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

Timing of Nutritional Support

Several general principles should be considered when determining the need for nutritional support.[11] Protein calorie malnutrition results in negative nitrogen balance and lean tissue wasting. If such a malnourished patient's condition is complicated by an acute flare of Crohn's disease, this interactive event, left untreated, can contribute to increased morbidity.[12] Because loss of lean body mass may have an overall detrimental effect on patient morbidity and delay functional recovery, hospitalized malnourished patients with active disease and continuing inadequate intake should receive nutritional support.[13] There have been few studies conducted to support this practice in Crohn's disease, particularly examining the degree of malnutrition and the duration of inadequate feeding.

Christie and Hill[14] demonstrated a decreased loss of protein with improved physiologic measurements in malnourished inflammatory bowel disease patients receiving short courses of intravenous nutrition. Enteral feeding is the preferred route of administration, but if contraindicated or not tolerated, TPN should be initiated in the first 1-3 days if malnutrition or if illness is severe and nutritional intake inadequate. For patients who are not malnourished but moderately ill at the outset, nutritional support should be considered in 5-7 days if oral intake is inadequate or the patient is non per orum (npo) for > 5-7 days, in order to prevent further loss of lean body mass. Although the criteria for defining degree of malnutrition are inexact, the use of the NRI, as defined earlier, provides a reasonable approximation. These general recommendations are supported in the "Guidelines for the Use of Parenteral and Enteral Nutrition in Adult and Pediatric Patients."[15]

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