Exclusive and Partial Enteral Nutrition in Crohn’s Disease

Exclusive enteral nutrition (EEN) is a well-establised primary therapy in active pediatric Crohn’s disease (CD). EEN promotes mucosal healing, restores bone mineral density, and improves growth. On the contrary, treatment of active CD with corticosteroids (CS) has a strong negative impact on the linear growth and bone density. Therefore, EEN is recommended as a first-line therapy in children with active CD. EEN has been evaluated in a number of clinical studies including randomized controlled trials. While meta-analyses of adult studies suggest superiority of CS, pediatric studies have shown that EEN is at least as effective as CS in inducing remission. The mechanisms by which EEN suppresses inflammation are not yet fully elucidated. Hypotheses include improvement in nutritional status, decreasing of the inflammatory cascade mechanism, limiting luminal antigen exposure, improving intestinal permeability, and modification of intestinal microbiota

Nutritional Therapy for Inflammatory Bowel Disease

The components of a diet influence intestinal microbiota, epithelial barrier function, immune system, and many other factors that play important role in both development and treatment of inflammation in gastrointestinal tract. We briefly review potential role of specific dietary compounds as a risk or protective factor, but we predominantly concentrate on nutritional status and nutritional intervention in patients with inflammatory bowel disease. Besides exclusive enteral nutrition as a potential first-line treatment in active Crohn’s disease, other nutritional therapeutic modalities such as partial enteral nutrition, parenteral nutrition, diets based on carbohydrate modifications, anti-inflammatory diet, and the use of specific dietary compounds with anti-inflammatory properties, known as pharmaconutrition, are presented

Partial Enteral Nutrition in Crohn’s Disease

Exclusive enteral nutrition (EEN) has proven to be a highly effective treatment option in inducing remission in active Crohn’s disease (CD) in the paediatric population. In adults with CD, the results of meta-analyses demonstrated that therapy with corticosteroids was more effective in comparison with EEN. The most important limitation of the success of EEN treatment is patients’ compliance. Exclusivity of enteral nutrition and its substantial impact on the quality of life are the main reasons why EEN is not acceptable to many patients. Therefore, the treatment with partial enteral nutrition (PEN), where patients are allowed to eat some ordinary food besides enteral formulas, is becoming an important treatment option, not only in inducing, but also in maintaining remission in CD. However, strong evidence on the efficacy of PEN for induction and maintenance of CD remission is still lacking. Due to the excellent safety profile of the treatment with enteral nutrition in comparison with other treatment modalities, further well-designed, randomised, controlled studies are necessary to elucidate the exact role of PEN in inducing and maintaining of remission in CD patients. Herein, the most relevant studies on the efficacy and the role of PEN in active and quiescent CD are reviewed

Cultivable Bacteria from Milk from Slovenian Breastfeeding Mothers

Majčino mlijeko ima važnu ulogu u razvoju crijevne mikrobiote, te u zaštiti dojenčadi od patogenih mikroorganizama. Svrha je ovoga rada bila istražiti mikrobni sastav majčinog mlijeka, uzorkovanog iz lijeve (L) i desne (R) dojke 47 dojilja, tridesetog dana nakon poroda. Kvantificirane su neke glavne skupine bakterija u majčinom mlijeku, uspoređene kultivabilne bakterije iz lijeve i desne dojke, te je identificirana raznolikost sojeva laktobacila. Rezultati pokazuju da majčino mlijeko sadržava bakterije mliječne kiseline, bifidobakterije i mezofilne aerobne bakterije, od kojih je posljednja skupina najviše zastupljena. Iako je mikrobiološki sastav majčinog mlijeka u uzorcima L i R bio usporediv, koncentracija se bakterija u ta dva uzorka od iste majke mogla razlikovati, pa uzorak mlijeka uzet samo iz jedne dojke ne odražava prosječni mikrobiološki sastav. Na osnovi rezultata dobivenih metodom RAPD (engl. random amplified polymorphic DNA), 86 je bakterijskih sojeva za koje se pretpostavljalo da pripadaju rodu Lactobacillus razvrstano u jedanaest skupina, te identificirano sekvenciranjem 16S rDNA. Od jedanaest analiziranih skupina izolata, za njih je četiri (21 % svih sojeva) ustanovljeno da pripadaju vrsti Lactobacillus gasseri. Utvrđeno je da 48 % izolata najzastupljenijeg profila RAPD pripada vrsti Lactobacillus fermentum, a u preostalim su skupinama izolata identificirane vrste L. salivarius, L. reuteri, Enterococcus faecium, Staphylococcus epidermidis i Bifidobacterium breve.The human milk microbiota plays an important role in the development of infant´s intestinal microbiota and in the protection of infants against pathogenic microorganisms. The aim of this study is to investigate the microbial composition of human milk from 47 breastfeeding mothers, sampled separately from the left (L) and the right (R) breast, on the 30th day after giving birth. We quantified some major bacterial groups in human milk, compared the cultivable bacteria from the left and the right breast and identified strain diversity of lactobacilli. The results revealed that human milk contains lactic acid bacteria, bifidobacteria and mesophilic aerobic bacteria, of which the last were the most abundant group. Although the microbial composition of human milk in L and R breast samples was comparable, the concentration of bacteria in the two samples from the same mother might vary, therefore milk sample taken from one breast only does not reflect the average microbial composition. Using random amplified polymorphic DNA (RAPD), 86 presumptive isolates of lactobacilli from representative samples of human milk from 11 mothers were classified into 11 groups. Moreover, representatives of different RAPD groups were identified using 16S rDNA sequencing. Out of 11 RAPD groups, 4 groups (21 % of all isolates) belonged to the species Lactobacillus gasseri. The most representative RAPD profile (48 % of isolates) was found to belong to the species Lactobacillus fermentum. Other RAPD groups were associated with L. salivarius, L. reuteri, Enterococcus faecium, Staphylococcus epidermidis and Bifidobacterium breve species

Terminologija klinične prehrane: Motnje prehranjenosti in s prehranjenostjo povezana stanja

Izhodišča: Prehransko stanje posameznika uvrščamo med ključne dejavnike njegovega zdravja. Za učinkovito individualno in multidisciplinarno obravnavo stanj, povezanih s prehranskim stanjem posameznika, moramo dobro poznati terminologijo klinične prehrane. Ker je klinična prehrana kot medicinska stroka razvita tudi pri nas, v tujini pa so tovrstni terminološki dokumenti že na voljo, želimo tudi v Sloveniji na podlagi konsenza oblikovati enotno terminologijo. Metode: Prispevek je osnovan na podlagi eksplicitnega terminološkega dogovora. K sodelovanju smo povabili obsežno skupino relevantnih slovenskih strokovnjakov s kliničnih, predkliničnih in drugih področij, ki so povezana z dejavnostjo klinične prehrane v medicini, pri oblikovanju pa je sodeloval tudi terminolog s področja medicine. Kot izhodišče smo izbrali terminološke smernice Evropskega združenja za klinično prehrano in presnovo ter ob njih upoštevali najnovejša strokovna priporočila za posamezne pojme. Avtorji so bili v stiku prek osebnih srečanj in elektronske pošte. Pri končnem oblikovanju konsenza je sodelovalo 42 avtorjev iz 19 slovenskih ustanov. Rezultati: Predstavljamo temeljne pojme, terminološke definicije in pripadajoče slovenske termine s področja klinične prehrane. Opredelili smo osnovne motnje prehranjenosti – podhranjenost, prekomerno hranjenost, neravnovesje mikrohranil in sindrom ponovnega hranjenja. Poleg tega smo opredelili tudi s prehranjenostjo povezana stanja – sarkopenijo in krhkost. Osnovne pojme smo podprli s kliničnim kontekstom, v katerem nastopajo. Zaključki: Poenoteno razumevanje osnovnih patoloških stanj, ki jih obravnava klinična prehrana, je izhodišče za nadaljnji razvoj stroke, poleg tega pa je podlaga tudi za prehransko obravnavo in učinkovito prehransko oskrbo

Terminologija klinične prehrane: Prehranska obravnava – presejanje prehranske ogroženosti in prehranski pregled

Izhodišča: Pomembno vlogo pri prehranski obravnavi imata tako presejanje prehranske ogroženosti kot prehranski pregled, na podlagi katerega lahko postavimo diagnozo motnje prehranjenosti ali s prehranjenostjo povezane motnje. Ocena posameznikovega prehranskega stanja, ki jo pridobimo s prehransko obravnavo, je namreč ključna za načrtovanje učinkovite prehranske oskrbe. Za razvoj področja je pomembno, da so vsi termini, ki se uporabljajo pri kliničnem delu, usklajeni. Taki terminološki dokumenti v mednarodnem prostoru že obstajajo, smiselni pa so tudi za slovenščino in naše okolje. Metode: Prispevek temelji na eksplicitnem terminološkem dogovoru skupine 42 relevantnih slovenskih strokovnjakov iz 19 slovenskih ustanov. Osnova oblikovanja terminoloških smernic je terminološki dokument Evropskega združenja za klinično prehrano in presnovo, pri čemer so bili upoštevani tudi novejši izsledki klinične prehrane. Rezultati: Predstavljeni so slovenski termini in terminološke definicije s področja klinične prehrane. Opredeljeni so osnovni pojmi s področja prehranske obravnave, ki je praviloma del medicinske obravnave. Predstavljena sta pojma prehranska ogroženost in presejanje prehranske ogroženosti, ob čemer so navedeni tudi različni presejalni testi za presejanje prehranskih motenj in s prehranjenostjo povezanih stanj. Podrobno so opredeljeni tudi prehranski pregled in njegovi sestavni deli. Zaključki: Tako presejanje prehranske ogroženosti kot prehranski pregled sta bistvena za diagnostično obravnavo v okviru klinične prehrane, poenoteno razumevanje terminologije pa omogoča primerno prepoznavo patoloških stanj pri bolnikih in pripravo ustreznega načrta prehranskih ukrepov

Dietary Sources of Vitamin D, Vitamin D Supplementation, and Its Bio-Viability

The focus of this paper is to review the data on the dietary sources of vitamin D, vitamin D supplementation and its bio-viability. Vitamin D is a fat-soluble vitamin that plays an important role in human health. Low vitamin D levels (<75 nmol/l) have been reported worldwide in all age groups in recent years. Vitamin D deficiency is rising, mainly due to modern lifestyle and malabsorption disorders. There are two main sources of vitamin D; dietary source which includes food of animal and plant origin as well as dietary supplements and endogenous synthesis under the UVB radiation in the skin. Dietary sources rich in vitamin D are mainly fish oil, sea fish, eggs, and margarines fortified with vitamin D. As the adequate intake of vitamin D is hard to achieve through the diet alone, dietary supplements of vitamin D are recommended. However, there are different factors influencing the bioavailability of vitamin D and are explained within this review article. There is no universal consent on the amount and the frequency of vitamin D supplementation. Furthermore, there is still missing information for better understanding the vitamin D absorption, bioavailability, and metabolism in human. Conclusion – A brief mini review article on vitamin D summarizes the current knowledge about dietary sources of vitamin D, vitamin D supplements, and its bio-viability. The best source of vitamin D is in vivo synthesis in the skin under the UVB radiation. The main dietary sources of vitamin D includes food of animal and plant origin. Adequate intake of vitamin D through the diet alone is hard to achieve, therefore vitamin D supplementation is recommended