The effect of disease, drug, and diet on whole body protein metabolism in adolescents with Crohn disease and growth failure

doi:10.1016/S0022-3476(82)80056-5

The Journal of Pediatrics

Volume 101, Issue 3, September 1982, Pages 345-351

https://doi.org/10.1016/S0022-3476(82)80056-5 Get rights and content

The effect of chronic inflammation, corticosteriod therapy, and nutritional supplementation on whole body protein metabolism and growth was determined in adolescent males with Crohn disease and growth failure. Body protein status was characterized in six patients and in five healthy, age-matched controls by nitrogen balance, whole body potassium (measured as ⁴⁰K), urinary creatinine excretion, and [¹⁵N]glycine turnover studies. The patients subsequently received an intragastric nutritional supplement that increased dietary protein and nergy intakes by 40% for seven months. Follow-up anthropometric measurements were obtained in both groups of adolescents. Our results demonstrated that lean body mass (⁴⁰K) and muscle mass (creatinine) were significantly reduced in the patients compared to the controls, despite similar nitrogen balances between both groups. Whole bodh nitrogen flux, rates of protein synthesis and breakdown, and net protein retention were no different between those patients with chronic inflammation, while receiving corticosteroid therapy, and their controls. Long-term nutritional supplementation significantly improved linear and ponderal growth velocities in the patients such that growth rates were commeasure with those of the healthy controls. We conclude that chronic inflammation and corticosteroid therapy are not associated with detectable alterations in protein metabolic processes at the whole body level. Rather, dietary insufficiency appears to be primarily responsible for growth failure in adolescents with Crohn disease.

References (30)

MotilKJ et al.
Whole body leucine metabolism in adolescents with growth failure during nutritional supplementation
Gastroenterology
(1982)
KeltsDG et al.
Nutritional basis of growth failure in children and adolescents with Crohn's disease
Gastroenterology
(1979)
KirschnerBS et al.
Reversal of growth retardation in Crohn's disease with therapy emphasizing on oral restitution
Gastroenterology
(1981)
MorinCL et al.
Continuous elemental enteral alimentation in children with Crohn's disease and growth failure
Gastroenterology
(1980)
FrisanchoAR
Triceps skin fold and upper arm muscle size norms for assessment of nutritional status
Am J Clin Nutr
(1974)
RittenbergD et al.
Studies in protein metabolism. II. The determination of nitrogen isotopes in organic compounds
J Biol Chem
(1939)
SteffeeWP et al.
Dietary intake and dynamic aspects of whole body nitrogen metabolism in adult humans
Metabolism
(1976)
YoungVR
The role of skeletal and cardiac muscle in the regulation of protein metabolism
LongCL et al.
Whole body protein synthesis and catabolism in septic man
Am J Clin Nutr
(1977)
MahalanabisD
Nitrogen balance during recovery from secretory diarrhea of cholera in children
Am J Clin Nutr
(1981)

KeltsDG et al.

Inflammatory bowel disease in children and adolescents

Curr Probl Pediatr

(1980)

HomerDR et al.

Growth, course and prognosis after surgery for Crohn's disease in children and adolescents

Pediatrics

(1977)

SchacterH et al.

Definition of inflammatory bowel disease of unknown etiology

Gastroenterology

(1975)

WalterlowJC

Classification and definition of protein calorie malnutrition

Br Med J

(1972)

Cited by (79)

Systematic review: Sarcopenia in paediatric inflammatory bowel disease
2023, Clinical Nutrition ESPEN
Low skeletal muscle mass (MM) and deteriorated function (sarcopenia) can be a frequent complication in paediatric inflammatory bowel disease (IBD).
To conduct a systematic review of the paediatric IBD literature on skeletal muscle function and mass and identify interventions that could affect them.
Systematic searches (EMBASE, Medline, Cochrane library central for registered control trials and Web of Science) were conducted using the terms ‘lean body mass’ (LM), ‘fat free mass' (FFM) or ‘MM’ and ‘IBD’.
Fourteenth studies were included, presenting data from 439 Crohn's disease (CD), 139 ulcerative colitis (UC) and 2 IBD-unclassified participants compared with healthy matched or unmatched groups or reference populations. Six out of 14 studies reported lower LM, whilst 7 studies observed lower MM and FFM in CD patients compared to healthy controls. Research in UC patients reported lower LM in 3 studies, lower MM in 3 studies and lower FFM in 4 studies. Three prospective studies measured the impact of enteral feeding and showed improvement on disease activity and LM or FFM, while one retrospective study did not show any impact on LM.
Despite the variety of experimental approaches and methods used to assess sarcopenia, most studies showed reduction in MM, LM and FFM in IBD. Nutritional intervention may have a positive effect on LM and FFM. Future research should focus on standardizing the terminology and methodologies used in assessing body composition and investigating sarcopenia in diseased and matched healthy control cohorts in adequately powered studies with a longitudinal design.
Body composition in children with chronic inflammatory diseases: A systematic review
2020, Clinical Nutrition
Citation Excerpt :
Lower nutrients intakes, e.g. reduced calcium intake in IBD [22,28,65], but also similar or higher values or those in accordance to that recommended have been reported e.g. in IBD [17] and in JIA [44]. Serum or plasma nutritional markers such as albumin [18,19,22,25,30,65–73], 25-hydroxyvitamin D [17,22,25,28,30,44,64,65] and transferrin [25,30,69] or some other markers [18,19,22,33,65,72] were reported in several of the studies. However, only a few articles had examined the association of these markers with body composition.
Aberrations in body composition are expected in children suffering from chronic inflammatory conditions. The objective is to examine whether children with inflammatory bowel disease (IBD: Crohn's disease and ulcerative colitis), coeliac disease, asthma and juvenile idiopathic arthritis (JIA) have an altered body composition as compared to healthy children.
A systematic review, registered in Prospero (registration number: CRD42018107645), was conducted according to PRISMA guidelines. We conducted a search of three databases, Pubmed, Cochrane and Scopus. An assessment of the quality of the study was performed.
Data from 50 studies, 32 with IBD, 8 with coeliac disease, 2 with asthma and 8 with JIA, involving 2399 children were selected for review after applying the eligibility criteria. In all but 4 studies, children with Crohn's disease exhibited decreased amounts of fat mass and fat free mass. Reductions in fat mass were also evident in studies in children with coeliac disease. It is uncertain whether body composition is altered in children with asthma or JIA.
Children with Crohn's disease manifest with lowered adiposity and lean mass and therefore are likely to be at risk for suffering malnutrition-related clinical complications. Apart from Crohn's disease, data examining body composition in children with chronic inflammatory conditions are scarce and there is a paucity of reports examining the relationship between inflammation and body composition. Interpretation of the current study results is hampered by the low quality of the studies and due to the fact that the analyses have been habitually secondary outcomes.
ESPEN Guidelines on Enteral Nutrition: Gastroenterology
2006, Clinical Nutrition
Undernutrition as well as specific nutrient deficiencies have been described in patients with Crohn's disease (CD), ulcerative colitis (UC) and short bowel syndrome (SBS).
The present guideline gives evidence-based recommendations for the indication, application and type of formula of enteral nutrition (EN) (oral nutritional supplements (ONS) or tube feeding (TF)) in these patients. It was developed in an interdisciplinary consensus-based process in accordance with officially accepted standards and is based on all relevant publications since 1985.
ONS and/or TF in addition to normal food is indicated in undernourished patients with CD or CU to improve nutritional status. In active CD EN is the first line therapy in children and should be used as sole therapy in adults mainly when treatment with corticosteroids is not feasible. No significant differences have been shown in the effects of free amino acid, peptide-based and whole protein formulae for TF. In remission ONS is recommended only in steroid dependent patients in CD. In patients with SBS TF should be introduced in the adaptation phase and should be changed with progressing adaptation to ONS in addition to normal food.
The full version of this article is available at www.espen.org.
Measured versus predicted energy expenditure in children with inactive Crohn's disease
2005, Clinical Nutrition
The aim of the study was to assess if the estimated average requirements for energy for normal children (EAR) and the Schofield equation could reliably predict energy requirements in children with inactive Crohn's disease (CD).
Twenty-three children with inactive CD were studied, median age 14.3 years (range 7.8–16.9). Resting energy expenditure (REE) was measured by indirect calorimetry and compared with that predicted using the Schofield equation (BMR). Total energy expenditure (TEE) was measured using REE and a 3-day activity diary and compared with EAR.
REE ranged from 79% to 136% of BMR. Mean REE was not significantly greater than mean BMR ( $P = 0.25$ 2-tailed t-test). TEE ranged from 72% to 163% of estimated average requirements for energy for children of that weight (EARw). EARw tended to underestimate TEE in large children and overestimate TEE in small children (Bland–Altman plot $R = 0.5$ , $P = 0.002$ ). EARw was a poor predictor of TEE ( $R = 0.35$ , $P = 0.1$ ). EAR underestimated energy requirements by >500 kcal/day in 40% of the children.
The Schofield equation and EAR are unreliable methods of predicting total energy requirements in children with inactive CD with a significant potential to underestimate energy needs. When energy requirements were greater than EAR it was due to physical activity and body habitus rather than raised REE.
Nutritional treatment in childhood Crohn's disease
2005, Archives de Pediatrie
Le retentissement sur la croissance staturopondérale et le développement pubertaire est la complication majeure de la maladie de Crohn (MC) chez l'enfant. L'évaluation nutritionnelle repose sur : la recherche d'anomalies de la vélocité de croissance (< 4–5 cm/an en période prépubertaire), l'évaluation du développement pubertaire et de l'âge osseux, la recherche d'un déficit calorique et de carences nutritionnelles. Au moment du diagnostic, un amaigrissement et un retard statural sont observés dans 80–90 % et 1/3 des cas, respectivement. En cas de poussée de MC avec croissance normale, la prise en charge nutritionnelle repose sur l'alimentation orale, avec des apports caloriques au moins égaux aux apports conseillés pour l'âge. Un régime pauvre en fibres n'est conseillé qu'en cas de sténose du grêle. Aucun régime alimentaire n'a fait la preuve de son efficacité dans la prévention des récidives. L'alimentation entérale (AE) exclusive représente une alternative efficace à la corticothérapie dans le traitement des poussées aiguës de la MC, en particulier en cas de dénutrition. L'AE nocturne prolongée présente un grand intérêt pour le traitement du retard staturopondéral ou pubertaire, et dans les formes corticodépendantes ou résistantes. Dans les formes corticodépendantes de MC, les immunosuppresseurs représentent une alternative à l'AE de longue durée chez les patients ne présentant pas de retard staturopondéral ou pubertaire. Les solutés polymériques ont une efficacité identique à celle des solutés élémentaires ou semi-élémentaires. Les indications de l'alimentation parentérale sont limitées : forme suraiguë, résistante au traitement médicamenteux ou à l'AE, et inaccessible à la chirurgie ; forme occlusive ou fistulisée ; résection intestinale étendue.
Growth retardation and delay in sexual maturation are the major complications of child-onset Crohn's disease (CD). Nutritional assessment and monitoring should comprise: weight and height measurement with calculation of respective velocities (growth velocity should be ≥ 4–5 cm/year during the prepubertal period); pubertal staging; dietetic evaluation; laboratory analysis for mineral, vitamin and trace element deficiencies; bone age. At diagnosis, weight loss and growth delay are present in 80–90% and 1/3 of cases, respectively. In case of an acute flare-up in a CD child with normal nutritional status, nutritional therapy is limited to oral feeding, with a caloric intake at least equal to recommended dietary allowances for age and sex. A low-fiber diet is advised in case of small bowel stenosis. No diet has been shown as efficient in the long-term maintenance of remission. Exclusive enteral nutrition (EN) is an alternative to corticosteroids for the treatment of an acute flare-up of CD, especially in case of malnutrition. Prolonged nocturnal EN is of great interest for the treatment of growth retardation and delay of sexual maturation and in case of steroid-dependent or steroid-refractory CD. In case of steroid-dependent CD with no delay of growth and/or sexual maturation, immunomodulating agents are nowadays an alternative to long-term EN. Efficacy of polymeric solutions is identical to that of semi-elemental or elemental solutions. Parenteral nutrition is limited to an acute flare-up with resistance to medical treatment and/or EN, and contraindications to surgery; occlusion or fistula; short bowel syndrome.
Nutritional management of inflammatory bowel disease
2023, Pediatric Inflammatory Bowel Disease

View all citing articles on Scopus

¹

Supported in part by National Institutes of Health, Clinical Research Center Grants RR-88 (MIT), RR-128 (CHMC), Research Grants AM-15756 (V.R.Y.); and by grants from the National Foundation for Ileitis and Colitis, New York, N.Y, and Ross Laboratories, Columbus, Ohio.

Presented in part at the meetings of the XII International Congress of Nutrition, San Diego, August, 1981.

View full text

Original articleThe effect of disease, drug, and diet on whole body protein metabolism in adolescents with Crohn disease and growth failure1

Gastroenterology

Gastroenterology

Gastroenterology

Gastroenterology

Am J Clin Nutr

J Biol Chem

Metabolism

Am J Clin Nutr

Am J Clin Nutr

Inflammatory bowel disease in children and adolescents

Curr Probl Pediatr

Growth, course and prognosis after surgery for Crohn's disease in children and adolescents

Pediatrics

Definition of inflammatory bowel disease of unknown etiology

Gastroenterology

Classification and definition of protein calorie malnutrition

Br Med J

Original article
The effect of disease, drug, and diet on whole body protein metabolism in adolescents with Crohn disease and growth failure1