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Lepp HL, Amrein K, Dizdar OS, Casaer MP, Gundogan K, de Man AME, Rezzi S, van Zanten ARH, Shenkin A, Berger MM. LLL 44 - Module 3: Micronutrients in Chronic disease. Clin Nutr ESPEN 2024; 62:285-295. [PMID: 38875118 DOI: 10.1016/j.clnesp.2024.05.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2024] [Revised: 04/26/2024] [Accepted: 05/15/2024] [Indexed: 06/16/2024]
Abstract
Micronutrients (MN), i.e. trace elements and vitamins, are essential organic molecules, which are required in the diet in relatively small amounts in any form of nutrition (oral, enteral, parenteral). The probability of MN depletion or deficiencies should be considered in all chronic illnesses, especially in those that can interfere with intake, digestion, or intestinal absorption. Low socio-economic status and food deprivation are recognized as the most prevalent reasons for MN deficiencies world-wide. Elderly multimorbid patients with multimodal therapy, as well as patients with long-lasting menu restrictions, are at high risk for both disease related malnutrition as well as multiple MN deficiencies, needing careful specific follow-up. The importance of monitoring MN blood levels along with CRP is essential for optimal care. Drug interactions are also highlighted. In patients with chronic conditions depending on medical nutrition therapy, the provision of adequate dietary reference intakes (DRI) of MN doses and monitoring of their adequacy belongs to standard of care.
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Affiliation(s)
- Hanna-Liis Lepp
- North Estonia Medical Centre Foundation, Department of Clinical Nutrition, Tallinn, Estonia.
| | - Karin Amrein
- Medical University of Graz, Department of Internal Medicine, Division of Endocrinology and Diabetology, Austria.
| | - Oguzhan S Dizdar
- Department of Internal Medicine and Clinical Nutrition Unit, University of Health Sciences Kayseri City Training and Research Hospital, Kayseri, Turkey.
| | - Michael P Casaer
- KU Leuven, Department of Cellular and Molecular Medicine, Laboratory of Intensive Care Medicine, Leuven, Belgium.
| | - Kursat Gundogan
- Division of Intensive Care Medicine, Department of Internal Medicine, Erciyes University School of Medicine, Kayseri, Turkey.
| | - Angélique M E de Man
- Amsterdam UMC, Location Vrije Universiteit, Department of Intensive Care, The Netherlands; Amsterdam Cardiovascular Sciences, Amsterdam, The Netherlands.
| | - Serge Rezzi
- Swiss Nutrition and Health Foundation, Epalinges, Switzerland.
| | - Arthur R H van Zanten
- Amsterdam UMC, Location Vrije Universiteit, Department of Intensive Care, The Netherlands; Amsterdam Cardiovascular Sciences, Amsterdam, The Netherlands.
| | - Alan Shenkin
- Institute of Aging and Chronic Disease, University of Liverpool, Liverpool, UK.
| | - Mette M Berger
- Faculty of Biology & Medicine, Lausanne University, Lausanne, Switzerland.
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Viganò C, Palermo A, Mulinacci G, Pirola L, Losco A, Meucci G, Saibeni S, Pastorelli L, Amato A, Gatti M, Cortelezzi C, Di Sabatino A, Morganti D, Boni F, Grasso G, Casella G, Casini V, Caprioli FA, Vecchi M, Bezzio C, Bergna I, Radaelli F, Mengoli C, Massironi S. Prevalence of Disease-Related Malnutrition and Micronutrients Deficit in Patients with Inflammatory Bowel Disease: A Multicentric Cross-Sectional Study by the GSMII (Inflammatory Bowel Disease Study Group). Inflamm Bowel Dis 2024; 30:1112-1120. [PMID: 37536282 DOI: 10.1093/ibd/izad146] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/16/2022] [Indexed: 08/05/2023]
Abstract
BACKGROUND AND AIMS Inflammatory bowel disease (IBD) patients might experience disease-related malnutrition (DRM), but prevalence and risk factors are not well defined. The primary aim of the study was to define the prevalence of DRM and micronutrient deficiency in IBD patients; the secondary aim was to assess variables related to DRM. MATERIALS AND METHODS A multicenter, cross-sectional study was performed including consecutive adult IBD patients during a period of 2 weeks. Nutritional status was assessed with the body mass index (BMI) and the Malnutrition Universal Screening Tool. DRM was defined according to European Society for Clinical Nutrition and Metabolism guidelines. RESULTS Among the 295 enrolled patients, the prevalence of DRM was 23%, with no statistical difference between Crohn's disease and ulcerative colitis. Compared with well-nourished patients, patients with DRM showed higher rate of hospitalization in the previous month, were more often receiving systemic steroids, and had lower hemoglobin, albumin, and prealbumin levels and higher median C-reactive protein levels. At univariate logistic regression, current hospitalization, hospitalization in the previous month, low serum albumin, low BMI, high C-reactive protein, high Crohn's Disease Activity Index, and female sex were variables related to DRM. At the multivariate logistic regression, low BMI, current hospitalization and hospitalization in the previous month were significantly associated with DRM. In 23% of IBD patients, a deficiency of at least 1 micronutrient was observed, with no difference between ulcerative colitis and Crohn's disease. CONCLUSIONS DRM and microelements malnutrition are frequent conditions in the IBD population. DRM seems to be associated with disease activity and hospitalization.
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Affiliation(s)
- Chiara Viganò
- Division of Gastroenterology, Center for Autoimmune Liver Diseases, Department of Medicine and Surgery, University of Milano-Bicocca, Monza, Italy
- European Reference Network on Hepatological Diseases, Fondazione IRCCS San Gerardo dei Tintori, Monza, Italia
| | - Andrea Palermo
- Division of Gastroenterology, Center for Autoimmune Liver Diseases, Department of Medicine and Surgery, University of Milano-Bicocca, Monza, Italy
- European Reference Network on Hepatological Diseases, Fondazione IRCCS San Gerardo dei Tintori, Monza, Italia
| | - Giacomo Mulinacci
- Division of Gastroenterology, Center for Autoimmune Liver Diseases, Department of Medicine and Surgery, University of Milano-Bicocca, Monza, Italy
- European Reference Network on Hepatological Diseases, Fondazione IRCCS San Gerardo dei Tintori, Monza, Italia
| | - Lorena Pirola
- Division of Gastroenterology, Center for Autoimmune Liver Diseases, Department of Medicine and Surgery, University of Milano-Bicocca, Monza, Italy
- European Reference Network on Hepatological Diseases, Fondazione IRCCS San Gerardo dei Tintori, Monza, Italia
| | - Alessandra Losco
- Gastroenterology Unit, ASST Santi Paolo e Carlo, Ospedale San Carlo, Milan, Italy
| | | | - Simone Saibeni
- IBD Unit, Gastroenterology Unit, Rho Hospital, ASST Rhodense, Rho, Italy
| | - Luca Pastorelli
- Gastroenterology Unit, IRCSS Policlinico San Donato, San Donato Milanese, Italy
- Department of Health Sciences, University of Milan, Milan, Italy
| | - Arnaldo Amato
- Digestive Endoscopy and Gastroenterology Department, Manzoni Hospital, ASST Lecco, Lecco, Italy
| | - Mario Gatti
- Digestive Endoscopy, Ospedale di Carate, ASST Brianza, Carate Brianza, Italy
| | - Claudio Cortelezzi
- Digestive Endoscopy and Gastroenterology Department, ASST Settelaghi, Varese, Italy
| | - Antonio Di Sabatino
- First Department of Medicine, IRCCS San Matteo Hospital Foundation, University of Pavia, Pavia, Italy
| | - Daniela Morganti
- Department of Health Sciences, University of Milan, Milan, Italy
| | - Francesca Boni
- Department of Gastroenterology, ASST Melegnano Martesana, Melegnano, Italy
| | | | | | - Valentina Casini
- Gastroenterology and Endoscopy Unit, Ospedale Bolognini, ASST Bergamo Est, Seriate, Italy
| | - Flavio Andrea Caprioli
- Digestive Endoscopy and Gastroenterology Department, Fondazione IRCCS Ca' Granda, Ospedale Maggiore Policlinico, Università degli Studi di Milano, Milan, Italy
| | - Maurizio Vecchi
- Digestive Endoscopy, Presidio Ospedaliero Garbagnate, USC Gastroenterologia, ASST Rhodense, Rho, Italy
| | - Cristina Bezzio
- IBD Unit, Gastroenterology Unit, Rho Hospital, ASST Rhodense, Rho, Italy
| | - Irene Bergna
- Digestive Endoscopy and Gastroenterology Department, Manzoni Hospital, ASST Lecco, Lecco, Italy
| | | | - Caterina Mengoli
- First Department of Medicine, IRCCS San Matteo Hospital Foundation, University of Pavia, Pavia, Italy
| | - Sara Massironi
- Division of Gastroenterology, Center for Autoimmune Liver Diseases, Department of Medicine and Surgery, University of Milano-Bicocca, Monza, Italy
- European Reference Network on Hepatological Diseases, Fondazione IRCCS San Gerardo dei Tintori, Monza, Italia
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McDonnell M, Sartain S, Westoby C, Katarachia V, Wootton SA, Cummings JRF. Micronutrient Status in Adult Crohn's Disease during Clinical Remission: A Systematic Review. Nutrients 2023; 15:4777. [PMID: 38004171 PMCID: PMC10674454 DOI: 10.3390/nu15224777] [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: 10/10/2023] [Revised: 11/07/2023] [Accepted: 11/09/2023] [Indexed: 11/26/2023] Open
Abstract
Adults with Crohn's disease (CD) may be at risk of micronutrient insufficiency in clinical remission through restrictive eating, malabsorption, abnormal losses or inflammation. This systematic review synthesises the literature on micronutrient insufficiency in CD in clinical remission in terms of the prevalence of low circulating micronutrient concentrations and as a comparison against a healthy control (HC). Studies were included if the population was predominantly in remission. A total of 42 studies met the inclusion criteria; 12 were rated as low quality, leaving 30 studies covering 21 micronutrients of medium/high quality that were included in the synthesis. Vitamins D and B12 were the most frequently reported nutrients (8 and 11); there were few eligible studies for the remaining micronutrients. The prevalence studies were consistent in reporting individuals with low Vitamins A, B6, B12 and C, β-carotene, D, Magnesium, Selenium and Zinc. The comparator studies were inconsistent in finding differences with CD populations; Vitamin D, the most reported nutrient, was only lower than the HC in one-quarter of the studies. Adult CD populations are likely to contain individuals with low levels of one or more micronutrients, with the most substantial evidence for Vitamins D and B12. The studies on other micronutrients are of insufficient number, standardisation and quality to inform practice.
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Affiliation(s)
- Martin McDonnell
- Human Health and Development, Faculty of Medicine, University of Southampton, Southampton SO16 6YD, UK (V.K.); (S.A.W.)
- NIHR Biomedical Research Center, University Hospital Southampton, Southampton SO16 6YD, UK
| | - Stephanie Sartain
- Human Health and Development, Faculty of Medicine, University of Southampton, Southampton SO16 6YD, UK (V.K.); (S.A.W.)
- NIHR Biomedical Research Center, University Hospital Southampton, Southampton SO16 6YD, UK
| | - Catherine Westoby
- Human Health and Development, Faculty of Medicine, University of Southampton, Southampton SO16 6YD, UK (V.K.); (S.A.W.)
- NIHR Biomedical Research Center, University Hospital Southampton, Southampton SO16 6YD, UK
- Department of Dietetics, University Hospital Southampton, Southampton SO16 6YD, UK
| | - Vasiliki Katarachia
- Human Health and Development, Faculty of Medicine, University of Southampton, Southampton SO16 6YD, UK (V.K.); (S.A.W.)
- NIHR Biomedical Research Center, University Hospital Southampton, Southampton SO16 6YD, UK
- Department of Dietetics, University Hospital Southampton, Southampton SO16 6YD, UK
| | - Stephen A. Wootton
- Human Health and Development, Faculty of Medicine, University of Southampton, Southampton SO16 6YD, UK (V.K.); (S.A.W.)
- NIHR Biomedical Research Center, University Hospital Southampton, Southampton SO16 6YD, UK
| | - J. R. Fraser Cummings
- NIHR Biomedical Research Center, University Hospital Southampton, Southampton SO16 6YD, UK
- Clinical and Experimental Sciences, Faculty of Medicine, University of Southampton, Southampton SO16 6YD, UK
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Atherosclerotic Cardiovascular Disease in Inflammatory Bowel Disease: The Role of Chronic Inflammation and Platelet Aggregation. Medicina (B Aires) 2023; 59:medicina59030554. [PMID: 36984554 PMCID: PMC10059701 DOI: 10.3390/medicina59030554] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2023] [Revised: 03/03/2023] [Accepted: 03/06/2023] [Indexed: 03/14/2023] Open
Abstract
Background and Objectives: Atherosclerosis is one of inflammatory bowel disease’s most significant cardiovascular manifestations. This research aimed to examine the relationship between biochemical, haemostatic, and immune parameters of atherosclerosis and ulcerative colitis patients and its relationship to platelet aggregation. Materials and Methods: A clinical, observational cross-sectional study was performed, during which the tested parameters were compared in the experimental and control groups. The patients were divided into four groups. The first group had 25 patients who had ulcerative colitis and atherosclerosis. The second group included 39 patients with ulcerative colitis without atherosclerosis. The third group comprised 31 patients suffering from atherosclerosis without ulcerative colitis, and the fourth group comprised 25 healthy subjects. Results: In our study, we registered statistically higher levels of inflammatory markers like SE, CRP, Le, fecal calprotectin, TNF-α, and IL-6, as well as the higher value of thrombocytes and thrombocyte aggregation in the group of patients with ulcerative colitis compared to the control group. Lower levels of total cholesterol and LDL were also recorded in patients with ulcerative colitis and atherosclerosis and ulcerative colitis without atherosclerosis compared to healthy control. Triglyceride and remnant cholesterol were higher in patients with ulcerative colitis and atherosclerosis when compared to patients with ulcerative colitis and healthy control but lower than in patients with atherosclerosis only. Conclusions: Several inflammatory markers and platelet aggregation could be good discrimination markers for subjects with ulcerative colitis with the highest risk of atherosclerosis.
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Kaliora AC. Nutrition in inflammatory bowel diseases; Is there a role? Best Pract Res Clin Gastroenterol 2023; 62-63:101827. [PMID: 37094912 DOI: 10.1016/j.bpg.2023.101827] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/31/2022] [Revised: 02/10/2023] [Accepted: 02/15/2023] [Indexed: 04/26/2023]
Abstract
Nutrition is of paramount importance not only for healthy individuals, but all the more for the ones with pathologies interlinked with the diet. In that light, diet, when used accordingly can act in a protective manner in inflammatory bowel diseases. The interplay of diet and IBD is not thoroughly defined, and guidelines are a work in progress. However, significant knowledge has been gained with regard to foods and nutrients that may exacerbate or alleviate the core symptoms. Patients with IBD restrict from their diet a plethora of foods often arbitrary, thus depriving themselves from valuable constituents. Careful navigation into the newfound field of genetic variants and personalization of diet should be employed with avoidance of the Westernized diet, processed foods and additives, and focus on a holistic approach with a balanced diet rich in bioactive compounds in order to improve the quality of life of these patients and address diet-related deficiencies.
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Affiliation(s)
- Andriana C Kaliora
- Human Nutrition and Foods, Department of Dietetics-Nutrition Science, School of Health and Education Sciences, Harokopio University, 70 El. Venizelou Ave., 17676, Athens, Greece.
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Gordon BL, Galati JS, Yang S, Longman RS, Lukin D, Scherl EJ, Battat R. Prevalence and factors associated with vitamin C deficiency in inflammatory bowel disease. World J Gastroenterol 2022; 28:4834-4845. [PMID: 36156920 PMCID: PMC9476859 DOI: 10.3748/wjg.v28.i33.4834] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/14/2022] [Revised: 05/23/2022] [Accepted: 08/06/2022] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Patients with inflammatory bowel disease (IBD) are prone to several nutritional deficiencies. However, data are lacking on vitamin C deficiency in Crohn’s disease (CD) and ulcerative colitis (UC) patients, as well as the impact of clinical, biomarker and endoscopic disease severity on the development of vitamin C deficiency.
AIM To determine proportions and factors associated with vitamin C deficiency in CD and UC patients.
METHODS In this retrospective study, we obtained clinical, laboratory and endoscopic data from CD and UC patients presenting to the IBD clinic at a single tertiary care center from 2014 to 2019. All patients had an available plasma vitamin C level. Of 353 subjects who met initial search criteria using a cohort discovery tool, 301 ultimately met criteria for inclusion in the study. The primary aim described vitamin C deficiency (≤ 11.4 μmol/L) rates in IBD. Secondary analyses compared proportions with deficiency between active and inactive IBD. Multivariate logistic regression analysis evaluated factors associated with deficiency.
RESULTS Of 301 IBD patients, 21.6% had deficiency, including 24.4% of CD patients and 16.0% of UC patients. Patients with elevated C-reactive protein (CRP) (39.1% vs 16.9%, P < 0.001) and fecal calprotectin (50.0% vs 20.0%, P = 0.009) had significantly higher proportions of deficiency compared to those without. Penetrating disease (P = 0.03), obesity (P = 0.02) and current biologic use (P = 0.006) were also associated with deficiency on univariate analysis. On multivariate analysis, the objective inflammatory marker utilized for analysis (elevated CRP) was the only factor associated with deficiency (odds ratio = 3.1, 95% confidence interval: 1.5-6.6, P = 0.003). There was no difference in the presence of clinical symptoms of scurvy in those with vitamin C deficiency and those without.
CONCLUSION Vitamin C deficiency was common in IBD. Patients with elevated inflammatory markers and penetrating disease had higher rates of vitamin C deficiency.
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Affiliation(s)
- Benjamin Langan Gordon
- Department of Medicine, New York Presbyterian/Weill Cornell Medical Center, New York, NY 10065, United States
| | - Jonathan S Galati
- Department of Medicine, New York Presbyterian/Weill Cornell Medical Center, New York, NY 10065, United States
| | - Stevie Yang
- Department of Gastroenterology and Hepatology, New York Presbyterian/Weill Cornell Medical Center, New York, NY 10021, United States
| | - Randy S Longman
- Department of Gastroenterology and Hepatology, New York Presbyterian/Weill Cornell Medical Center, New York, NY 10021, United States
| | - Dana Lukin
- Department of Gastroenterology and Hepatology, New York Presbyterian/Weill Cornell Medical Center, New York, NY 10021, United States
| | - Ellen J Scherl
- Department of Gastroenterology and Hepatology, New York Presbyterian/Weill Cornell Medical Center, New York, NY 10021, United States
| | - Robert Battat
- Department of Gastroenterology and Hepatology, New York Presbyterian/Weill Cornell Medical Center, New York, NY 10021, United States
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Battat R, Sandborn WJ. Advances in the Comprehensive Management of Postoperative Crohn's Disease. Clin Gastroenterol Hepatol 2022; 20:1436-1449. [PMID: 33819666 DOI: 10.1016/j.cgh.2021.03.048] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/03/2021] [Revised: 03/21/2021] [Accepted: 03/30/2021] [Indexed: 02/06/2023]
Abstract
Patients with postoperative Crohn's disease are difficult to manage because of their risk of experiencing a more severe course, multiple symptom confounders, and poor sensitivity of symptomatic remission to rule out intestinal inflammation. In this group, data are lacking on biologic therapeutic efficacy, and recommendations are lacking for those with multiple medication failures. Novel noninvasive testing can simultaneously exclude alternate causes of symptoms (serum C4, fecal fat, small intestinal bowel overgrowth breath testing) and assess intestinal inflammation (fecal calprotectin, endoscopic healing index). In addition, endoscopy-based disease activity assessment and management are required. Endoscopy should be performed within 6 months of surgery, and aggressive disease activity monitoring can be considered with colonoscopy every 1-2 years subsequently to ensure late recurrence is detected. Patients with multiple resections should be screened for short bowel syndrome. Predictive biomarkers are needed to guide medication selection in this high-risk population. Postoperative prophylactic biologic therapy is prudent for patients with preoperative biologic failure. However, there are no high-quality data to guide which agent should be selected. Selecting biologics with an alternative mechanism of action in those who had failed a biologic with adequate drug concentrations and selection of different agents in those with previous intolerance are reasonable. Significantly more study is required to assess the efficacy of therapies in this setting.
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Affiliation(s)
- Robert Battat
- Jill Roberts Center for IBD, Division of Gastroenterology and Hepatology, Weill Cornell Medicine, New York, New York.
| | - William J Sandborn
- Division of Gastroenterology, University of California San Diego, La Jolla, California
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Battat R, Qatomah A, Kopylov U, Wyse J, Cohen A, Afif W, Lakatos PL, Seidman E, Bitton A, Bessissow T. Fucosyltransferase 2 Mutations Are Associated With a Favorable Clinical Course in Crohn's Disease. J Clin Gastroenterol 2022; 56:e166-e170. [PMID: 34739405 DOI: 10.1097/mcg.0000000000001626] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/27/2021] [Accepted: 09/07/2021] [Indexed: 12/10/2022]
Abstract
BACKGROUND Fucosyltransferase 2 (FUT2) participates in intestinal antigen secretion and bacterial adherence. FUT2 homozygous nonsense mutations (FUT2M) and subsequent nonsecretor status is associated with Crohn's disease (CD). The common null allele is rs601338. We assessed the relationship between FUT2M and disease course. METHODS In consecutive adult CD outpatients, clinical, biochemical, and genetic data were collected at baseline visits. Patients were longitudinally followed over 5 years. The primary outcome analyzed the relationship between FUT2M and rates of CD patients in persistent steroid-free clinical remission requiring neither surgery, biologics, nor immunomodulators. RESULTS Sixty-two CD patients were recruited. FUT2M homozygotes (rs601338 or any mutation in linkage disequilibrium) were detected in 27% of CD (17/62). Patients with rs601338 mutations had higher rates of the primary outcome (homozygous: 46.6%, heterozygous: 28.0%, wild-type: 5.3%, P=0.02). Similar findings existed for CD patients with homozygous mutations in any single-nucleotide polymorphism for FUT2 (homozygous: 41.2%, heterozygous: 25.9%, wild-type: 5.6%, P=0.04). On multivariable analysis, rs601338 mutation was associated with the primary outcome (odds ratio=3.4, 95% confidence interval: 1.3-8.7, P=0.01), while other parameters were not. Mutation of rs601338 was associated with lower rates of penetrating disease (homozygous: 13.3%, heterozygous: 28.0%, wild-type: 52.6%, P=0.05) and particularly in high-risk patients (homozygous: 0%, heterozygous: 37.5%, wild-type: 83.3%, P=0.01). CONCLUSIONS FUT2 mutation status is associated with a favorable clinical course in CD. Further confirmatory studies are needed.
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Affiliation(s)
- Robert Battat
- Division of Gastroenterology and Hepatology, Department of Medicine, Jill Roberts Center for Inflammatory Bowel Disease, Weill Cornell Medical College, New York, NY
- Division of Gastroenterology and Hepatology, McGill University Health Centre
| | - Abdulrahman Qatomah
- Division of Gastroenterology and Hepatology, McGill University Health Centre
| | - Uri Kopylov
- Department of Gastroenterology, Sheba Medical Center, Tel Hashomer
- Sackler Medical School, Tel Aviv, Israel
| | - Jonathan Wyse
- Division of Gastroenterology, Jewish General Hospital, McGill University, Montreal, QC, Canada
| | - Albert Cohen
- Division of Gastroenterology, Jewish General Hospital, McGill University, Montreal, QC, Canada
| | - Waqqas Afif
- Division of Gastroenterology and Hepatology, McGill University Health Centre
| | - Peter L Lakatos
- Division of Gastroenterology and Hepatology, McGill University Health Centre
- 1st Department of Medicine, Semmelweis University, Budapest, Hungary
| | - Ernest Seidman
- Division of Gastroenterology and Hepatology, McGill University Health Centre
| | - Alain Bitton
- Division of Gastroenterology and Hepatology, McGill University Health Centre
| | - Talat Bessissow
- Division of Gastroenterology and Hepatology, McGill University Health Centre
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9
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Sasson AN, Ingram RJM, Raman M, Ananthakrishnan AN. Nutrition in the Management of Inflammatory Bowel Diseases. Gastroenterol Clin North Am 2021; 50:151-167. [PMID: 33518162 DOI: 10.1016/j.gtc.2020.10.001] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
With the increasing global prevalence of inflammatory bowel diseases, research in this field is expanding to better understand the multifactorial etiologies of this complex disease. Nutrition and diet, as modifiable risk factors, have been shown to play an important role in disease activity and prognosis. This article reviews the role of nutrition in inflammatory bowel disease, including appropriate nutrition screening in this at-risk population, and associated micronutrient deficiencies. We provide recommendations on dosing supplementation. We briefly review diet as a risk factor for inflammatory bowel disease and the currently proposed published dietary intervention studies.
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Affiliation(s)
- Alexa N Sasson
- Division of Gastroenterology, University of Toronto, 27 King's College Circle, Toronto, Ontario M5S 2E4, Canada
| | - Richard J M Ingram
- Division of Gastroenterology, University of Calgary, 6D27 TRW Building, 3280 Hospital Drive Northwest, Calgary, Alberta T2N 4Z6, Canada
| | - Maitreyi Raman
- Division of Gastroenterology, University of Calgary, 6D33 TRW Building, 3280 Hospital Drive Northwest, Calgary, Alberta T2N 4Z6, Canada
| | - Ashwin N Ananthakrishnan
- Division of Gastroenterology, Massachusetts General Hospital and Harvard Medical School, 165 Cambridge Street, 9th Floor, Boston, MA 02114, USA.
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Anemia in Children With Inflammatory Bowel Disease: A Position Paper by the IBD Committee of the North American Society of Pediatric Gastroenterology, Hepatology and Nutrition. J Pediatr Gastroenterol Nutr 2020; 71:563-582. [PMID: 32947565 DOI: 10.1097/mpg.0000000000002885] [Citation(s) in RCA: 29] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Anemia is one of the most common extraintestinal manifestations of inflammatory bowel disease (IBD). It can be asymptomatic or associated with nonspecific symptoms, such as irritability, headaches, fatigue, dizziness, and anorexia. In IBD patients, the etiology of anemia is often multifactorial. Various causes include iron deficiency, anemia of inflammation and chronic disease, vitamin deficiencies, hemolysis, or myelosuppressive effect of drugs. Anemia and iron deficiency in these patients may be underestimated because of their insidious onset, lack of standardized screening practices, and possibly underappreciation that treatment of anemia is also required when treating IBD. Practitioners may hesitate to use oral preparations because of their intolerance whereas intravenous preparations are underutilized because of fear of adverse events, availability, and cost. Several publications in recent years have documented the safety and comparative efficacy of various intravenous preparations. This article reviews management of anemia in children with IBD, including diagnosis, etiopathogenesis, evaluation of a patient, protocol to screen and monitor patients for early detection and response to therapy, treatment including parenteral iron therapy, and newer approaches in management of anemia of chronic disease. This report has been compiled by a group of pediatric gastroenterologists serving on the North American Society for Pediatric Gastroenterology, Hepatology and Nutrition (NASPGHAN) IBD committee, in collaboration with a pediatric hematologist, pharmacist, and a registered dietician who specializes in pediatric IBD (IBD Anemia Working Group), after an extensive review of the current literature. The purpose of this review is to raise awareness of under-diagnosis of anemia in children with IBD and make recommendations for screening, testing, and treatment in this population.
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Mańkowska-Wierzbicka D, Karczewski J, Swora-Cwynar E, Dobrowolska A, Stelmach-Mardas M. The Clinical Importance of 21-Day Combined Parenteral and Enteral Nutrition in Active Inflammatory Bowel Disease Patients. Nutrients 2019; 11:nu11092246. [PMID: 31540473 PMCID: PMC6770879 DOI: 10.3390/nu11092246] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2019] [Revised: 09/12/2019] [Accepted: 09/13/2019] [Indexed: 12/13/2022] Open
Abstract
The aim of the study was to show the clinical magnitude of short-term feeding: enteral nutrition (EN) combined with parenteral nutrition (PN) in active Crohn’s disease and ulcerative colitis patients. Among 122 eligible inflammatory bowel disease (IBD) patients, 65 met the inclusion criteria. Combined EN and PN was administered for 21 days, wherein over the first 3–5 days of treatment, trophic enteral nutrition (300 kcal/day) was used with an energy increase of up to 1500 kcal. An EN was administered using a nasogastric tube or, in case of intolerance, using a naso-jejunal tube. For PN, the “All in One” system was used according to individually prepared admixtures (ESPEN Guidelines). In addition to routine blood measurement (i.e., ALAT, ASPAT, GGTP, creatinine, lipid profile), the following parameters were assessed: adiponectin, leptin, (hs)TNF-α, hsIL-6 and hsIL-10, TSH, NT-proBNP, serum vitamin B12 concentration, and tHcy. The results showed a considerable improvement in all clinically significant parameters (p < 0.05), showing the benefits and importance of short-term well-balanced EN combined with PN for nutritional and clinical status in IBD patients with active disease. The daily work at hospitals with active IBD patients demonstrates the potential of continued administration of home-based nutrition by patients.
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Affiliation(s)
- Dorota Mańkowska-Wierzbicka
- Department of Gastroenterology, Metabolic Diseases, Internal Medicine and Dietetics, Poznan University of Medical Sciences, Poznan 60-355, Poland.
| | - Jacek Karczewski
- Department of Gastroenterology, Metabolic Diseases, Internal Medicine and Dietetics, Poznan University of Medical Sciences, Poznan 60-355, Poland.
- Department of Environmental Medicine, Poznan University of Medical Sciences, Poznan 60-806, Poland.
| | - Ewelina Swora-Cwynar
- Department of Gastroenterology, Metabolic Diseases, Internal Medicine and Dietetics, Poznan University of Medical Sciences, Poznan 60-355, Poland.
| | - Agnieszka Dobrowolska
- Department of Gastroenterology, Metabolic Diseases, Internal Medicine and Dietetics, Poznan University of Medical Sciences, Poznan 60-355, Poland.
| | - Marta Stelmach-Mardas
- Department of Biophysics, Poznan University of Medical Sciences, Poznan 60-780, Poland.
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12
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Marcil V, Levy E, Amre D, Bitton A, Sant’Anna AMGDA, Szilagy A, Sinnett D, Seidman EG. A Cross-Sectional Study on Malnutrition in Inflammatory Bowel Disease: Is There a Difference Based on Pediatric or Adult Age Grouping? Inflamm Bowel Dis 2019; 25:1428-1441. [PMID: 30793155 PMCID: PMC6635818 DOI: 10.1093/ibd/izy403] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/13/2018] [Indexed: 02/07/2023]
Abstract
BACKGROUND Malnutrition, commonly observed in inflammatory bowel disease (IBD), is associated with increased morbidity and mortality and is attributed to multiple causes. The added energy costs of growth in the child and adolescent with IBD are an additional risk factor. METHODS The aim of the study was to perform a cross-sectional comparison of nutritional parameters in IBD between pediatric and adult cases. RESULTS We found that prevalence of undernutrition (low body mass index) and hypoalbuminemia was not different in pediatric, compared with adult patients. Anemia and iron deficiency were more often observed in pediatric subjects, compared with adults (59.1% vs 36.9%, respectively, P < 0.0001; and 37.9% vs 25.3%, P < 0.002). Vitamin B12 deficiency was significantly less common in the pediatric than in the adult group (5.4% vs 19.4%, P < 0.0001). Elevated C-reactive protein was more frequent in pediatric compared with adult cases (49.8% vs 38.4%, P < 0.01). CONCLUSIONS Patients with active Crohn's disease were more likely to be undernourished in both pediatric and adult populations. In both groups, predicators of undernutrition included low albumin levels (odds ratio [OR], 2.53; P < 0.006) and active disease (OR, 1.99; P < 0.03). Our results call for close surveillance of nutritional status for IBD patients, regardless of age.
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Affiliation(s)
- Valérie Marcil
- IBD Research Group, McGill University Health Center, Montreal, Quebec, Canada; Research Centre, Sainte-Justine UHC,Department of Nutrition, Université de Montréal, Montreal, Quebec, Canada
| | - Emile Levy
- Department of Nutrition, Université de Montréal, Montreal, Quebec, Canada
| | - Devendra Amre
- Pediatrics, Université de Montréal, Montreal, Quebec, Canada
| | - Alain Bitton
- IBD Research Group, McGill University Health Center, Montreal, Quebec, Canada; Research Centre, Sainte-Justine UHC
| | | | - Andrew Szilagy
- IBD Research Group, McGill University Health Center, Montreal, Quebec, Canada; Research Centre, Sainte-Justine UHC
| | - Daniel Sinnett
- Pediatrics, Université de Montréal, Montreal, Quebec, Canada
| | - Ernest G Seidman
- IBD Research Group, McGill University Health Center, Montreal, Quebec, Canada; Research Centre, Sainte-Justine UHC,Address correspondence to: Ernest Seidman, MD, Center for IBD Research, Research Institute of the McGill University Health Center, MGH Campus, 1650 Cedar Avenue, #C10.145, Montreal, Quebec, Canada, H3G 1A4 ()
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13
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Kilby K, Mathias H, Boisvenue L, Heisler C, Jones JL. Micronutrient Absorption and Related Outcomes in People with Inflammatory Bowel Disease: A Review. Nutrients 2019; 11:E1388. [PMID: 31226828 PMCID: PMC6627381 DOI: 10.3390/nu11061388] [Citation(s) in RCA: 38] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2019] [Revised: 05/31/2019] [Accepted: 06/08/2019] [Indexed: 12/14/2022] Open
Abstract
Inflammatory Bowel Disease (IBD) is a chronic disorder associated with immune dysregulation and chronic inflammation of the digestive tract. While it is poorly understood, the role of nutrition and nutrient status in the etiology of IBD and its associated outcomes has led to increased research relating to micronutrient deficiency. This review offers an overview of recent literature related to micronutrient absorption and outcomes in adults with IBD. Although the absorption and IBD-related outcomes of some micronutrients (e.g., vitamin D and iron) are well understood, other micronutrients (e.g., vitamin A) require further research. Increased research and clinician knowledge of the relationship between micronutrients and IBD may manifest in improved nutrient screening, monitoring, treatment, and outcomes for people living with IBD.
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Affiliation(s)
- Kyle Kilby
- Faculty of Medicine, Dalhousie University, 1459 Oxford Street, Halifax, NS B3J 4R2, Canada.
| | - Holly Mathias
- School of Health and Human Performance, Dalhousie University, 6230 South Street, Halifax, NS B3H 1T8, Canada.
| | - Lindsay Boisvenue
- Seaway Valley Community Health Care, 353 Pitt Street, Cornwall, ON K6J 3R1, Canada.
| | - Courtney Heisler
- Nova Scotia Collaborative Inflammatory Bowel Disease Program, Division of Digestive Care and Endoscopy, QEII Health Science Centre, Room 932, Victoria Building, 1276 South Park Street, Halifax, NS B3H 2Y9, Canada.
| | - Jennifer L Jones
- Nova Scotia Collaborative Inflammatory Bowel Disease Program, Division of Digestive Care and Endoscopy, QEII Health Science Centre, Room 932, Victoria Building, 1276 South Park Street, Halifax, NS B3H 2Y9, Canada.
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