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Title: Exclusive enteral nutrition remission induction treatment impact on body mass composition and adipokines concentration in newly – onset pediatric Crohn’s disease

Abstract:

Introduction: Crohn’s disease is characterized by chronic and proceeding inflammation. In pediatric patients this chronic inflammatory condition may be associated with underweight, altered body composition (protein deficiency), which may lead to growth retardation, pubertal delay and decreased bone mineral density. The exclusive enteral nutrition (EEN), as a primary treatment in mild to moderate Crohn’s disease is highly effective in gaining clinical remission, has positive influence on inflammatory markers decrease and improves nutritional status. One of EEN claimed mechanism of anti-inflammatory action is its impact on adipokines, produced by mesenteric fat tissue, which local periintestinal hypertrophy is diagnosed in patients with Crohn’s disease in medical imaging. Aim of the study: Assessment of exclusive enteral nutrition remission induction treatment influence on nutritional status and body mass composition, estimated by bioimpedance analysis, and adipokines concentration in newly - onset pediatric Crohn’s disease. Material and methods: In years 2012 - 2016 forty - three patients hospitalized at the Department of Pediatrics, Gastroenterology and Nutrition, University Children’s Hospital, with newly - onset, mild to moderate, uncomplicated Crohn’s disease, qualified to exclusive enteral nutrition remission induction treatment were enrolled into the study. 6 – week course of EEN was pursue by polymeric diet, administered by nasogastric tube or orally. Twenty two children, hospitalized at the Department of Pediatrics, Gastroenterology and Nutrition, University Children’s Hospital with no disorders served as controls. Bioimpedance analysis and adipokines concentration were estimated by enzyme – linked immunosorbent assay (ELISA) fourfold (before diagnosis, after completion of the 6- week exclusive enteral nutrition, at week 20 and at week 52). ; The fourfold at the same points of evaluation as bioimpedance analysis were performed. The same parameters were obtained in the control group once. Results: At diagnosis of Crohn’s disease the body mass deficiency was observed in 35% patients. In accordance to references values, the fat free mass deficiency was observed in 54% patients (in 41% of cases with normal BMI) and fat free mass index deficiency in 74% cases. 69% of study group did not reveal fat mass deficiency. In comparison to the control group, in the study group both fat free mass (p = 0,032) and fat mass (p = 0,005) were decreased. The phasal angel values were lower than 5 degrees in 65% of children with Crohn’s disease. In comparison to the control group, the average phasal angle values were decreased (p = 0,003). In presented study strong correlations between phasal angle and lean tissue mass index (r = 0,761, p < 0,001), lean tissue mass (r = 0,758, p < 0,001), fat free mass (r = 0,702, p < 0,001) were present. After EEN completion increase in lean tissue mass (p = 0,001), fat free mass (p < 0,001) and fat mass (p < 0,001) was obtained. At week 52 the highest values of medium lean tissue mass and fat free mass were obtained. Also phasal angle values were significantly higher in comparison with their values before EEN (p = 0,001). After EEN completion, strong correlation between BMI and fat mass as well as between phasal angle and fat free were observed. At diagnosis chemerin (p < 0,001) and resistin (p < 0,001) concentrations were significantly higher whereas leptin (p = 0,004) lower in comparison to the control group. There were no differences in visfatin and adiponectin concentrations between both groups. Gender differences revealed higher leptin concentration observed in girls both in the study and the control group. Negative correlations between visfatin concentration and fat mass (r = (-) 0,344, p = 0,024) as well as visfatin and fat mass index (r = (-) 0,344, p = 0,020) were observed at the point of Crohn’s disease diagnosis. After EEN completion increase in medium leptin concentration (p = 0,013) and decrease in medium resistin concentration (p = 0,002) were present. Conclusions: Exclusive enteral nutrition was effective not only in inducting remission but also had positive influence on nutrition status and body mass composition. The majority of pediatric patients with newly - onset Crohn’s disease had proper body weight, concomitantly showing alterations in body mass composition, most frequently fat free mass deficiency. BMI correlated with fat mass and thus was not precise enough tool to asses patients nutritional status. Phasal angle strongly correlated with lean tissue, fat free mass, albumin concentration and showed no correlation with fat mass. The assessment of its utility in malnutrition and protein deficiency estimation, requires further investigation with a larger group of patients. Children with newly - onset Crohn’s disease presented differential of adipokines concentration. The exclusive enteral nutrition induction treatment had early, contrary impact on leptin and resistin concentration. Decreased resistin concentration may positive influence on gaining clinical remission in Crohn’s disease.

Place of publishing:

Kraków

Level of degree:

2 - studia doktoranckie

Degree discipline:

choroby układu trawiennego

Degree grantor:

Uniwersytet Jagielloński. Collegium Medicum. Wydział Lekarski.

Promoter:

Małgorzata Sładek

Date issued:

2019

Format:

application/pdf

Identifier:

oai:dl.cm-uj.krakow.pl:4316

Call number:

ZB-130611

Access rights:

tylko w bibliotece

Location of original object:

Biblioteka Medyczna Uniwersytetu Jagiellońskiego- Collegium Medicum

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Last modified:

Mar 11, 2021

In our library since:

Jun 10, 2020

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0

All available object's versions:

http://dl.cm-uj.krakow.pl:8080/publication/4317

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ZB-130611 Mar 11, 2021
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