Energy and substrate metabolism in patients with active Crohn's disease

The aim of the study was to evaluate the possible contribution of changes in energy metabolism and substrate oxidation rates to malnutrition in Crohn's disease and to assess the effect of enteral nutrition on these parameters. Energy metabolism was evaluated by indirect calorimetry in 32 patients with active Crohn's disease and 19 age- and sex-matched healthy individuals. Measurements were done in the postabsorptive state. Seven out of 32 patients received enteral nutrition via a nasogastric tube. In these patients, resting energy metabolism was determined at d 0 (postabsorptive), 7, 14 (during full enteral nutrition) and 15 (postabsorptive). Resting energy expenditure was not significantly different between patients and controls, whereas the respiratory quotient (RQ) was lower in patients (0.78 +/- 0.05 vs. 0.86 +/- 0.05; P < 0.05). During enteral nutrition in 7 patients with Crohn's disease, the RQ increased on d 7 compared with d 0 and remained high even after cessation of enteral nutrition (d 0, 0.78 +/- 0.03; d 7, 0.91 +/- 0.04; d 15, 0. 84 +/- 0.05; P < 0.05; d 7 and 15 vs. d 0). No effects of enteral nutrition on resting energy expenditure were found. Active Crohn's disease is associated with changes in substrate metabolism that resemble a starvation pattern. These changes appear not to be specific to Crohn's disease but to malnutrition and are readily reversed by enteral nutrition. Enteral nutrition did not affect resting energy expenditure. Wasting is a consequence of malnutrition but not of hypermetabolism in Crohn's disease.     

Energy metabolism and substrate oxidation as possible factors for net protein accretion in growing rats

This study describes an experimental model with growing rats in which we have measured energy expenditure and substrate oxidation as possible factors for regulation of net protein synthesis in intravenously fed growing rats. Orally fed rats were used as a reference group. Rats were given intravenous nutrition for 10 days at a high (350 kcal/kg/day) and a low (270 kcal/kg/day) energy level with four different fat-to-carbohydrate compositions at each energy level: N (no fat), L (low fat, 6% nonprotein calories), M (medium fat, 30% nonprotein calories) and H (high fat, 60% nonprotein calories). Continuous O2-consumption and CO2 production of the animals were measured. Whole body substrate oxidation was calculated from respiratory gas exchange and nitrogen excretion. Body composition was assessed in all animals at the end of infusions. Energy balance with zero growth was reached at 240 kcal/kg/day. Growth rate was normal in animals receiving 350 kcal/kg/day compared with freely eating reference animals irrespective of the glucose-to-fat ratio of the intravenous solutions. Animals on 270 kcal/kg/day showed retarded growth rate, but the differences in growth rate among the groups were mainly explained by carcass fat. Net protein accretion did not differ among most of the groups irrespective of intravenous or oral intake at different levels. The whole body oxidation rate of glucose was directly proportional to the infusion rate of glucose, while the net fat oxidation was inversely correlated to the infusion rate of glucose. The oxidation rate of amino acids and proteins was not directly correlated to the oxidation of glucose or fat.(ABSTRACT TRUNCATED AT 250 WORDS)     

Hypermetabolism and altered substrate oxidation in HIV-infected patients with lipodystrophy

ObjectiveHuman immunodeficiency virus type 1 (HIV)-associated lipodystrophy syndrome compromises body composition and produces metabolic alterations, such as dyslipidemia and insulin resistance. This study aims to determine whether energy expenditure and substrate oxidation are altered due to human HIV-associated lipodystrophy syndrome.MethodsWe compared energy expenditure and substrate oxidation in 10 HIV-infected men with lipodystrophy syndrome (HIV+LIPO+), 22 HIV-infected men without lipodystrophy syndrome (HIV+LIPO?), and 12 healthy controls. Energy expenditure and substrate oxidation were assessed by indirect calorimetry, and body composition was assessed by dual-energy X-ray absorptiometry. The substrate oxidation assessments were performed during fasting and 30 min after eucaloric breakfast consumption (300 kcal).ResultsThe resting energy expenditure adjusted for lean body mass was significantly higher in the HIV+LIPO+ group than in the healthy controls (P = 0.02). HIV-infected patients had increased carbohydrate oxidation and lower lipid oxidation when compared to the control group (P < 0.05) during fasting conditions. After the consumption of a eucaloric breakfast, there was a significant increase in carbohydrate oxidation only in the HIV+LIPO? and control groups (P < 0.05), but there was no increase in the HIV+LIPO+ group.ConclusionHypermetabolism and alteration in substrate oxidation were observed in the HIV+LIPO+ group.     

Selenium status in patients with Crohn's disease.

Twenty-seven of 66 patients with Crohn's disease had reduced concentrations of selenium and glutathione peroxidase in plasma and erythrocytes. When the patients were subgrouped according to the length of resected small bowel, a significant reduction of selenium and glutathione peroxidase in both plasma and erythrocytes was only found in patients with a resection > 200 cm. A highly significant correlation between selenium and glutathione peroxidase was found in plasma (r = 0.81) as well as in erythrocytes (r = 0.62), but no correlation was observed in the control group. A statistically significant correlation was also found between plasma selenium and the Harvey-Bradshaw score (r = -0.44), body mass index (wt/ht2) (r = 0.47), and plasma albumin (r = 0.29). Patients with a small-bowel resection > 200 cm appear to be at risk of developing severe selenium deficiency. These patients should have their selenium status monitored and probably receive selenium supplementation.     

克罗恩病的围手术期营养支持

目的:探讨围手术期营养支持对克罗恩病(CD)手术治疗的应用价值和经验。方法:回顾性分析因CD相关并发症而进行手术的150例次病人,对病人的营养指标、CD病变活动度指标、病变部位、手术原因、手术方式、术前及术后营养支持应用情况、手术相关并发症等进行相关统计。结果:有130例病人入院时即存在营养不良(86.67%),表现为体质指数(BMI)<18.5或近3个月体质量下降10%以上。围手术期营养支持后病人术前和出院时Hb、ALB、PA、TF和淋巴细胞计数等较入院时均显著改善,但BMI增加不明显。53例病人出院后继续行家庭EN,3个月后平均BMI显著增加(19.24vs17.64,P<0.001)。136例手术获得成功,14例发生手术相关并发症,其中2例死亡。2例危重病人采取损伤控制性手术原则联合营养支持救治成功。出院时,病人病变活动度(CDAI)评分、C-反应蛋白(CRP)水平、红细胞沉降率(ESR)均较入院时显著下降。结论:围手术期营养支持对改善CD病人的预后具有积极的意义。对于危重CD病人采用损伤控制性手术,能取得较好的治疗效果。     

Energy metabolism in infants with congenital heart disease

Failure to thrive is common in children with congenital heart disease and influences the metabolic response to injury and outcome after corrective cardiac surgery. Energy imbalance is a major contributing factor. However, the published literature is difficult to interpret as studies generally involve small patient numbers with a diverse range of types and severity of cardiac lesions and genetic and/or prenatal factors. The age and time of corrective surgery affects the potential for nutritional recovery. Although the immediate postoperative period is characterized by a hypermetabolic state, low total and resting energy expenditure are reported within 24 h of surgery. After 5 d, resting energy expenditure returns to preoperative levels. Significant improvements in weight and growth occur within months after corrective surgery. However, limited postoperative recovery in nutritional status and growth occurs in infants with a low birth weight, intellectual deficit, or residual malformation. Further studies are needed to inform the timing of corrective cardiac surgery to maximize nutritional outcomes and to identify those infants who may benefit from aggressive preoperative nutrition support.     

Plasma and skeletal muscle electrolytes in patients with Crohn's disease

Plasma and skeletal muscle electrolytes were measured in 13 patients with Crohn's disease, and in an age- and sex-matched reference group. Patients with Crohn's disease demonstrated significantly lower muscle potassium content (p less than 0.01) than did controls. Patients with extensive involvement of the bowel tended to have lower muscle potassium content. The patient population did not differ significantly from the controls with regard to skeletal muscle magnesium content but displayed a far wider range of values. Our results indicate that potassium depletion is present in nonresected patients with Crohn's disease.     

Anti-Saccharomyces cerevisiae antibodies in patients with Crohn's disease]

Inflammatory Bowel Diseases are a group of diseases with chronic inflammation of the gastrointestinal tract, but without proven etiology. Immunologic, environmental, infective and genetic factors equally can play role in their development. Antibodies to an oligomannose epitope of the Saccharomyces cerevisiae demonstrated in 60-70% of the patients with Crohn's disease. The origin and the clinicopathological role are not clarified. It is important that there are no surveys with patients suffering in gluten sensitive enteropathy in the literature. As there are no ASCA survey in Hungary, the aim of this study was to determine the prevalence of the ASCA. The authors examined at their patients the ASCA's occurrence and compared with the clinical picture of the Crohn's disease. The results supported the theory that ASCA positivity correlates with small intestines' Crohn's disease and in these cases both the IgG and IgA type antibodies proved. The antibodies in the sera at the analyzed ASCA positive cases prove a systemic immune response against Saccharomyces cerevisiae and the authors suggest the end of the oral tolerance against the yeast's antigens. The diet restriction (elemental diet, total parenteral nutrition, and fecal diversion) may ameliorate the status of the patients with Crohn's disease. It is speculated that the yeast-free diet as a part of the therapy for the ASCA positive patients can be reasonable: moreover the permanent "forbidding" of the yeast can be an acceptable alternative in case of getting well.     

Acute phase response in malnourished patients with Crohn's disease

The acute phase reactants, C-reactive protein (CRP) and α1 acid glycoprotein, are elevated in active Crohn's disease and can be used as markers of disease activity. It is not known whether the acute phase response is impaired in patients with malnutrition. The acute phase response of CRP and α1 acid glycoprotein was measured in 21 patients requiring in-patient treatment for active Crohn's disease. Ten malnourished patients (being less than 80% ideal body weight—Group 1) had a similar acute phase response compared to 11 well nourished patients (Group 2). Both groups had similar disease activity as assessed by clinical score, erythrocyte sedimentation rate and gastrointestinal protein loss. Malnourished patients with active Crohn's disease are able to mount an appropriate acute phase response. Acute phase reactants can be used as markers of disease activity in patients with Crohn's disease whose nutritional status is unknown.     

Energy expenditure and substrate oxidation predict changes in body fat in children

BACKGROUND: The hypothesis that alterations in energy metabolism predict body fat gain is controversial. OBJECTIVE: The aim of this study was to determine which components of energy metabolism were most important in predicting fat gain in children aged 10.8 +/- 0.6 y. DESIGN: A 2-y longitudinal study to examine whether components of energy metabolism are predictors of body fat gain was conducted in 114 preadolescent African American and white children aged 9-11 y by measuring total daily energy expenditure on the basis of doubly labeled water (DLW), resting metabolic rate, the thermic effect of food, energy expended in physical activity, and substrate oxidation after a meal. The primary endpoint was the 2-y change in percentage body fat (%BF). RESULTS: Individual variables of energy metabolism predicted up to 7% of the variance in changes in %BF over the 2-y interval in the whole group. Predictors of change in body fatness tended to be sex and race specific. Protein oxidation during a test meal explained a significant portion of the variance in change in %BF in the overall group and in nearly all of the subgroups. Multivariate prediction models accounted for 10-41% of the variance in change in %BF. Tanner stage at 2-y follow-up was highly predictive of change in body fatness and improved the overall prediction, accounting for 24-62% of the variance in change in %BF in those groups in which Tanner entered the model. CONCLUSION: This study provides evidence that total daily energy expenditure, resting metabolic rate, substrate oxidation, and total energy intake are predictors of gain in body fatness during late childhood in boys and girls.     

Plasma and skeletal muscle electrolytes in patients with Crohn's disease.

Plasma and skeletal muscle electrolytes were measured in 13 patients with Crohn's disease, and in an age- and sex-matched reference group. Patients with Crohn's disease demonstrated significantly lower muscle potassium content (p less than 0.01) than did controls. Patients with extensive involvement of the bowel tended to have lower muscle potassium content. The patient population did not differ significantly from the controls with regard to skeletal muscle magnesium content but displayed a far wider range of values. Our results indicate that potassium depletion is present in nonresected patients with Crohn's disease.     

克罗恩病住院病人的营养风险筛查

目的:筛查克罗恩病(CD)住院病人的营养风险的发生情况. 方法:采用营养风险筛查2002(NRS2002)方法,对118例CD住院病人进行营养风险筛查.根据CD活动指数(CDAI)将其分为临床缓解期、轻度活动期、中度活动期和重度活动期,对比各组间营养风险发生率的差异. 结果:CD住院病人总营养风险发生率为75.4％.其中临床缓解期病人营养风险发生率为48.7％,轻度活动期病人为85.7％,中度活动期病人为88.2％,重度活动期为100％.临床缓解期与各活动期营养风险发生率比较有显著性差异(P＜0.05). 结论:CD住院病人存在较高的营养风险发生率,活动期CD病人较缓解期病人营养风险发生率更高.     

Improvement of bone metabolism after infliximab therapy in Crohn's disease

BACKGROUND: Osteoporosis has received increasing attention as a potential complication of Crohn's disease. Among cytokines tumor necrosis factor-alpha plays a pivotal role in the pathogenesis of inflammatory bowel diseases by inducing a wide variety of inflammatory responses, including bone resorption. Only few data are present about the effect of infliximab on bone metabolism. AIMS: The authors evaluated the effect of infliximab on bone metabolism in patients with Crohn's disease. PATIENTS AND METHODS: Twenty seven patients (17 females, 10 males, mean age 32.58 yrs) with refractory fistulizing Crohn's disease were treated with a series of three infusions of 5 mg infliximab per kg at weeks 0, 2, and 6. Biochemical markers of bone formation (osteocalcin) and bone resorption (beta-CrossLaps) were measured before administration of each infliximab infusion. 54 patients were studied with inactive Crohn's disease (Crohn's disease activity index < 150) as a control. RESULTS: There were significant differences in beta-CrossLaps concentrations (ng/ml) between the day 0 and 14 (0.57 +/- 0.32 vs. 0.46 +/- 0.29, p < 0.01) and the day 0 and 42 (0.57 +/- 0.32 vs. 0.45 +/- 0.26, p < 0.05). The osteocalcin levels significantly increased from day 0 to day 42 (21.31 +/- 12.14 vs. 25.64 +/- 16.97, p < 0.05). The serum beta-CrossLaps and osteocalcin levels were 0.47 +/- 0.24, 27.2 +/- 8.44 in the control group respectively. These results differed from the serum levels of active patients before the treatment, but there were no notable differences at the day 42. CONCLUSION: Infliximab therapy in Crohn's disease patients displayed a rapid influence on bone metabolism by enhancing bone formation and decreasing bone resorption. In addition to its mucosal effect affecting the bone homeostasis, indicate a further rationale usage of tumor necrosis factor-alpha blockade in the therapy of inflammatory bowel diseases.     

Glutamine metabolism in Crohn's disease: a stable isotope study

AIMS: To determine whether chronic intestinal inflammation alters glutamine utilization, six 31 +/- 6 yr-old patients with Crohn's disease and an age-matched group of 6 healthy subjects received 7-h intravenous infusions of L-[5,5,5-2H3]leucine, along with an infusion of L-[1-13C]glutamine delivered intravenously for the first 3.5 h, and via a nasogastric tube for the subsequent 3.5 hrs. None of the patients was receiving any nutritional supplement or antiinflammatory drug. All were in remission (Crohn's disease activity index < 150) and in a near-normal nutritional status. METHODS: We used plasma 2H3-alpha-ketoisocaproate to determine leucine appearance rate (Ra), and plasma 13C-glutamine and breath 13CO2 to determine glutamine Ra and oxidation, respectively. The fraction of enteral glutamine undergoing uptake in the splanchnic bed was determined from the difference in plasma 13C-glutamine enrichments between the intravenous and nasogastric 13C-glutamine infusion periods. RESULTS: Neither leucine Ra, nor plasma glutamine concentration (526 +/- 40 vs. 530 +/- 50 micromol/l), glutamine Ra (364 +/- 19 vs. 355 +/- 24 micromol kg(-1) h(-1)), or splanchnic glutamine uptake (61 +/- 5 vs. 65 +/- 2%) differed between groups. In both groups, glutamine oxidation rose when the glutamine tracer was supplied enterally, compared with the intravenous route (70 +/- 6 vs. 39 +/- 2% in patients; 69 +/- 2 vs. 38 +/- 1% in controls), but did not differ between groups. CONCLUSION: When in remission, patients with Crohn's disease have normal rates of proteolysis, and glutamine production, utilization, oxidation, and splanchnic uptake. The data suggest there is no obvious requirement for glutamine in patients with quiescent Crohn's disease.     

Consensus for infliximab treatment of patients with Crohn's disease

Very recently infliximab--a tumour necrosis factor blocking antibody--was registered as an important novel immunomodulating therapy for active Crohn's disease in the Netherlands. Although this treatment can have a very significant and sometimes dramatic effect (on remission induction), its longterm effects are still uncertain and the high cost is a major drawback. An expert committee of specialists in inflammatory bowel disease (IBD) in the Netherlands therefore produced a consensus report on specific treatment indications for its use. It is stated that only immunosuppressive-resistant patients or patients with incompatibilities and allergies to prednisone, azathioprine and methotrexate should be candidates, a second indication being patients with serious enterocutaneous fistulae not reacting to a full course of conventional therapy. Its use is not indicated in patients with stenosing disease. It is also stated that the effect of longterm repeated therapy in active Crohn's disease still has to be established. Since budget limitations for medications are a major disadvantage, the formation of expert committees (with an expert in the treatment of complicated inflammatory bowel disease) in each hospital should be stimulated to limit the treatment to only cases with real immunosuppressive-resistant disease.     

The faecal flora of patients with Crohn's disease.

The faecal flora of patients with Crohn''s disease was compared with that of healthy subjects. In patients with terminal ileitis, numbers of anaerobic gram-negative and coccoid rods (species of Eubacterium and peptostreptococcus) were higher than in the controls whereas anaerobic gram-positive rods and cocci and aerobes occurred in normal numbers. The composition of the flora was neither influenced by duration of the disease nor by ileocaecal resection. In healthy subjects and patients, a chemically defined diet induced only slight changes in the flora. Thus, the flora in terminal ileitis although stable was permanently abnormal. In the patients with Crohn''s colitis, abnormally low numbers of anaerobes were found in patients with severe, bloody diarrhoea while aerobic counts were normal. The flora in patients with mild colitis was similar to that in terminal ileitis. It is suggested that the abnormal flora composition might be an expression of the genetic predisposition to Crohn''s disease.     

Cigarette smoking and risk of clinical relapse in patients with Crohn's disease

Risk of clinical relapse among cigarette smokers and nonsmokers was examined in a cohort of 74 adult Crohn's disease (CD) patients who were identified and followed at monthly intervals for six months. We measured clinical activity by a weighted symptom index used previously. Relapse at any point during the study was defined by the index score exceeding 150. Approximately 50% of nonsmokers experienced clinical relapse during the study period. Current smokers experienced a relapse risk 1.6 times that of nonsmokers (P less than .01). The risk estimates correspond to mean overall clinical activity scores of 142 +/- 34 for smokers compared to 119 +/- 26 for nonsmokers. Adjustment for confounding effects did not substantially alter the association shown between cigarette use and clinical relapse. We observed no increase in the likelihood of relapse among former smokers. The statistically significant finding that current smoking increases the risk of relapse for CD patients is of clinical importance, given the high prevalence of smoking (42%) among CD patients in this sample.