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Influence of nutritional status on the therapeutic effect of infliximab in patients with Crohn’s disease

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Abstract

Purpose

Crohn’s disease (CD) is a refractory inflammatory bowel disease of unknown etiology, frequently complicated by malnutrition. It is thought that the delayed wound healing associated with this malnutrition in CD patients might adversely affect the therapeutic benefits of infliximab (IFX). Therefore, we investigated the effects of nutritional status on IFX treatment.

Methods

We assessed nutritional status and CD activity when IFX therapy was initiated and following the third dose, 6 weeks later. Nutritional status was assessed using the body mass index (BMI) and nutritional risk index (NRI), whereas CD activity was assessed using the CD activity index (CDAI).

Results

All patients with a BMI ≥ 18.5 kg/m2 at the time of IFX therapy met the effective criteria for the CDAI, and IFX treatment was considered responsive in these patients. Furthermore, IFX treatment was responsive, with a high level of effectiveness, in all five subjects (31.3 %) with NRI scores of 97.5 and above with no risk of malnutrition (p = 0.037).

Conclusions

Our results suggest that nutritional status does influence the therapeutic effect of IFX in CD patients. The response rate to IFX treatment thus could be improved by optimizing the nutritional status. We recommend comprehensive nutritional assessment and intervention prior to IFX treatment schedules.

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Abbreviations

CD:

Crohn’s disease

IFX:

Infliximab

RCT:

Randomized controlled trial

BMI:

Body mass index

NRI:

Nutritional risk index

CDAI:

Crohn’s disease activity index

Alb:

Albumin

CRP:

C-reactive protein

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Authors and Affiliations

  1. Division of Nutrition and Medical Engineering, Global Center for Medical Engineering and Informatics, Osaka University, Osaka, Japan

    Ryoko Sumi & Yoshifumi Inoue

  2. Department of Integrative Medicine, Osaka University Graduate School of Medicine, Osaka, Japan

    Ryoko Sumi & Toshinori Ito

  3. Department of Gastroenterological Surgery, Osaka University Graduate School of Medicine, 2-2, E-2, Yamadaoka, Suita, Osaka, 565-0871, Japan

    Kiyokazu Nakajima & Toshinori Ito

  4. Department of Gastroenterology and Hepatology, Osaka University Graduate School of Medicine, Osaka, Japan

    Hideki Iijima & Shinichiro Shinzaki

  5. Department of Pediatric Surgery, Osaka University Graduate School of Medicine, Osaka, Japan

    Masafumi Wasa

  6. Nishinomiya Municipal Central Hospital, Hyogo, Japan

    Riichiro Nezu

Authors
  1. Ryoko Sumi
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  2. Kiyokazu Nakajima
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  3. Hideki Iijima
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  4. Masafumi Wasa
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  5. Shinichiro Shinzaki
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  6. Riichiro Nezu
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  7. Yoshifumi Inoue
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  8. Toshinori Ito
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Corresponding author

Correspondence to Kiyokazu Nakajima.

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All authors declare that no competing interests exist.

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Sumi, R., Nakajima, K., Iijima, H. et al. Influence of nutritional status on the therapeutic effect of infliximab in patients with Crohn’s disease. Surg Today 46, 922–929 (2016). https://doi.org/10.1007/s00595-015-1257-5

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  • DOI: https://doi.org/10.1007/s00595-015-1257-5

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