The IX t h Makassed Medical Congress - American University of Beirut

NUTRITION IN INFLAMMATORY BOWEL DISEASE
Dominique Turck MD
Children represent 10-15% of cases of Crohn’s disease (CD), mainly arising after the age of 10, i.e.
during puberty. Thus, it is not surprising that malnutrition, impaired growth and pubertal delay
are major complications of pediatric CD. Decreased oral intake, malabsorption and increased
needs and losses in energy and nutrients are major determinants modulating nutritional status
and growth. A deleterious effect on growth of corticosteroids has also been shown. Impaired
growth or altered growth velocity may precede the occurrence of clinical symptoms of CD. At
diagnosis, weight loss and growth delay are present in 80-90% and 1/3 of cases, respectively.
No diet has been shown as efficient in the maintenance of remission. Exclusive enteral nutrition
(EN) for 6-8 weeks should be the first choice for the treatment of a flare-up. Prolonged nocturnal
EN can be helpful for the treatment of growth retardation and in case of steroid-dependent
or steroid-refractory CD. However, immunomodulating (azathioprine, 6-mercaptopurine,
methotrexate) and biological agents (infliximab, adalimumab) are nowadays an efficient
alternative to prolonged nocturnal EN in most patients with active disease. Efficacy of polymeric
solutions is identical to that of semi-elemental or elemental solutions. Parenteral nutrition is
limited to a flare-up with resistance to medical treatment and/or EN, and contraindications
to surgery; occlusion or fistula; short bowel syndrome. At diagnosis of ulcerative colitis (UC),
weight loss and growth delay are present in 50% and 5-10% of cases, respectively. As opposed
to CD, nutritional therapy can not be used per se to treat a flare-up of UC.
NUTITION IN INFLAMMATORY BOWEL DISEASE
Dominique Turck MD
Life expectancy for patients with cystic fibrosis (CF) has steadily improved during the last 3 decades,
and death in childhood is now uncommon. Nutrition is a critical component of the management
of CF, and nutritional status is directly associated with both pulmonary status and survival. Expert
dietetic care is necessary, and attention must be given to ensuring an adequate energy intake
in the face of demands which may be increased by inadequately controlled malabsorption,
chronic broncho-pulmonary colonisation by bacteria and fungi, exacerbations of acute lung
infection, impaired lung function, and the need for rehabilitation, repair and growth.
Pancreatic enzyme replacement therapy (PERT) is needed by up to 90% of CF patients in Northern
Europe, but a smaller proportion in Mediterranean countries and elsewhere. Complications of CF
including liver disease and CF-related diabetes pose further challenges. In addition, deficiency
of specific nutrients including fat soluble vitamins (particularly A, E and perhaps K) essential fatty
acids and occasionally minerals occur for a variety of reasons. Osteopenia is common and poorly
understood. Liver disease increases the likelihood of vitamin D deficiency.
Glucose intolerance and diabetes affect at least 25% of CF adults, and the diabetes differs from
both types 1 and 2 diabetes mellitus, but it inversely correlates with prognosis. Management
consists of anticipating problems and addressing them vigorously as soon as they appear.
Supplements of vitamins are routinely given. Energy supplements can be oral, enteral or, rarely,
parenteral. All supplements, including PERT, are adjusted to individual needs.
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