Crohn's Disease: The Role of Nutrition Support

Donald R. Duerksen, MD, St. Boniface General Hospital and University of Manitoba, Winnipeg, Manitoba, Canada.

Disclosures
In This Article

Abstract and Introduction

Abstract

Crohn's disease is frequently complicated by protein calorie malnutrition. Nutrition support is important in maintaining functional status and preventing loss of lean tissue. Determinants of lean tissue loss include severity of underlying injury, baseline nutritional status, and duration of inadequate nutrition. One of the clinically useful measures of nutritional status is the nutritional risk index (NRI), which is defined on the basis of the serum albumin and weight loss. Nutritional support is important in severely malnourished patients. Enteral nutrition is the treatment of choice provided there are no contraindications to using the gastrointestinal tract. In acute exacerbations of Crohn's disease, enteral nutrition also has a role in the primary management of disease, although it is not as effective as corticosteroids in inducing remission. The mechanism of action is poorly understood, and the most effective enteral formulation needs to be determined. Total parenteral nutrition is justified in severely malnourished Crohn's disease patients who are unable to tolerate enteral feeding or in whom enteral feeding is contraindicated. There is some preliminary evidence that omega 3 fatty acids may be effective in preventing disease relapse. There is no clinical evidence to support the routine use of glutamine supplementation, and exclusion diets are of limited use in maintaining remission. Micronutrient deficiencies are common in patients with Crohn's disease; therefore, patients with this disorder should receive a multivitamin supplement. More clinical studies are needed to assess the role of malnutrition in Crohn's disease, the effects of nutritional management on functional status, and the timing of nutritional intervention.

Introduction

Decisions regarding the appropriate use of nutrition support in inflammatory bowel disease require an integrated assessment of nutritional status, disease severity, function of the gastrointestinal tract, and need for surgery. Crohn's disease is a chronic inflammatory disorder of unknown etiology that may affect any level of the gastrointestinal tract. Because many Crohn's disease patients are significantly at risk for protein-calorie malnutrition, nutrition support can be an important adjunct to medical therapy.[1] While the mechanism is uncertain, nutrition support also has a primary role in inducing remission in patients with acute flares of Crohn's disease.[2]

This review examines the role of nutrition support in 4 major clinical presentations of Crohn's disease: (1) acute exacerbation; (2) intestinal obstruction; (3) perianal disease; and (4) fistulizing disease. In addition, the role of specialized nutrients and exclusion diets as well as the incidence of micronutrient deficiencies are addressed.

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