Elsevier

Nutrition

Volume 14, Issue 10, October 1998, Pages 788-791
Nutrition

Specific Conditions
Inflammatory bowel disease

https://doi.org/10.1016/S0899-9007(98)00085-9Get rights and content

Abstract

Many nutritional issues are important in the care of children and adolescents with inflammatory bowel disease. No specific dietary toxin or antigen has been identified to have an etiologic role in either ulcerative colitis or Crohn’s disease. A possible modulating effect of ω-3 polyunsaturated fatty acids on intestinal inflammation is being investigated. Most prevalent among the nutritional consequences of inflammatory bowel disease is weight loss, for which inadequate caloric intake is primarily responsible. Impairment of linear growth and associated delay in pubertal development commonly complicate childhood Crohn’s disease. The two major etiologic factors are chronic undernutrition and direct effects of inflammatory mediators secreted from the inflamed gut. Recent studies have incriminated interleukin-6. Treatment of intestinal inflammation and provision of adequate nutrition are of paramount importance in preventing or remedying growth impairment. Exclusive enteral nutrition using formulated food is efficacious primary therapy of active Crohn’s disease, although the mode of action is poorly understood.

Introduction

Inflammatory bowel disease (IBD) encompasses at least two forms of chronic intestinal inflammation: Crohn’s disease (CD) and ulcerative colitis (UC). IBD develops during childhood or adolescence in 20–25% of patients. The observed spectrum of disease severity and nutritional impact is wide, in part related to the site, nature, and extent of intestinal involvement. Many nutritional issues are important in the care of patients with IBD. This article reviews the question of the role of diet in the etiopathogenesis of IBD, discusses its nutritional impact on children, and examines the use of nutritional therapies in the primary modulation of intestinal inflammation.

Section snippets

Pathogenesis of inflammatory bowel disease: current concepts

Understanding the etiopathogenesis of UC and CD is a major challenge of gastroenterologic research.1 To date, a positive family history in a first-degree relative is the major known risk factor for IBD. Environmental factors must also play a role, however, as evidenced by the increasing incidence of CD in recent decades and changing incidences of IBD in migrant populations.2 Predisposing genes must interact with exogenous or endogenous triggers and modifying factors to result in a chronic

Malnutrition

Weight loss and emaciation are the most prevalent nutritional disturbances in IBD. At the time of first diagnosis, approximately 85% of pediatric CD and 65% of pediatric UC patients have lost weight.7

General dietary measures

For the majority of ambulatory patients, it is most important to consume a diet liberal in protein with calories sufficient to maintain or restore weight, or to support growth in children and adolescents. Liquid dietary supplements may help motivated patients achieve these goals, although in young patients these will often simply displace ingested calories from regular food without increasing total caloric intake.25

The merits and necessity of dietary restrictions need to be critically examined.

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