Prospective Study
Copyright ©The Author(s) 2015. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastroenterol. Jan 28, 2015; 21(4): 1299-1304
Published online Jan 28, 2015. doi: 10.3748/wjg.v21.i4.1299
Impact of enteral nutrition on energy metabolism in patients with Crohn’s disease
Jie Zhao, Jian-Ning Dong, Jian-Feng Gong, Hong-Gang Wang, Yi Li, Liang Zhang, Lu-Gen Zuo, Yun Feng, Li-Li Gu, Ning Li, Jie-Shou Li, Wei-Ming Zhu
Jie Zhao, Jian-Ning Dong, Jian-Feng Gong, Hong-Gang Wang, Yi Li, Liang Zhang, Lu-Gen Zuo, Yun Feng, Li-Li Gu, Ning Li, Jie-Shou Li, Wei-Ming Zhu, Department of General Surgery, Jinling Hospital, Medical School of Nanjing University, Nanjing 210002, Jiangsu Province, China
Author contributions: Zhao J and Zhu WM designed the research; Gong JF, Wang HG, Gu LL, Li N, Li Y and Li N performed the research; Zhang L, Feng Y, Zuo LG and Li JS analyzed the data; Zhao J and Dong JN wrote the manuscript.
Supported by National Ministry of Health for the Digestive Disease, No. 201002020; National Natural Science Foundation of China, No. 81200263, No. 81170365 and No. 81270006; and Jiangsu Provincial Special Program of Medical Science, No. BL2012006.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Wei-Ming Zhu, PhD, Department of General Surgery, Jinling Hospital, Medical School of Nanjing University, No. 305 East Zhongshan Rd, Nanjing 210002, Jiangsu Province, China. zhuweimingtg@163.com
Telephone: +86-25-80863736 Fax: +86-25-80860036
Received: June 10, 2014
Peer-review started: June 12, 2014
First decision: June 27, 2014
Revised: July 23, 2014
Accepted: November 7, 2014
Article in press: November 11, 2014
Published online: January 28, 2015
Processing time: 230 Days and 22.4 Hours
Abstract

AIM: To investigate the impact of enteral nutrition (EN) on the body composition and metabolism in patients with Crohn’s disease (CD).

METHODS: Sixty-one patients diagnosed with CD were enrolled in this study. They were given only EN (enteral nutritional suspension, TPF, non-elemental diet) support for 4 wk, without any treatment with corticosteroids, immunosuppressive drugs, infliximab or by surgical operation. Body composition statistics such as weight, body mass index, skeletal muscle mass (SMM), fat mass, protein mass and inflammation indexes such as C-reactive protein (CRP), erythrocyte sedimentation rate (ESR) and CD activity index (CDAI) were recorded before and after EN support.

RESULTS: The 61 patients were divided into three groups according to CDAI before and after EN support: A (active phase into remission via EN, n = 21), B (remained in active phase before and after EN, n = 19) and C (in remission before and after EN, n = 21). Patients in group A had a significant increase in SMM (22.11 ± 4.77 kg vs 23.23 ± 4.49 kg, P = 0.044), protein mass (8.01 ± 1.57 kg vs 8.44 ± 1.45 kg, P = 0.019) and decrease in resting energy expenditure (REE) per kilogram (27.42 ± 5.01 kcal/kg per day vs 22.62 ± 5.45 kcal/kg per day, P < 0.05). There was no significant difference between predicted and measured REE in active CD patients according to the Harris-Benedict equation. There was no linear correlation between the measured REE and CRP, ESR or CDAI in active CD patients.

CONCLUSION: EN could decrease the hypermetabolism in active CD patients by reducing the inflammatory response.

Keywords: Crohn’s disease; Enteral nutrition; Body composition; Metabolism

Core tip: Unlike traditional research that uses normal volunteers or ulcerative colitis patients as the control group, this study aimed to observe the same patient in different phases of Crohn’s disease (CD), and in this study, several confounding factors, such as height, age, gender and race, were removed. This study showed that enteral nutrition could decrease the hypermetabolism in active CD patients by reducing the inflammatory response.