Fat composition may be a clue to explain the primary therapeutic effect of enteral nutrition in Crohn's disease: results of a double blind randomised multicentre European trial

Gassull, Miquel A.; Fernández‐Bañares, Fernando; Cabré, Eduard; Papo, Matthias; Giaffer, M. H.; Sánchez-Lombraña, J L; Richart, C; Malchow, H; González-Húix, Ferrán; Esteve, María

doi:10.1136/gut.51.2.164

Cited by 160 publications

(115 citation statements)

References 21 publications

(27 reference statements)

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“…In a previous study performed in this same population, we observed that a high intake of total, monounsaturated fat, as well as a higher ratio of n6/n3 polyunsaturated fatty acids, were associated with a more active disease. 15 Fat intake is now regarded as a potent immunomodulatory therapy in patients with CD [30][31][32][33][34][35] either by modulating eicosanoid synthesis, by altering cell membrane fluidity, cell signal transduction, or even gene expression. More interestingly, Gassull et al, 30 in a randomized controlled study performed in patients with active CD, examined the effects of an n-6-versus an n-9-enriched diet as compared with conventional therapy with steroids.…”

Section: Discussionmentioning

confidence: 99%

“…15 Fat intake is now regarded as a potent immunomodulatory therapy in patients with CD [30][31][32][33][34][35] either by modulating eicosanoid synthesis, by altering cell membrane fluidity, cell signal transduction, or even gene expression. More interestingly, Gassull et al, 30 in a randomized controlled study performed in patients with active CD, examined the effects of an n-6-versus an n-9-enriched diet as compared with conventional therapy with steroids. The study was prematurely stopped because, as opposed to what was expected, patients treated with an n-9-enriched diet had a much lower response rate compared with the other two groups.…”

Section: Discussionmentioning

confidence: 99%

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Risk factors for metabolic bone disease in Crohnʼs disease patients

Cravo

Guerreiro

Santos

et al. 2010

Inflammatory Bowel Diseases

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Risk factors for metabolic bone disease in Crohnʼs disease patients

Cravo

Guerreiro

Santos

et al. 2010

Inflammatory Bowel Diseases

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“…Dietary fat, in particular, has been shown to negatively influence elemental diet therapy [88,89]. Effects on arachidonic acid metabolism and prostaglandin synthesis have been postulated as mechanisms by which dietary fat may influence inflammation [89,90], but changes in the composition of bile may also be important. Although bile salts have important physiological properties, they may play a role in disease.…”

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confidence: 99%

Crohn’s disease as an immunodeficiency

Hayee

Rahman

Sewell

et al. 2010

Expert Review of Clinical Immunology

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The pathogenesis of Crohn's disease (CD) has widely been regarded as the consequence of a dysregulated T-cell-mediated response to intestinal microbes, and the majority of the worldwide research effort has focused on characterizing and treating the chronic inflammatory phase of the disease. However, recent molecular biological and clinical investigations indicate that CD is actually a primary immunodeficiency. At first counter-intuitive, the apparent paradox of a pathogenic innate immune defect can be linked mechanistically to the granulomatous chronic inflammation characteristic of the disease. Genome-wide association studies have corroborated the involvement of innate immune dysfunction in the pathogenesis of CD, but less than 20% of the heritable risk is accounted for. By contrast, in vitro and in vivo stimulation of the immune system has highlighted novel areas of interest that may lead to the development of targeted therapeutic and diagnostic tools. Keywordsbacteria; Crohn's disease; immunodeficiency; innate immunity; macrophage; neutrophil Established intestinal lesions in Crohn's disease (CD) contain a massive, mixed inflammatory cell infiltrate associated with a complex storm of cytokines in a selfperpetuating, chronic inflammatory response [1][2][3]. Most research to date has focused on the the immunological characteristics of established lesions and drawn inferences about their initiation. The predominance of a classically Th1-associated cytokine profile in these lesions led to the assumption that T lymphocytes were central to the initial pathogenesis. More recently, the role of regulatory (Treg) FoxP3 + and IL-23-induced responsive Th17-type T lymphocytes has gained popularity [2,4,5]. Treg cell populations are diminished in patients with CD [6] and, although the hypothesis of CD as an immunodeficiency does not necessarily exclude defects in T-cell function, to date, no convincing intrinsic (primary) defect has been identified to implicate these cells in the pathogenesis of human CD.The hypothesis that immunodeficiency underpins the development of CD seems, at first, to be in direct contrast with histological observations of established intestinal lesions and the † Author for correspondence: Tel.: +44 207 679 6170 Fax: +44 207 679 0967 b.hayee@nhs.net. Financial & competing interests disclosure The authors have no other relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript apart from those disclosed. Europe PMC Funders Group Association between immunodeficiency diseases & CDThere is a well-known and strong association between primary immunodeficiency disorders and non-infectious granulomatous intestinal inflammation. Chronic granulomatous disease (CGD), glycogen storage disease type 1b, leukocyte adhesion deficiency, Chediak-Higashi and Hermansky-Pudlak syndromes are all strongly associated with intestinal inflammation that is indistinguishable from CD [...

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“…Low antigenic load (absence of whole protein) was initially proposed to contribute to the therapeutic effect, but it is now known, however, that whole-protein enteral feeds are as effective as the amino acid-based elemental diets (73) . Other theories (74) relate to the provision of fatty acids (75) , (62) After detailed discussion EN may be used in preference to steroids, immune modulators or surgery in any patient with active disease or for those unresponsive to mesalazine or in whom steroids are contraindicated EN is appropriate for growth failure in children or adolescents with active small bowel CD European Society for Clinical Nutrition and Metabolism (76) EN is effective in the treatment of active disease. In adults, however, corticosteroids are more effective.…”

Section: Mode Of Actionmentioning

confidence: 99%

Session 3: Joint Nutrition Society and Irish Nutrition and Dietetic Institute Symposium on ‘Nutrition and autoimmune disease’ Nutrition in Crohn's disease

O’Sullivan

2009

Proc. Nutr. Soc.

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The exact aetiology of Crohn's disease remains unknown. The consensus is that the disease results from a complex interaction between genes, immunity and environmental factors. Diet is attractive, in theory, as an environmental risk factor in the aetiology of the disease. The epidemiological data, often impeded by methodological issues, have failed to confirm a direct link between pre-diet illness and the development of Crohn's disease. Once diagnosed, however, nutrition has an important role in disease management. Among the nutritional issues are malnutrition, weight loss and suboptimal nutritional status; these outcomes may be present at any stage of the disease but are likely to be overt during acute illness and hospitalisation. Malnutrition has been identified in approximately 40% of hospital admissions with Crohn's disease and is associated with higher mortality, longer hospital stays and higher healthcare costs. Patients in remission may indeed be overweight and appear to be influenced by the general population trends toward overweight and obesity. Irrespective of BMI, patients are at risk of micronutrient deficiencies. Vitamin D deficiency, for example, is common in Crohn's disease and has important implications for bone health. Moreover, newer evidence suggests that vitamin D has potential anti-inflammatory effects. Dietary approaches, in the form of enteral nutrition, have previously been shown to reduce inflammation and treat the active disease. Current guidelines now recommend that corticosteroids are more effective than enteral nutrition for treating adults. Enteral nutrition has important growth and developmental benefits and continues to be a recommended therapy for children with Crohn's disease.

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Fat composition may be a clue to explain the primary therapeutic effect of enteral nutrition in Crohn's disease: results of a double blind randomised multicentre European trial

Cited by 160 publications

References 21 publications

Risk factors for metabolic bone disease in Crohnʼs disease patients

Risk factors for metabolic bone disease in Crohnʼs disease patients

Crohn’s disease as an immunodeficiency

Session 3: Joint Nutrition Society and Irish Nutrition and Dietetic Institute Symposium on ‘Nutrition and autoimmune disease’ Nutrition in Crohn's disease

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