Crohn's Disease: The Role of Nutrition Support

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

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In This Article

Malnutrition and Crohn's Disease

Malnutrition is very common in Crohn's disease, with an incidence ranging from 25%-80%.[1] While several factors, including malabsorption[1] and increased resting energy expenditure in septic or underweight patients, may contribute to malnutrition,[3,4] decreased oral intake is the primary cause.[5] Based on its ability to improve body composition and promote weight gain even in patients with active Crohn's disease, enteral nutrition is the treatment of choice in this setting.[6] In the outpatient management of Crohn's disease, the use of nutritional supplements should be instituted in nutritionally-at-risk patients. However, the timing of specific nutritional intervention and the effect of nutritional support on clinically based outcomes such as infectious complications and functional status have not been well defined in this disease setting.

The VA cooperative study on the use of preoperative total parenteral nutrition (TPN) therapy provides a valuable database for identifying biomarkers of clinically significant and severe malnutrition.[7] The severely malnourished, as defined by a score of < 83.5 on the nutrition risk index (NRI; 1.519 × serum albumin [g/L] + 0.417 × [current weight/usual weight] × 100) had a decrease in noninfectious complications when supported preoperatively with TPN. Patients who have a serum albumin <30 g/L and a 10 % loss of usual body weight would fall into this category, as would the individual with severe hypoalbuminemia (< 27.5 g/L) or severe weight loss (25%) alone. The significance of weight loss on functional status has been demonstrated in other studies as well.[8,9] Hydration status must be considered in the evaluation of weight loss. Based on this index, a highly select group of at-risk patients who are appropriate candidates for nutritional support can be identified using the criteria defined above. In all cases, if the gastrointestinal tract is functional, enteral feeding would be the nutritional therapy of choice.[10]

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