Nutritional Rehabilitation in Patients with Malnutrition Due to Crohn’s Disease

Abstract

Background: Crohn’s disease (CD) is a chronic inflammatory bowel disease frequently associated with malabsorption and secondary protein-energy malnutrition (PEM). Methods: Biochemical and clinical data of 63 (34 females, 29 males) patients with PEM due to CD sent to our outpatient unit for nutritional evaluation were retrospectively analyzed. Patients were divided into two groups, according to disease activity. Thirty-eight patients (group A) had the active disease, and 25 patients (group B) suffered from malabsorption resulting from past intestinal resections due to CD. After a physical and hemato-biochemical evaluation at the first visit, all patients received disease-specific personalized dietetic indications. When indicated, oral nutritional supplements, oral/parenteral vitamins, micronutrients, and electrolytes, up to parenteral nutrition, were prescribed. Results: After 1, 3, and 6 months of nutritional therapy, body weight, body mass index (BMI), and serum butyryl-cholinesterase significantly improved in both groups. In 8 out of 13 (61.5%) patients with a cutaneous stoma, intestinal continuity was restored. Conclusions: This study confirms the effectiveness of nutritional rehabilitation and provides information on the time required for nutritional treatment in patients with CD, both during the acute phase and after malabsorption due to intestinal resection.

Serum Cholinesterases, a Novel Marker of Clinical Activity in Inflammatory Bowel Disease: A Retrospective Case-Control Study

“…After nutritional therapy, serum BChE significantly improved in CD patients. On the other hand, the increased BChE levels after nutritional support demonstrated the recovery of nutritional status and liver protein synthesis [21]. Thus, we inferred that serum BChE levels may be more closely related to CD than to UC.…”

“…In our study, we used body mass index to represent the nutritional status of IBD patients, and we found that body mass index in CD patients was lower than that in UC patients. CD is frequently associated with malabsorption and secondary protein-energy malnutrition [21]. Nutritional interventions for the treatment of CD were consistently effective but were limited and were generally not effective for UC patients [22,23].…”

Nutrition in HIV-Infected Infants and Children: Current Knowledge, Existing Challenges, and New Dietary Management Opportunities

“…The primary cause of persistent intestinal inflammation has been linked to undernutrition and dysbiosis of the gut microbiome with PD as some of the major consequences (30)(31)(32)147). The WHO guidelines on the management of diarrhea in HIV-infected infants and children stipulates the use of vitamin A supplementation as a prevention strategy, whereas zinc supplementation, low-osmolarity oral rehydration solution (ORS), and daily micronutrients have been recommended as treatment (148).…”

“…Undernutrition is also characterized by functional and structural alterations in the intestinal mucosa, which is associated with chronic intestinal inflammation (22). The impact of undernutrition (30,31) and dysbiosis in the gut microbiome (32) has been hypothesized as a primary cause for persistent intestinal inflammation and epithelial damage.…”

Association between Health-Related Quality of Life and Nutritional Status in Adult Patients with Crohn’s Disease

“…Thus far, several studies have shown a close relationship between malnutrition and decreased quality of life in different populations [7][8][9][10][11][12][13][14], including subjects with IBD [15][16][17]. Malnutrition is frequently observed among patients with CD [18,19], and it is known to be associated with low muscle mass and an impaired functional status [15,17,20,21]. Recently, we have observed reduced muscle strength in CD patients compared to healthy controls, independent of disease activity and gender [21].…”