Nutritional Global Status and Its Impact in Crohn’s Disease

Abstract

Background Malnutrition among inflammatory bowel disease (IBD) subjects is well documented in literature and may emerge from factors including inadequate dietary intake, malabsorption and disease activity. The aim of this study was to complete a comprehensive nutrition assessment and explore what possibilities may help bring a better quality of life for IBD subjects. Methods Nutritional status based on biochemical tests, body composition and body mass index (BMI). Food intake was assessed by an alternate 3-day food record and the adequacy of intake was evaluated according to national and international references. Clinical disease activity was evaluated by the Harvey-Bradshaw index and CRP levels. Results The study included 217 patients and 65 controls, where 54.4% of these patients were classified as normal weight with a mean BMI lower than controls (23.8 ± 4.9 versus 26.9 ± 4.8 kg/m2, P = 0.02). Patients with disease activity showed more overweight and obesity than patients with controlled disease. Vitamin B12 deficiency was present in 19% of Crohn’s disease (CD), mainly in patients with ileal commitment and small bowel resections. Anemia was present in 21.7% of patients, being more common in patients with active disease (25%) and bowel resection (23%). Regarding calorie intake (EI), CD group ingested more than controls (1986.3 ± 595.9 kcal versus 1701.8 ± 478.9 kcal; P = 0.003). Conclusions CD patients presented micronutrient deficiency when compared with controls, explained for other reasons than intake restrictions. Also, fat excess might have contributed to disease burden as continuously reported in the literature.

Vitamin D levels in the assessment of Crohn's disease activity and their relation to nutritional status and inflammation

“…[71][72][73][74] A study by Prieto JMI et al illustrated a similar relationship between low weight and micronutrient deficiency in CD patients who were underweight and deficient in micronutrients. 72 In summary, we found that VD was associated with both nutritional deficits and inflammation, and that nutritional deficit was associated with inflammation, suggesting that VD supplementation may play an anti-inflammatory role, improve nutritional status and thus improve prognosis. These findings provide new ideas for the clinical treatment of CD.…”

“…Treatment of monocytes with 1,25(OH)2D was found to inhibit lipopolysaccharide (LPS)‐induced p38 phosphorylation as well as IL‐6 and TNF‐ α production, thus preventing excessive activation of pro‐inflammatory responses 70 . Although VD is thought to be associated with nutritional status in CD patients, there have been few studies on the association between the serum VD level and nutritional status in CD patients 71–74 . A study by Prieto JMI et al illustrated a similar relationship between low weight and micronutrient deficiency in CD patients who were underweight and deficient in micronutrients 72 .…”

“…Although VD is thought to be associated with nutritional status in CD patients, there have been few studies on the association between the serum VD level and nutritional status in CD patients 71–74 . A study by Prieto JMI et al illustrated a similar relationship between low weight and micronutrient deficiency in CD patients who were underweight and deficient in micronutrients 72 . In summary, we found that VD was associated with both nutritional deficits and inflammation, and that nutritional deficit was associated with inflammation, suggesting that VD supplementation may play an anti‐inflammatory role, improve nutritional status and thus improve prognosis.…”

Intestinal Oxalate Absorption, Enteric Hyperoxaluria, and Risk of Urinary Stone Formation in Patients with Crohn’s Disease

“…The nutritional status of patients with inflammatory bowel disease is often impaired, with malnutrition presenting as imbalanced energy or nutrient intake, including protein–energy malnutrition, disease-related malnutrition, sarcopenia, and micronutrient deficiency [ 37 ]. The pathogenesis of malnutrition involves several factors, such as reduced food intake, intestinal malabsorption, chronic loss of protein in stool, and increased energy requirements due to hypercatabolism [ 37 , 38 , 39 ]. In the present study, urinary excretion of sulfate and creatinine were significantly lower in patients with Crohn’s disease than in healthy controls.…”

Bone health in patients with inflammatory bowel disease

“…It involves malabsorption, corticosteroid treatment and the systemic inflammatory process itself, all of which may adversely affect the adequate formation of peak bone mass (up to the age of about 30 years), age-related loss of bone mass or both. Malnutrition might occur in patients with IBD from reduced dietary intake, malabsorption due to intestinal inflammation, short bowel syndrome after intestinal resection or increased energy requirements due to hypercatabolism [3]. In particu-lar, calcium and vitamin D deficiencies are detrimental to bone health and mineralisation, especially in combination with physical inactivity and decreased exposure to sunshine in patients with active disease.…”