Nutritional modulation of the inflammatory response in inflammatory bowel disease- From the molecular to the integrative to the clinical

DESCRITORES -Doença InflamatóriaIntestinal. Avaliação nutricional. Obesidade. ABSTRACT -Background -The inflammatory bowel diseases are characterized by multiple digestive tract symptoms and therefore may interfere with nutritional status. Aim -To assess the nutritional status of patients with inflammatory bowel disease in different stages of inflammatory activity. Methods -Fifty five patients with inflammatory bowel disease were demographically evaluated with weight measurement, height, arm circumference and triceps skinfold and had their body composition determined by bioelectrical impedance. For determination of inflammatory activity of the disease were used serum C-reactive protein and the index of Harvey and Bradshaw. To compare means it was used the unpaired t test, and the average non-parametric, the Mann-Whitney test, level of significance p <0.05. Results -Among the patients, 28 had Crohn's disease and 27 ulcerative colitis, aged between 19 and 63 years and time since diagnosis 1-22 years. There was no difference in anthropometric measurements and body composition of patients whose disease was inflammatory activity or in remission. Patients who used glucocorticoids in the six months preceding the assessment showed body fat percentage of 23.4 ± 8.2% whilst those who did not use the percentage was 30.7 ± 11.3 (p <0.0199). The most common gastrointestinal symptoms were abdominal distension (41%), diarrhea (18%), nausea (13%), constipation (12%), anorexia (11%) and vomiting (5%). All symptoms were more common in patients with higher body mass index and body fat. Conclusion -There were more patients with excess weight and body fat, and these patients were more symptomatic and had higher values of C-reactive protein. RESUMO -Racional

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“…Não se sabe a causa da DII mas sabe-se que existe interação entre fatores genéticos, ambientais e imunes 29 .…”

Section: Introductionunclassified

Relação entre estado nutricional e atividade inflamatória em pacientes com doença inflamatória intestinal

Silva

Schieferdecker

Rocco

et al. 2010

ABCD, arq. bras. cir. dig.

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“…It must be put in mind, that the present study evaluated only nutrient intake according to dietary recall, not considering the use of supplements such as folate, calcium and vitamin D used by some patients. It is known that drug treatment of IBD with sulfasalazine decreases the absorption of folic acid and corticosteroids reduce calcium absorption 33 . It is well established that patients treated with corticosteroids should receive supplementation of cholecalciferol 800-1000 IE / 1000 mg / d calcium ion 21 .…”

Section: Discussionmentioning

confidence: 99%

“…The cause of IBD is still unknown and there is interaction between genetic, environmental and immune influences 33 . Nutritional status in IBD may be affected by reduction in food intake caused by gastrointestinal symptoms, malabsorption and for drug treatment, with larger changes in the acute phase of illness.…”

mentioning

confidence: 99%

Ingestão alimentar em pacientes com doença inflamatória intestinal

Silva¹,

Schieferdecker²,

Amarante³

2011

ABCD, arq. bras. cir. dig.

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-Background -Patients with inflammatory bowel disease may have nutritional deficiencies. Aim -To verify the adequacy of dietary intake of patients with Crohn's disease and ulcerative colitis. Methods -To assess food intake of 55 patients, 28 with Crohn's disease and 27 with ulcerative colitis treated in the gastroenterology clinic, was used the 24-Hour Food Recall and Food Frequency Questionnaire. The inflammatory activity of the disease was evaluated by serum C-reactive protein and Harvey and Bradshaw Index. For comparison of means t test was used, and the average on non-parametric, the Mann-Whitney test, with level of significance p <0.05. Results -The patients were aged between 19 and 63 years and time since diagnosis was 7.9 years (1 to 22). According to the food intake was identified deficiency in energy intake, fiber, iron, potassium, sodium, magnesium, calcium, menadione, riboflavin, niacin, folate, pantothenic acid, tocopherol and cholecalciferol in Crohn's disease and ulcerative colitis, active or in remission. The intake of vegetables, fruits, dairy products and beans were low, and intake of fats and sweets was higher than the recommendations. Conclusion -There was a deficiency in food intake both in Crohn's disease and in ulcerative colitis, in activity and in remission. These deficiencies can adversely affect the disease course, and justify the need for nutritional intervention with these patients. ABCDDV/794RESUMO -Racional -Pacientes com doença inflamatória intestinal podem apresentar deficiências nutricionais. Objetivo -Verificar a adequação da ingestão alimentar de pacientes com doença de Crohn e retocolite ulcerativa inespecífica. Métodos -Para avaliação da ingestão alimentar de 55 pacientes, 28 com doença de Crohn e 27 com retocolite ulcerativa atendidos em ambulatório de gastroenterologia, utilizou-se o Recordatório Alimentar de 24 Horas e o Questionário de Frequência Alimentar. A atividade inflamatória da doença foi avaliada pelos níveis séricos de proteína C reativa e o Índice de Harvey e Bradshaw. Para comparação de médias foi usado o teste t não pareado e, para as médias não paramétricas, o teste de Mann-Whitney, considerando nível de significância valor de p<0,05. Resultados -Os pacientes tinham idade entre 19 e 63 anos e tempo de diagnóstico de 7,9 anos (1 a 22). De acordo com a ingestão alimentar identificou-se deficiência na ingestão de energia, fibras, ferro, potássio, sódio, magnésio, cálcio, menadiona, riboflavina, niacina, folato, ácido pantotênico, tocoferol e colecalciferol na doença de Crohn e na retocolite ulcerativa em atividade ou em remissão. A ingestão de legumes, frutas, laticínios e feijão foi baixa, e a de doces e gorduras foi maior que as recomendações. Conclusão -Houve deficiência na ingestão alimentar tanto na doença de Crohn como na retocolite ulcerativa, em atividade e em remissão. Essas deficiências podem afetar negativamente o curso da doença e justificam a necessidade de intervenção nutricional com esses pacientes.

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“…The use of TPN in the management of active CD is based on theoretical advantages including bowel rest, which could reduce the motor and transport functions of the diseased bowel; reduction of antigenic stimulation, which could eliminate the immunological response to food favored by the presence of impaired intestinal permeability; and stimulation of protein synthesis, which could lead to cell renewal and mucosal healing in the intestine (35). Nevertheless, few controlled clinical trials have been conducted on the use of TPN to induce remission in active CD.…”

Section: Nutritional Induction Therapymentioning

confidence: 99%

Nutritional treatment in inflammatory bowel disease: An update

Guagnozzi

González-Castillo

Olveira

et al. 2012

Rev. esp. enferm. dig.

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Background and aims: enteral (EN) and parenteral (TPN) nutrition exert variable therapeutic effects on the induction and maintenance of remission in inflammatory bowel disease (IBD).This review aims to provide an updated discussion on the complex relationship between diet and IBD.Methods: medline, Cochrane and Scopus database searches were conducted. Sources cited in the articles obtained were also searched to identify other potential sources of information.Results: nutritional status is significantly compromised in IBD patients, especially those with Crohn's disease (CD). Apart from restoring malnourishment, dietary components contribute to modulate intestinal immune responses. Nutritional treatment is divided into support therapy and primary therapy to induce and maintain remission through TPN and EN. EN is considered a first-line therapy in children with active CD whereas it is usually used in adult CD patients when corticosteroid therapy is not possible. TPN has limited effects on IBD.En formula composition, in terms of carbohydrates, nitrogen source and bioactive molecules supplementation, differentially influence on IBD treatment outcomes. Other dietary components, such as poorly absorbed short-chain carbohydrate, polyols, and exogenous microparticles, also participate in the etiopathogenesis of IBD. Finally, new approaches to understanding the complex relationship between IBD and diet are provided by nutrigenenomic.Conclusion: further long-term, well-powered studies are required to accurately assess the usefulness of nutrition in treating IBD. In future research, the potential role of nutrient-gene interaction in drug trials and specific dietary formula compositions should be investigated in order to incorporate new knowledge about the etiopathology of IBD into nutritional intervention.

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Nutritional modulation of the inflammatory response in inflammatory bowel disease- From the molecular to the integrative to the clinical

Cited by 43 publications

References 96 publications

Relação entre estado nutricional e atividade inflamatória em pacientes com doença inflamatória intestinal

Relação entre estado nutricional e atividade inflamatória em pacientes com doença inflamatória intestinal

Ingestão alimentar em pacientes com doença inflamatória intestinal

Nutritional treatment in inflammatory bowel disease: An update

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