Research gaps in diet and nutrition in inflammatory bowel disease. A topical review by D-ECCO Working Group (Dietitians of ECCO)

Although the current doctrine of IBD pathogenesis proposes an interaction between environmental factors with gut microbiota in genetically-susceptible individuals, dietary exposures have attracted recent interest and are, at least in part, likely to explain the rapid rise in disease incidence and prevalence. The D-ECCO working group along with other ECCO experts with expertise in nutrition, microbiology, physiology and medicine reviewed the evidence investigating the role of diet and nutritional therapy in the onset, perpetuation and management of IBD. A narrative topical review is presented where evidence pertinent to the topic is summarized collectively under three main thematic domains: i) the role of diet as an environmental factor in IBD aetiology; ii) the role of diet as induction and maintenance therapy in IBD; and iii) assessment of nutritional status and supportive nutritional therapy in IBD. A summary of research gaps for each of these thematic domains is proposed which is anticipated to be agenda setting for future research in the area of diet and nutrition in IBD

Prescription of physical exercise in Crohn's disease

AbstractBackgroundPhysical exercise may be potentially beneficial for recovering physical condition and improving quality of life in populations suffering from chronic conditions, but little is known about its effects on patients suffering from Crohn's disease.AimsTo provide reasonable and conservative recommendations for exercise regimens that appear clinically safe and feasible in patients suffering from Crohn's disease.MethodsRelevant clinical studies about the effects of physical exercise on Crohn's disease, written in English language and carried out with human subjects were reviewed.ResultsFew relevant clinical studies have evaluated the effects of an exercise intervention on patients experiencing Crohn's disease. There seem to be two main types of physical interventions that should be recommended: aerobic activity and muscular resistance training.ConclusionsSome basic guidelines about how to prescribe physical exercise in Crohn's disease can be provided. However, more research is needed as few studies have been carried out so far

Carbohydrate Intake in the Etiology of Crohn's Disease and Ulcerative Colitis

Background: Diet may have a role in the etiology of inflammatory bowel disease. In previous studies, the associations between increased intakes of carbohydrates, sugar, starch, and inflammatory bowel disease are inconsistent. However, few prospective studies have investigated the associations between these macronutrients and incident Crohn's disease (CD) or ulcerative colitis (UC). Methods: A total of 401,326 men and women were recruited between 1991 and 1998. At recruitment, dietary intakes of carbohydrate, sugar, and starch were measured using validated food frequency questionnaires. The cohort was monitored identifying participants who developed incident CD or UC. Cases were matched with 4 controls, and odds ratios were calculated for quintiles of total carbohydrate, sugar, and starch intakes adjusted for total energy intake, body mass index, and smoking. Results: One hundred ten participants developed CD, and 244 participants developed UC during follow-up. The adjusted odds ratio for the highest versus the lowest quintiles of total carbohydrate intake for CD was 0.87, 95% CI = 0.24 to 3.12 and for UC 1.46, 95% CI = 0.62 to 3.46, with no significant trends across quintiles for either (CD, Ptrend = 0.70; UC, Ptrend = 0.41). Similarly, no associations were observed with intakes of total sugar (CD, Ptrend = 0.50; UC, Ptrend = 0.71) or starch (CD, Ptrend = 0.69; UC, Ptrend = 0.17). Conclusions: The lack of associations with these nutrients is in agreement with many case–control studies that have not identified associations with CD or UC. As there is biological plausibility for how specific carbohydrates could have an etiological role in inflammatory bowel disease, future epidemiological work should assess individual carbohydrates, although there does not seem to be a macronutrient effect

The therapeutic management of gut barrier leaking: the emerging role for mucosal barrier protectors

OBJECTIVE: Gut barrier is a functional unit organized as a multi-layer system and its multiple functions are crucial for maintaining gut homeostasis. Numerous scientific evidences showed a significant association between gut barrier leaking and gastro-intestinal/extra-intestinal diseases. MATERIALS AND METHODS: In this review we focus on the relationship between gut barrier leaking and human health. At the same time we speculate on the possible new role of gut barrier protectors in enhancing and restoring gut barrier physiology with the final goal of promoting gut health. RESULTS: The alteration of the equilibrium in gut barrier leads to the passage of the luminal contents to the underlying tissues and thus into the bloodstream, resulting in the activation of the immune response and in the induction of gut inflammation. This permeability alteration is the basis for the pathogenesis of many diseases, including infectious enterocolitis, inflammatory bowel diseases, irritable bowel syndrome, small intestinal bacterial overgrowth, celiac disease, hepatic fibrosis, food intolerances and also atopic manifestations. Many drugs or compounds used in the treatment of gastrointestinal disease are able to alter the permeability of the intestinal barrier. Recent data highlighted and introduced the possibility of using gelatin tannate, a mucosal barrier protector, for an innovative approach in the management of intestinal diseases, allowing an original therapeutic orientation with the aim of enhancing mucus barrier activity and restoring gut barrier. CONCLUSIONS: These results suggest how the mucus layer recovering, beside the gut microbiota modulation, exerted by gut barrier protectors could be a useful weapon to re-establish the physiological intestinal homeostasis after an acute and chronic injury

Abdominal body composition in paediatric Crohn’s disease

Childhood Crohn’s disease is associated with growth failure, weight loss and malnutrition. The aetiology of which is multifactorial; chronic inflammation, therapy induced and reduced calorific intake. These factors contribute to alterations in metabolism and body composition. Visceral adipose tissue is the adipose compartment, most strongly associated with chronic inflammation. Intestinal adipose tissue expansion described as ‘creeping fat’ is well recognized from surgical specimens as a hallmark of Crohn’s disease. Expansion of visceral adipose tissue is associated with cardiometabolic risk factors which have been reported in adults and children with inflammatory bowel disease. I performed a systematic review, to understand gaps in the literature in the context of body composition in children with inflammatory bowel disease. 22 studies were included, reporting on body composition in a total of 1477 children with inflammatory bowel disease . Lean mass deficits were more pronounced in children with Crohn’s ; 93.6% of Crohn’s and 47.7% of ulcerative colitis. Fat related compartment findings were inconsistent, and no clear conclusions could be drawn. Given that children with Crohn’s disease had more pronounced deficits in body composition, and intestinal fat expansion is a hallmark of disease, but there is a paucity of data regarding body fat measures; my main aim was to quantify visceral adipose tissue volumes and liver ectopic fat using magnetic resonance imaging (MRI) and Magnetic Resonance Spectrometry (MRS), in this cohort. My secondary aim was to examine relationship of visceral adipose tissue and ectopic liver fat in children with Crohn’s disease, disease specific and, metabolic parameters and plasma adipokines. I tested a null hypothesis in that no difference would be observed in abdominal adipose tissue or ectopic liver fat between children with Crohn’s disease and healthy children. A prospective cohort of children (7–17 years) with CD and healthy children, were recruited. Visceral adipose tissue , abdominal subcutaneous adipose tissue, abdominal muscle volumes (expressed in litres), and intrahepatocellular lipid (IHCL), was determined using MRS. Blood was analysed for CRP, ESR, albumin, fasting insulin, fasting glucose, lipid profile, adipokines (adiponectin, leptin, visfatin and resistin). Multiple regression analysis was used to identify factors associated with the dependent variable (compartment volume) significance was set at p<0.05. Spearman’s rank coefficient for non-parametric data was determined to examine relationship between adipose tissue volumes and disease and blood parameters, R values were reported as per published cut offs. 33 children were recruited (25 CD; 16 males), and 8 controls (5 males), mean age 14.0 ± 2.3 years and 13.4 ± 2.5 years. No participant with CD was receiving concurrent systemic steroids. CD vs. healthy controls; CD was significantly associated with 0.41 litres [0.15 to 0.55] more visceral adipose tissue and 1.71 litres [1.36 to 2.45] more abdominal subcutaneous adipose tissue; after adjusting for sex, weight z score, height z score, and pubertal status (p<0.05). Abdominal muscle volumes were lower in Crohn’s disease. There was no significant difference in intrahepatocellular lipid. In children with CD, disease duration, male sex and CRP were significant positive predictors of visceral adipose tissue volume. abdominal subcutaneous adipose tissue had a positive relationship with plasma leptin. Dyslipidaemia was observed, and visceral adipose tissue was associated with plasma triglyceride levels. Visceral adipose tissue was found to positively influence adiposity in CD, namely intrahepatocellular lipid and abdominal subcutaneous adipose tissue. Children with Crohn’s were found to have poor quality diets; low calorie, macronutrient imbalance and high percentage non-milk extrinsic sugars . For the first time in paediatric CD patients, we show an association with abdominal adipose tissue obesity (visceral adipose tissue and abdominal subcutaneous adipose tissue) and a trend towards muscle deficit in the context of normal hepatic lipid. Possible drivers of this obesity phenotype in children with Crohn’s disease may be the result of dietary inadequacy, energy imbalance, systemic and local chronic inflammation.Open Acces

Scoping review on health-related physical fitness in patients with inflammatory bowel disease:Assessment, interventions, and future directions

BACKGROUND:Reaching the Selecting Therapeutic Targets in Inflammatory Bowel Disease-II (STRIDE-II) therapeutic targets for inflammatory bowel disease (IBD) requires an interdisciplinary approach. Lifestyle interventions focusing on enhancing and preserving health-related physical fitness (HRPF) may aid in improving subjective health, decreasing disability, or even controlling inflammation. However, ambiguity remains about the status and impact of HRPF (i.e. body composition, cardiorespiratory fitness, muscular strength, muscular endurance, and flexibility) in IBD patients, hindering the development of physical activity and physical exercise training guidelines. AIM:To review HRPF components in IBD patients and the impact of physical activity and physical exercise training interventions on HRPF. METHODS:A systematic search in multiple databases was conducted for original studies that included patients with IBD, assessed one or more HRPF components, and/or evaluated physical activity or physical exercise training interventions. RESULTS:Sixty-eight articles were included. No study examined the complete concept of HRPF, and considerable heterogeneity existed in assessment methods, with frequent use of non-validated tests. According to studies that used gold standard tests, cardiorespiratory fitness seemed to be reduced, but findings on muscular strength and endurance were inconsistent. A limited number of studies that evaluated physical activity or physical exercise training interventions reported effects on HRPF, overall showing a positive impact. CONCLUSION:This review revealed a gap in the literature regarding the accurate assessment of HRPF in patients with IBD and highlighted important methodological limitations of studies that evaluated physical activity or physical exercise training interventions. Future well-designed studies are required to determine the optimal training paradigm for improving HRPF in patients with IBD before guidelines can be developed and integrated into the therapeutic strategy.</p

EFSUMB Recommendations and Guidelines for Gastrointestinal Ultrasound - Part 1: Examination Techniques and Normal Findings (Short version)

Abstract ▼ In October 2014 the European Federation of Societies for Ultrasound in Medicine and Biology formed a Gastrointestinal Ultrasound (GIUS) task force group to promote the use of GIUS in a clinical setting. One of the main objectives of the task force group was to develop clinical recommendations and guidelines for the use of GIUS under the auspices of EFSUMB. The first part, gives an overview of the examination techniques for GIUS recommended by experts in the field. It also presents the current evidence for the interpretation of normal sonoanatomical and physiological features as examined with different ultrasound modalities