Measurement of Nutrition Status in Crohn's Disease Patients Receiving Infliximab Therapy

Abstract

Aim There is limited information on the nutrition impact of antitumor necrosis factor-α treatment in adult Crohn's disease (CD). This study was performed to examine the effect of a 6-month course of infliximab on enterocyte function, nutrient status, metabolism, and body composition in these patients. Methods Seven CD patients were assessed for disease activity, enterocyte function, and body composition prior to, after 6 weeks, and after 6 months of infliximab treatment. Measurements included (1) disease activity: Inflammatory Bowel Disease Questionnaire, Harvey Bradshaw Index, and C-reactive protein; (2) enterocyte function: folate, homocysteine, vitamin B12, citrulline, vitamin D, β-carotene, d-xylose absorption; (3) Prognostic Inflammatory and Nutritional Index (PINI); and (4) body composition and metabolism: body mass index (BMI), fat and lean body mass, resting energy expenditure (RRE), and respiratory quotient. Results Most patients had improvement in disease activity with infliximab. PINI decreased in all patients (–3.35, P = .04). Plasma folate concentration significantly increased. There was an increase in BMI, fat mass, and lean body mass. The respiratory quotient increased in most patients. Changes in citrulline level and REE were inconsistent. Conclusions Crohn's disease patients have improvements in an index that measures both inflammation and nutrition (PINI) with infliximab therapy. Increases in plasma folate suggest improvement in enterocyte function and/or increased oral intake. The increase in respiratory quotient suggests decreased lipolysis and the lack of a starvation state. It was unclear whether weight gain was predominantly fat or lean muscle mass. These finding also support the use of PINI in Crohn's patients as an overall marker of inflammation and nutrition, and as a measure of response to infliximab therapy.

Impact of biological therapy on body composition of patients with Chron's disease

“…It should be noted that all patients had the body water percentage within normal values, so that FM and LM could not be affected by disturbances in the patients' hydration status. 21 Increased FM after treatment with anti-TNF in patients with CD has also been reported in the study by Wiese et al 34 The gain of FM in patients who achieved clinical remission after biological therapy can be explained by factors such as improvement in the quantity and quality of food intake due to absence of symptoms, less catabolism secondary to reduction of inflammation and, last, TNF-α blockade. TNF is a mediator of cachexia induced by inflammation.…”

Changes of energy metabolism, nutritional status and serum cytokine levels in patients with Crohn’s disease after anti-tumor necrosis factor-α therapy

“…Findings concerning the effects of anti-TNF-α therapy on energy metabolism in CD patients are controversial. Wiese et al (22) reported that RQ tended to increase after infliximab therapy ( p  = 0.07), whereas no increase was detected in the REE value. In contrast, Steiner et al (23) working with pediatric patients reported a significant reduction in RQ during parenteral nutrition after infliximab therapy.…”

Vitamin D Levels in Adults with Crohnʼs Disease Are Responsive to Disease Activity and Treatment

“…Previous studies have reported improvements in nutritional status and metabolism after infliximab therapy but did not measure vitamin D levels per se. 29,30 …”