Enteral Nutrition in Adult Crohn’s Disease: Toward a Paradigm Shift

Di, Simona; Fragkos, Konstantinos C.; Keetarut, Katie; Koo, Hui Fen; Sebepos‐Rogers, Gregory; Saravanapavan, Hajeena; Barragry, John; Rogers, James P.; Mehta, Shameer; Rahman, Farooq

doi:10.3390/nu11092222

Cited by 31 publications

(36 citation statements)

References 177 publications

(279 reference statements)

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“…PEN in CD is known to be associated with an extended period of disease remission. 48 We acknowledge certain limitations including, the relatively small number of children in VEOIBD group and inability to perform mutation analysis in a large fraction of children. We did not assess all the PIBD patients routinely for growth failure-so we could not assess the extent of growth failure in various groups which is important aspect of PIBD specially in CD.…”

Section: Discussionmentioning

confidence: 99%

Very early onset inflammatory bowel disease in a South Asian country where inflammatory bowel disease is emerging: a distinct clinical phenotype from later onset disease

et al. 2021

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cluding a severe and aggressive course of disease, predominant colonic involvement and a higher incidence of familial IBD compared to PIBD other than VEOIBD (6-17 years). 1 The incidence of PIBD is on the rise globally. 2 A complex interplay of genetic and changing environmental factors has been implicated for the rising incidence although specific factors are yet to be completely understood. 2-6 Most of the epidemiological data however are from the West including North America, Canada, and Europe. 3 A few recent studies from Asia also suggest a rising trend of PIBD. Interestingly the phenotype appears to be distinct from that of the West including a milder ulcerative colitis (UC) and a higher perianal

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Section: Discussionmentioning

confidence: 99%

Very early onset inflammatory bowel disease in a South Asian country where inflammatory bowel disease is emerging: a distinct clinical phenotype from later onset disease

et al. 2021

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“… 9 Hypotheses were generated on the impact of EN intervention on the gut microbiome, mucosal integrity, and the immune system, the three components of the current inflammatory bowel disease (IBD) paradigm. 10 Some studies investigated dietary effects on the intestinal microbiota by tracing changes in the levels of some bacterial metabolites, while others investigated the potential impact on gene regulation for cell growth and inflammatory pathways. 10 – 17 Studying the effects on the metabolome, characterizing small molecules that are intermediate or end products of biochemical reactions, may provide insights on an individual’s genome and its interactions with environmental exposures that affect cellular metabolism and functions.…”

Section: Introductionmentioning

confidence: 99%

Metabolomic Signatures in Pediatric Crohn’s Disease Patients with Mild or Quiescent Disease Treated with Partial Enteral Nutrition: A Feasibility Study

Marques¹,

Shokry²,

Frivolt

et al. 2021

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Little is known about the metabolic response of pediatric Crohn’s disease (CD) patients to partial enteral nutrition (PEN) therapy and the impact of disease activity and inflammation. We analyzed plasma samples from a nonrandomized controlled intervention study investigating the effect of partial enteral nutrition (PEN) on bone health and growth throughout one year with untargeted metabolomics using high-performance liquid chromatography (HPLC) coupled with high-resolution mass spectrometry (HRMS). Thirty-four paired samples from two time points (baseline and 12 months) were analyzed. Patients (median age: 13.9 years, range: 7–18.9 years, 44% females) were in remission or had mild disease activity. The intervention group received a casein-based formula for 12 months, providing ~25% of estimated daily energy requirements. Sparse partial least squares discriminant analysis (splsda) was applied for group discrimination and identifying sources of variation to identify the impact of PEN. We also investigated the correlation of metabolites with inflammation markers, including erythrocyte sedimentation rate (ESR), C-reactive protein (CRP), and fecal calprotectin. After 12 months, our results show substantial difference between PEN and non-PEN groups in the metabolome of CD patients in remission or with mild disease activity. Inflammatory markers were associated with individual compounds and chemical classes such as isoprenoids and phospholipids. Identified compounds comprise metabolites produced by human or bacterial metabolism, as well as xenobiotics recognized as flavoring agents and environmental contaminants and their biotransformation products. Further longitudinal studies that also include patients with higher disease activity are warranted to evaluate the suitability of these metabolic biomarkers for predicting disease activity.

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Section: Introductionmentioning

confidence: 99%

“…Enteral nutrition (EN) can reduce Crohn's disease (CD) activity and maintain remission in both children and adults [1,2]. According to the international guidelines, nutritional support using orally administered liquid formulas should be considered for CD patients, serious cases of ulcerative colitis (UC), in combination with steroids in undernourished individuals, in cases of steroid intolerance, and in patients with stenosis of the small intestine [1][2][3][4]. Transforming Growth Factor-β (TGFβ), a polypeptide present in both human and bovine milk, has been shown to play an important role in the development of immune tolerance and the prevention of autoimmunity, being concurrently an inhibitor of intestinal epithelial cell growth and a stimulator of intestinal epithelial cell differentiation [5].…”

Section: Introductionmentioning

confidence: 99%

Enteral Nutrition Supplemented with Transforming Growth Factor-β, Colostrum, Probiotics, and Other Nutritional Compounds in the Treatment of Patients with Inflammatory Bowel Disease

2020

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Enteral nutrition seems to play a significant role in the treatment of both adults and children with active Crohn’s disease, and to a lesser degree in the treatment of patients with active ulcerative colitis. The inclusion of some special factors in the enteral nutrition formulas might increase the rate of the efficacy. Actually, enteral nutrition enriched in Transforming Growth Factor-β reduced the activity index and maintained remission in patients with Crohn’s disease. In addition, a number of experimental animal studies have shown that colostrum exerts a significantly positive result. Probiotics of a special type and a certain dosage could also reduce the inflammatory process in patients with active ulcerative colitis. Therefore, the addition of these factors in an enteral nutrition formula might increase its effectiveness. Although the use of these formulas is not supported by large clinical trials, it could be argued that their administration in selected cases as an exclusive diet or in combination with the drugs used in patients with inflammatory bowel disease could benefit the patient. In this review, the authors provide an update on the role of enteral nutrition, supplemented with Transforming Growth Factor-β, colostrum, and probiotics in patients with inflammatory bowel disease.

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Enteral Nutrition in Adult Crohn’s Disease: Toward a Paradigm Shift

Cited by 31 publications

References 177 publications

Very early onset inflammatory bowel disease in a South Asian country where inflammatory bowel disease is emerging: a distinct clinical phenotype from later onset disease

Very early onset inflammatory bowel disease in a South Asian country where inflammatory bowel disease is emerging: a distinct clinical phenotype from later onset disease

Metabolomic Signatures in Pediatric Crohn’s Disease Patients with Mild or Quiescent Disease Treated with Partial Enteral Nutrition: A Feasibility Study

Enteral Nutrition Supplemented with Transforming Growth Factor-β, Colostrum, Probiotics, and Other Nutritional Compounds in the Treatment of Patients with Inflammatory Bowel Disease

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