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Nutrition in IBD

  • Zubin Grover
  • Peter Lewindon
Chapter

Abstract

Malnutrition in inflammatory bowel disease (IBD) is related to reduced oral intake, malabsorption and catabolic stress due to inflammatory burden ultimately leading to loss of body form, composition and function. Malnutrition persists even when disease is in remission, and it is associated with increase in mortality, prolonged hospitalisations, post-operative complications, poor quality of life and greater health-care burden. There are multiple proxies of malnutrition, ranging from a simple bedside anthropometry and biochemistry to a more detailed body composition analysis. Anthropometry and biochemistry are practical and low-cost pragmatic malnutrition screening tools; however they cannot discriminate key body composition changes such as loss of lean body mass (LBM) or fat-free mass (FFM) and mesenteric fat deposition (MFD). These key body composition changes contribute to the higher inflammatory burden, poor therapeutic response to anti-TNFs and increased risk for intestinal surgery.

Treatments targets for IBD have also evolved with increasing emphasis on using therapies capable of inducing mucosal healing. Exclusive enteral nutrition (EEN) is the most well-established therapeutic diet in CD capable of inducing mucosal healing rates compared to conventional steroids. Concomitant use of partial enteral nutrition is also associated with reduction in loss of response to infliximab. There is also growing interest in anti-inflammatory exclusion diets to maintain remission, but robust endpoints like endoscopic remission are missing. Multiple serum and faecal biomarker studies have demonstrated anti-inflammatory effects of enteral diet, but the exact mechanism of action remains elusive. Modulation of microbiota and metabolomic changes following dietary elimination studies, more specifically in Crohn’s disease, have been tested in many recent studies; however these shifts do not establish a cause and effect relationship and may simply reflect functional gut adaptations due to changes in dietary substrates. As our understanding of the relationship between diet, nutrition and gut health evolves, we expect to see major advances in the role of dietary patterns and constituents in the development, treatment, cure and finally prevention of IBD.

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Copyright information

© Springer Nature Switzerland AG 2019

Authors and Affiliations

  • Zubin Grover
    • 1
  • Peter Lewindon
    • 2
  1. 1.Princess Margaret Hospital for ChildrenPerthAustralia
  2. 2.Lady Cilento Children’s HospitalSouth BrisbaneAustralia

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