Energy expenditure and body composition in children with Crohn’s disease: effect of enteral nutrition and treatment with prednisolone

Abstract

Background-Malnutrition and growth retardation are common complications of Crohn's disease in children. The contribution of resting energy expenditure (REE) to malnutrition is unclear. Aims-To characterise the REE and body composition in children with Crohn's disease and compare them with normal controls and patients with anorexia nervosa; to compare the eVects of prednisolone and enteral nutrition on energy expenditure and body composition. Subjects-Twenty four children with Crohn's disease, 19 malnourished females with anorexia nervosa, and 22 healthy control subjects were studied. Methods-In children with Crohn's disease measurements were done when the disease was acute and repeated at one and three months after treatment with either prednisolone or enteral nutrition. Resting energy expenditure was measured by indirect calorimetry and body composition by anthropometry, bioelectrical impedance analysis, total body potassium, H 2 18 O, and bromide space studies. Results-Body weight and ideal body weight were significantly lower in patients with Crohn's disease than in healthy controls. Lean tissue was depleted and there was an increase in extracellular water. Per unit of lean body mass, there was no diVerence between REE in patients with Crohn's disease and controls, whereas patients with anorexia nervosa had significantly reduced REE. With enteral nutrition all body compartments and REE increased significantly (p<0.001). In a subgroup of age-matched men there was a significant increase in height after three months of enteral nutrition compared with prednisolone (p<0.01). Those treated with steroids did not show a significant change in height but did show an increase in all body compartments. However, intracellular water as well as lean body mass accretion were significantly higher in the enteral nutrition group than in the prednisolone group. Conclusions-Despite being malnourished, children with Crohn's disease fail to adapt their REE per unit of lean body mass. This might be a factor contributing to their malnutrition. Lean tissue accretion is higher in patients treated with enteral nutrition than in those treated with prednisolone.

Comprehensive nutritional status in recently diagnosed patients with inflammatory bowel disease compared with population controls

“…In these patients malnutrition is often reported, especially in CD patients with active disease (Harries & Heatley, 1983;Fernandez-Banares et al, 1989Cristie & Hill, 1990;Janczewska et al, 1991;Stokes, 1992;Kuroki et al, 1993, Royall et al, 1995Teahon et al, 1995;Zurita et al, 1995;Ascue et al, 1997;Capristo et al, 1998). In a recent study, we found several nutritional and functional de®ciencies in patients with longstanding CD, currently in remission (Geerling et al, 1998a, b).…”

Impact of Disease and Treatments on Growth and Puberty of Pediatric Patients with Inflammatory Bowel Disease

“…As shown by several authors [23,24,25], children with active CD have significantly reduced energy intake, which normalizes during remission. Literature is controversial regarding the effect of IBD on resting energy expenditure (REE) [26,27,28,29], probably due to the way results are expressed. Even though REE tends to decrease in anorexia as a sparing mechanism, some authors found an increase in REE, presumably due to inflammation and body composition changes in IBD patients [26,27,28,29].…”

Corticosteroids Increase Protein Breakdown and Loss in Newly Diagnosed Pediatric Crohn Disease

“…In addition, the increased oxidation of leucine observed in their study suggested significant essential amino acid loss, with protein loss observed even in the postabsorptive state. However, enteral nutrition resulted in greater increases in fat free mass than corticosteroid therapy in children with active Crohn disease (22).…”