, The Sixth Affiliated Hospital of Sun Yat-sen University, Guangzhou, Guangdong, China.,Guangdong Provincial Key Laboratory of Colorectal and Pelvic Floor Diseases, The Sixth Affiliated Hospital of Sun Yat-sen University, Guangzhou, Guangdong, China
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13
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Abstract
BACKGROUND An epidemiological association implicating diet in IBD risk or protection is widely accepted. Patients with IBD often make links to diet, but there is a dearth of literature exploring dietary perceptions and practices in this population. Our objective was to evaluate dietary beliefs and behaviors in IBD patients. METHODS We developed a questionnaire assessing demographics, dietary beliefs and habits in IBD patients. This was prospectively administered to 400 consecutive patients attending our IBD clinics. RESULTS Mean patient age was 48.4 years; 55% were female, 88% white, 39% had Crohn's disease and 51% had ulcerative colitis. Around 48% felt that diet could be the initiating factor in IBD and 57% felt it could trigger a flare. Worsening symptoms with certain foods was reported by 60%. About 66% deprived themselves of their favorite foods in order to prevent relapse. Three-fourth of patients believed that IBD affects appetite, more so during a relapse. Nearly half had never received any formal dietary advice, and two-thirds requested for further dietary advice. After adjusting for other predictors, the IBD subtype and ethnicity of the patients remained as significant factors for influencing beliefs held by patients. CONCLUSIONS Our study showed that patients hold beliefs pertaining to the role of diet in IBD, with a high level of consistency around key perceived triggers. Whether all the symptoms reported are due to active inflammation cannot be ascertained, but the potential exists for dietary components triggering active disease and perpetuating gut injury, impacting on quality of life and health care costs.
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14
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Zhu W, Guo Z, Zuo L, Gong J, Li Y, Gu L, Cao L, Li N, Li J. CONSORT: Different End-Points of Preoperative Nutrition and Outcome of Bowel Resection of Crohn Disease: A Randomized Clinical Trial. Medicine (Baltimore) 2015; 94:e1175. [PMID: 26200619 PMCID: PMC4603011 DOI: 10.1097/md.0000000000001175] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
Nutritional therapy cannot only improve nutritional status but also reduce bowel inflammation in Crohn disease (CD). The benefits of preoperative nutritional therapy on outcomes of surgery for CD have been demonstrated. However, the ideal end-points of preoperative nutrition in CD remain elusive. We conducted this study to figure out whether improvement of malnutrition or reduction of inflammation is the better end-point of preoperative nutrition for CD. This was a prospective, randomized study. All patients enrolled received preoperative nutrition with different end-points (improvement of malnutrition, IOM, or reduction of inflammation, ROI). The end-points were defined using serum albumin and body weight gain, and serum C-reactive protein (CRP), respectively. Postoperative complications, rate of fecal diversion, and postoperative recurrence of the disease were compared. A total of 108 patients were randomized and 91 patients (44 in IOM group and 47 in ROI group) completed this study. It took 25.57 ± 11.68 days to achieve ROI and 45.29 ± 18.47 days for IOM (P = 0.0023). After nutritional therapy, serum CRP, CDAI, and serum albumin in both groups improved significantly. But patients in the IOM group had a higher albumin level and body weight gain compared with ROI group (P = 0.0026, P < 0.0001). When comparing postoperative complications, rate of fecal diversion, and postoperative recurrence, no significant differences were noted. Compared with IOM, ROI as the end-point of preoperative nutrition had the same benefits on operative outcomes in CD patients undergoing resection, but could be achieved in a shorter time (NCT01540942).
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Affiliation(s)
- Weiming Zhu
- From the Department of General Surgery, Jinling Hospital, Medical School of Nanjing University, Nanjing, PR China
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15
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Gomollón F, García-López S, Sicilia B, Gisbert JP, Hinojosa J. [Therapeutic guidelines on ulcerative colitis: a GRADE methodology based effort of GETECCU]. GASTROENTEROLOGIA Y HEPATOLOGIA 2014; 36:e1-47. [PMID: 24215088 DOI: 10.1016/j.gastrohep.2012.11.001] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
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16
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Abstract
Nutritional care and therapy forms an integral part of the management of patients with Crohn's disease (CD). Nutritional deficiencies result from reduced oral intake, malabsorption, medication side effects and systemic inflammation due to active disease. Enteral nutrition has a role in support for the malnourished patient, as well as in primary therapy to induce and maintain remission. The use of parenteral nutrition in CD is mainly limited to the preoperative setting or for patients with intestinal failure, but does not offer any additional advantage over EN in disease control. Dietary modifications, including elimination-reintroduction diets and a low fermentable, oligosaccharides, disaccharides, monosaccharides and polyols (FODMAP) diet may improve symptoms but there are currently no data to suggest that these approaches have any role in the induction or maintenance of remission.
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Affiliation(s)
- Clare F Donnellan
- Consultant Gastroenterologist, Leeds Gastroenterology Institute, Bexley Wing, Level 4, St James's University Hospital, Leeds LS9 7JT, UK
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17
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Massironi S, Rossi RE, Cavalcoli FA, Della Valle S, Fraquelli M, Conte D. Nutritional deficiencies in inflammatory bowel disease: therapeutic approaches. Clin Nutr 2013; 32:904-10. [PMID: 23602613 DOI: 10.1016/j.clnu.2013.03.020] [Citation(s) in RCA: 97] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2013] [Revised: 03/19/2013] [Accepted: 03/24/2013] [Indexed: 02/05/2023]
Abstract
BACKGROUND & AIMS Malnutrition is common in inflammatory bowel diseases (IBD), mainly in Crohn's disease (CD) because the small bowel is primarily affected. We reviewed the literature to highlight the importance of proper nutrition management. METHODS A PubMed search was performed for English-language publications from 1999 through 2012. Manuscripts comparing nutritional approaches for IBD patients were selected. RESULTS We identified 2025 manuscripts: six meta-analyses, 170 clinical-trials, 692 reviews. The study findings are discordant. In adult CD, enteral nutrition plays a supportive role, steroid therapy remaining the first choice treatment. In CD children enteral nutrition may represent the primary therapy. As regards parenteral nutrition, there are no large randomized studies, although mild improvements in morbidity have been described as a result of parenteral nutrition in malnourished surgical IBD patients. Specific micronutrient deficiencies are common in IBD. A number of factors may contribute to micronutrient deficiencies, and these include: dietary restriction, disease activity and surgery. The possible therapeutic roles of omega-3 fatty-acids, probiotics and prebiotics have been studied, but the results are still preliminary. CONCLUSION Protein-energy malnutrition and micronutrient depletion are clinical concerns in IBD patients. Enteral nutrition, parenteral nutrition and micronutrient supplementation are cornerstone of the multidisciplinary management of IBD patients.
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Affiliation(s)
- Sara Massironi
- Gastroenterology Unit II, Fondazione IRCCS Ca' Granda- Ospedale Maggiore Policlinico, Milan, Italy.
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18
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Zallot C, Quilliot D, Chevaux JB, Peyrin-Biroulet C, Guéant-Rodriguez RM, Freling E, Collet-Fenetrier B, Williet N, Ziegler O, Bigard MA, Guéant JL, Peyrin-Biroulet L. Dietary beliefs and behavior among inflammatory bowel disease patients. Inflamm Bowel Dis 2013; 19:66-72. [PMID: 22467242 DOI: 10.1002/ibd.22965] [Citation(s) in RCA: 158] [Impact Index Per Article: 14.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
BACKGROUND We investigated dietary beliefs and behavior in a large population of adult inflammatory bowel disease (IBD) patients and evaluated their impact on patients' social life. METHODS A questionnaire of 14 items was administered to all consecutive IBD patients followed at the Nancy University Hospital Department of Gastroenterology from February to July 2011. RESULTS A total of 244 patients participated in the survey; 15.6% (n = 38) of patients believed that diet could initiate the disease, while 57.8% (n = 141) believed that food can play a role in causing a relapse. Forty percent (107/244) of patients identified food as a risk factor for relapse. Seventy-three percent of respondents reported having already received nutritional advice. The majority of respondents (47.5%, n = 116) reported that the disease had changed the pleasure of eating. Only one-quarter of patients had a normal diet in case of relapse. Almost two out of three patients (66.8%, n = 163) reported not eating certain foods they usually like to eat in order to prevent a relapse. Dietary beliefs and behavior had an impact on their social life for one-fifth of patients. Excluding food was associated with refusing outdoor dining for fear of causing relapse (P = 0.006) and not sharing the same menu as the other members of the family living under the same roof (P = 0.002). CONCLUSIONS The majority of IBD patients are avoiding certain foods. Dietary beliefs and behavior have a strong impact on their social life.
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Affiliation(s)
- Camille Zallot
- Inserm, U954 and Department of Hepato-Gastroenterology, Nancy University Hospital, France
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19
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Gomollón F. [The future of inflammatory bowel disease from the perspective of Digestive Disease Week 2012]. GASTROENTEROLOGIA Y HEPATOLOGIA 2012; 35 Suppl 1:43-50. [PMID: 23018007 DOI: 10.1016/s0210-5705(12)70033-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
The new information presented in Digestive Disease Week has allowed us to speculate on the future of inflammatory bowel disease. Manipulation of diet and the microbioma will probably play an increasingly important role in the treatment of this disease and, in the long term, in its prevention. Biological agents will probably be used earlier and more widely; new information on levels of biological agents, mucosal healing and new comparative studies will also allow these agents to be used in a more precise and personalized way. In addition to infliximab, adalimumab, natalizumab and certolizumab, other biological agents will be employed; among the first of these to be used will be ustekinumab, golimumab and vedolizumab. In the near future, biological agents will be used as frequently in ulcerative colitis as in Crohn's disease. New healthcare models will be developed that will progressively include greater participation among patients and nurses. The ability to predict new diagnostic and prognostic models will allow decisions to be more individualized.
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Affiliation(s)
- Fernando Gomollón
- Servicio de Aparato Digestivo, Hospital Clínico Universitario Lozano Blesa, Instituto de Investigación Sanitaria de Aragón (IIS), Facultad de Medicina de Zaragoza y Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBEREHD), Zaragoza, Spain.
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20
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Nguyen LN, Lopes LCL, Cordero RJB, Nosanchuk JD. Sodium butyrate inhibits pathogenic yeast growth and enhances the functions of macrophages. J Antimicrob Chemother 2011; 66:2573-80. [DOI: 10.1093/jac/dkr358] [Citation(s) in RCA: 61] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
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21
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Bin CM, Flores C, Alvares-da-Silva MR, Francesconi CFM. Comparison between handgrip strength, subjective global assessment, anthropometry, and biochemical markers in assessing nutritional status of patients with Crohn's disease in clinical remission. Dig Dis Sci 2010; 55:137-44. [PMID: 19229617 DOI: 10.1007/s10620-008-0692-1] [Citation(s) in RCA: 38] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/07/2008] [Accepted: 12/29/2008] [Indexed: 12/12/2022]
Abstract
INTRODUCTION Crohn's disease (CD) may lead to protein and calorie malnutrition (PCM) secondary to impaired digestive and absorptive functions of the small intestine and sometimes to the influence of diet taboos. The earlier the PCM is diagnosed, the higher are the odds of reversal. The objective of this study was to compare different methods of nutritional assessment in patients with CD and correlate them with the disease characteristics. SAMPLE The sample comprised 75 patients with CD from the Gastroenterology Service at the Hospital de Clínicas de Porto Alegre; 37 were male, with a mean age of 38.2 years old (SD = 13.3). All patients had been in clinical remission (CDAI <150) for over 3 months. They were not receiving enteral or parenteral nutrition. The nutritional assessment was considered: body mass index (BMI), triceps skin fold (TSF), arm circumference (MAC), arm muscle circumference (MAMC), subjective global assessment (SGA), non-dominating handgrip strength (HGS) and food intake inquiries. RESULTS When comparing the different nutritional assessment methods, 26.7% of the patients were malnourished according to the MAC, 29.3% according to the MAMC, 18.7% according to the SGA, 6.7% according to the BMI, 37.3% according to the TSF and 73.3% according to the HGS. No statistically significant associations were found for disease location, its behavior, drugs utilized, ESR, CRP, age of patients and disease time with the nutritional state verified by HGS, TSF, MAMC and SGA. CONCLUSION The prevalence of malnutrition is significant in patients with CD, even in clinical remission. The BMI should not be used as reference in this population. The HGS detected a high prevalence of nutritional risk in patients with CD in remission. Studies are required that correlate it with more sensitive methods, for the patients' effective nutritional state assessment.
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Affiliation(s)
- Céres Maltz Bin
- Universidade Federal do Rio Grande do Sul (UFRGS), Rua Ramiro Barcelos, 2350, sala 2033, Porto Alegre, RS 90430-000, Brazil
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22
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Lucendo AJ, De Rezende LC. Importance of nutrition in inflammatory bowel disease. World J Gastroenterol 2009. [PMID: 19418580 DOI: 10.3748/wjg.15.] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 09/29/2022] Open
Abstract
Inflammatory bowel disease (IBD) results from the interaction between an individual's immune response and precipitant environmental factors, which generate an anomalous chronic inflammatory response in those who are genetically predisposed. Various feeding practices have been implicated in the origin of IBD based on epidemiological observations in developed countries, but we do not have solid evidence for the etiological role played by specific food types. IBD is associated with frequent nutritional deficiencies, the pattern and severity of which depends on the extent, duration and activity of the inflammation. Nutritional support allows these deficiencies in calories, macro- and micro-nutrients to be rectified. Enteral nutrition is also a primary therapy for IBD, especially for Crohn's disease, as it allows the inflammatory activity to be controlled, kept in remission, and prevents or delays the need for surgery. Nutritional support is especially important in childhood IBD as an alternative to pharmacological treatment. This report discusses the complex relationship between diet and IBD.
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Affiliation(s)
- Alfredo José Lucendo
- Department of Gastroenterology, Hospital General de Tomelloso, Vereda de Socuéllamos, s/n. 13700 Tomelloso, Ciudad Real, Spain.
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23
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Abstract
Inflammatory bowel disease (IBD) results from the interaction between an individual’s immune response and precipitant environmental factors, which generate an anomalous chronic inflammatory response in those who are genetically predisposed. Various feeding practices have been implicated in the origin of IBD based on epidemiological observations in developed countries, but we do not have solid evidence for the etiological role played by specific food types. IBD is associated with frequent nutritional deficiencies, the pattern and severity of which depends on the extent, duration and activity of the inflammation. Nutritional support allows these deficiencies in calories, macro- and micro-nutrients to be rectified. Enteral nutrition is also a primary therapy for IBD, especially for Crohn’s disease, as it allows the inflammatory activity to be controlled, kept in remission, and prevents or delays the need for surgery. Nutritional support is especially important in childhood IBD as an alternative to pharmacological treatment. This report discusses the complex relationship between diet and IBD.
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24
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Abstract
Nutrients may be involved in the modulation of the immune response through at least three different mechanisms. First, the intestinal ecosystem plays a pivotal role in the pathogenesis of inflammatory bowel disease, triggering the uncontrolled inflammatory response in genetically predisposed individuals. Nutrients, together with bacteria, are major components of, and can therefore influence, the intestinal environment. Second, as components of cell membranes, nutrients can mediate the expression of proteins involved in the immune response, such as cytokines, adhesion molecules and nitric oxide synthase. The composition of lipids in the cell membrane is modified by dietary changes and can influence cellular responses. Indeed, various epidemiological, experimental and clinical data suggest that the immune response may be sensitive to changes in dietary composition. Finally, suboptimal levels of micronutrients are often found in both children and adults with inflammatory bowel disease, although, with the exception of iron and folate, it is unusual to discover symptoms attributable to these deficits. However, subclinical deficits may have a pathophysiological significance, as they may favour the self-perpetuation of the disease (due to defects in the mechanisms of tissue repair), cause defective defence against damage produced by oxygen free radicals and facilitate lipid peroxidation. These events can occur even in clinically inactive or mildly active disease, as well as in the development of dysplasia in the intestinal mucosa. Some dietary manipulations have been attempted as primary treatment for rheumatoid arthritis, and specially formulated diets for enteral nutrition have proved to be an effective treatment for Crohn's disease. Most trials, although lacking sufficient patient numbers, have demonstrated a role for dietary manipulation as primary therapy for inflammatory disease. Dietary lipids are one of the most active nutritional substrates modulating the immune response. Recently, it has been demonstrated that lipids may be a key factor explaining the therapeutic effect of clinical nutrition in Crohn's disease.
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Affiliation(s)
- M A Gassull
- Department of Gastroenterology and Hepatology, Hospital Universitari Germans, Trias i Pujol, Catalonia, Spain.
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25
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Abstract
Major advances in the understanding of the aetio-pathogenesis and genetics of inflammatory bowel disease have been accompanied by an escalation in the sophistication of immunomodulatory inflammatory bowel disease therapeutics. However, the basic 'triple' therapy (5-aminosalicylates, corticosteroids, azathioprine) and nutrition have maintained their central role in the management of patients with inflammatory bowel disease over recent decades. This review provides an overview of the supportive and therapeutic perspectives of nutrition in adult inflammatory bowel disease. The objective of supportive nutrition is to correct malnutrition in terms of calorie intake or specific macro- or micronutrients. Of particular clinical relevance is deficiency in calcium, vitamin D, folate, vitamin B12 and zinc. There is justifiably a growing sense of unease amongst clinicians and patients with regard to the long-term use of corticosteroids in inflammatory bowel disease. This, rather than arguments about efficacy, should be the catalyst for revisiting the use of enteral nutrition as primary treatment in Crohn's disease. Treatment failure is usually related to a failure to comply with enteral nutrition. Potential factors that militate against successful completion of enteral nutrition are feed palatability, inability to stay on a solid-free diet for weeks, social inconvenience and transient feed-related adverse reactions. Actions that can be taken to improve treatment outcome include the provision of good support from dietitians and clinicians for the duration of treatment and the subsequent 'weaning' period. There is evidence to support a gradual return to a normal diet through exclusion-re-introduction or other dietary regimen following the completion of enteral nutrition to increase remission rates. We also review the evidence for emerging therapies, such as glutamine, growth factors and short-chain fatty acids. The future may see the evolution of enteral nutrition into an important therapeutic strategy, and the design of a 'Crohn's disease-specific formulation' that is individually tailored, acceptable to patients, cost-effective, free from adverse side-effects and combines enteral nutrition with novel pre- and pro-biotics and other factors.
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Affiliation(s)
- J Goh
- Gastrointestinal Unit, University Hospital Birmingham NHS Trust, Queen Elizabeth and Selly Oak Hospitals, UK.
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