The many faces of malnutrition in Crohn disease.
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Crohn Disease↗
Biomedical subjects
K N Jeejeebhoy
Publications and source records attributed to K N Jeejeebhoy.
Changes in body composition and dietary intake induced by tumor necrosis factor alpha and corticosterone--individually and in combination.
Previous studies have shown that anorexia and reduced food intake are the main causes of weight loss in rats infused with tumor necrosis factor alpha (TNF-alpha), with no influence on corticosterone concentrations. In contrast, in clinical sepsis, muscle wasting due to increased catabolism is associated with increased corticosteroid concentrations. We hypothesized that in the rat model, corticosterone potentiates the catabolic effect of TNF-alpha in amounts that by itself does not influence muscle catabolism. Orally fed rats were divided into 3 treatment groups: continuous infusion of TNF-alpha (TNF; 100 microg x kg(-1) x d(-1)), corticosterone (Cort; 50 microg x g(-1) x d(-1)), or both (TNF+Cort). Each group was compared with a respective pair-fed (PF) group. In addition an ad libitum (AL)-fed group receiving an infusion of physiologic saline was studied to observe unrestricted food intake and weight gain. After 4 d of infusion, dietary intake and weight gain were significantly higher in the Cort and AL groups than in the TNF and TNF+Cort groups. Although wet liver weights and protein contents were significantly higher in the Cort, TNF, and TNF+Cort groups than in their respective PF group, the TNF and TNF+Cort groups had lower relative carcass weights. The weight and protein content of the diaphragm were lower and nitrogen excretion was higher in the TNF+Cort group than in the respective PF group. The results suggest that TNF-alpha plus corticosterone had a specific catabolic effect on the diaphragm. In addition, together they increased overall nitrogen excretion.
Animals↗
Feeding a low energy diet and refeeding a control diet affect glycolysis differently in the slow- and fast-twitch muscles of adult male Wistar rats.
Muscle glycogen concentrations in underfed (HYPO) and refed rats (RE) in an earlier study did not correlate with fatigue. We hypothesized that underfeeding slowed glycolysis in the slow-twitch soleus, but not in the fast-twitch extensor digitorum longus (EDL). Thirty adult male Wistar rats were randomly assigned to receive one of two isovolemic and micronutrient-complete liquid diets, a control (CN) energy-complete diet for 10 d or a diet 80% lower in energy (HYPO) for 7 d producing a 20% loss of initial weight. Rats were refed an energy-complete diet for 1 or 4 d (RE1, RE4). Rats were then anesthetized, and the soleus and EDL muscles of the hindlimbs were isolated and electrically stimulated in situ. The pre- and postfatigued muscles were freeze-clamped, lyophilized and stored at -70 degreesC until assayed for specific glycolytic and Krebs cycle metabolites. The HYPO diet caused significantly slower glycolysis in the stimulated soleus but not the EDL compared with the CN diet as supported by the following: 1) a lower fructose-1,6-bisphosphate (F-1,6-P2)/fructose-6-phosphate (F-6-P) ratio; 2) a greater glucose-6-phosphate (G-6-P)/lactate ratio; 3) a lower lactate/glycogen ratio; and 4) lower lactate concentration. Four days of refeeding normalized the F-1,6-P2/F-6-P ratio, but did not improve the lactate/glycogen or the G-6-P/lactate ratios. We conclude that undernutrition compromises glycolysis only in slow-twitch muscles and that 4 d of refeeding restores phosphofructokinase activity.
Analysis of Variance↗
The role of micronutrients in the 1990s.
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Dietary Supplements↗
Nutritional management of anorexia.
The prevalence of eating disorders, such as anorexia nervosa, is increasing in young adults, particularly young adult women. Sometimes, gastrointestinal complaints in patients with anorexia nervosa may lead to an erroneous diagnosis of gastrointestinal disease and unnecessary diagnostic studies and therapies. In contrast, patients with gastrointestinal disease may experience anorexia because of abdominal pain and other gastrointestinal symptoms induced by eating. In these patients, anorexia minimizes symptoms and can obscure the underlying gastrointestinal disease by "resting" the bowel. Therefore, a careful history and physical examination and laboratory tests are needed to make the correct diagnosis and begin appropriate treatment.
Adolescent↗
Risk and significance of endoscopic/radiological evidence of recurrent Crohn's disease.
BACKGROUND & AIMS: The aim of this study was to determine the risk of endoscopic/radiological recurrence of Crohn's disease postoperatively and the long-term outcome. METHODS: A randomized placebo-controlled trial was performed to determine the effectiveness of mesalamine in preventing recurrent Crohn's disease postoperatively. Patients in the control group were examined endoscopically/radiologically before entry into and annually during the trial. Findings were classified as minimal or severe. RESULTS: There were 76 patients (49 men and 37 women; mean age, 37.1 +/- 13.2 years). Fifty (61.7%) had terminal ileal resections. Overall, 55 endoscopic/radiological recurrences were observed in 51 patients (67.1%). Expressed actuarially, the recurrence rate was 27.5% at 1 year (95% confidence interval [CI], 15.8%-37.6%), 60.8% at 2 years (95% CI, 46%-71.3%), and 77.3% at 3 years (95% CI, 62.7%-86.3%). Nineteen (37%) were symptomatic and 12 (24%) were initially asymptomatic but later became symptomatic (mean, 13.0 +/- 8.8 months), whereas 20 (39%) remained asymptomatic (mean, 16.9 +/- 17.4 months). Patients with severe endoscopic/radiological disease were significantly more likely to be or become symptomatic than those with minimal disease (23 of 32 vs. 8 of 19, respectively; P = 0.0437). CONCLUSIONS: This study suggests that postoperative endoscopic/radiological recurrences occur later than previously reported. Furthermore, many of these patients, especially with minimal disease, will remain asymptomatic.
Actuarial Analysis↗
Immunonutrition.
The immune system is designed to protect the individual from foreign substances or organisms. It is expressed as cellular and humoral immunity. The former is dependent upon T lymphocytes and the latter on B lymphocytes, which become plasma cells and secrete antibodies. The immune system can be influenced by protein-energy malnutrition (PEM) and by catabolic illnesses such as sepsis and trauma, which in turn cause PEM. Specific trace element and vitamin deficiencies can also alter the immune state. However, overnutrition and obesity can also influence immune mechanisms. Obesity can promote the development of diabetes, which can alter the immune state. Finally, immunity becomes less effective with ageing and this process is enhanced by associated malnutrition.
Animals↗
Effect of hypoenergetic feeding and high-carbohydrate refeeding on muscle tetanic tension, relaxation rate, and fatigue in slow- and fast-twitch muscles in rats.
Studies using nuclear magnetic resonance have shown that undernutrition affects muscle performance and energetics. It is unclear to what extent underfeeding and refeeding influence the availability of muscle glycogen, net glycogenolysis, skeletal muscle wasting, and recovery. We hypothesized that muscle performance is independent of muscle size and weight, is specific to muscle type, and is unrelated to muscle glycogen concentrations. Slow- and fast-twitch muscles were studied in three groups of adult male Wistar rats: well-fed controls, hypoenergetically fed (Hypo) rats, and rats refed for 4 d after the hypoenergetic diet. Glycogen concentrations and net glycogenolysis; serum glucose, insulin, and protein concentrations; and muscle weight, protein, and cross-sectional area were studied relative to the performance of both types of muscles. Our study controlled for muscle size, weight, and type and electrolyte-micronutrient deficiency. Undernutrition affected muscle performance in five ways. First, compared with controls, fatigue increased only in the soleus muscles of Hypo rats yet the maximal relaxation rate (MRR) decreased in both the soleus and extensor digitorum longus (EDL) muscles. Second, muscle glycogen concentrations did not significantly correlate with fatigue in either the soleus or the EDL although net glycogenolysis was significantly correlated with fatigue in the soleus (r = -0.64; P > 0.01 < 0.05). Third, lower glycogen concentrations did not hinder net glycogenolysis in the EDL of Hypo rats or the soleus of refed rats. Fourth, muscle weight, size, and protein were dissociated from function. Fifth, refeeding did not restore muscle endurance; however, the MRR of the soleus normalized. In conclusion, glycogen values and muscle performance did not correlate but net glycogenolysis correlated with fatigue in the soleus. Also, there was a dissociation between muscle weight, size, and protein and muscle function during hypoenergetic feeding and refeeding.
Animals↗
Perioperative artificial nutrition in elective adult surgery.
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Journal Article↗
Nutritional status and function in patients following Whipple procedure compared with controls.
OBJECTIVE: Despite the potential for nutritional deficits in patients undergoing pancreaticoduodenectomy or Whipple procedure, long-term assessment of nutritional status has largely been ignored. This study assessed nutritional status of 24 Whipple patients compared with matched post-cholecystectomy controls. METHODS: Clinical assessment was by subjective global assessment, body composition was assessed by bioelectric impedance analysis and functional assessment was by respiratory muscle strength and skeletal muscle function performed by electrical stimulation of the ulnar nerve of the wrist and hand-grip dynamometry. RESULTS: Whipple patients studied 4.6+/-0.7 years since surgery and controls (4.8+/-0.7 years since surgery) were all judged clinically to be in a good nutritional state. Compared with controls, Whipple patients had significantly lower body weight (Whipple: 72.5+/-2.8 kg, control: 83.9+/-3.3 kg, p<0.05) however, the mean body weight of both Whipple and controls was above ideal weight (Whipple: 113.3+/-4.3%, control: 122.3+/-3.7% p = NS). No significant differences in functional performance were observed between groups. Energy intake of Whipple and controls was also comparable. In the Whipple group, neither the extent of gastric resection or the pathological diagnosis had an effect on the nutritional parameters studied. CONCLUSIONS: Long-term follow-up of patients having undergone Whipple procedure failed to reveal the presence of any nutritional or functional deficits suggesting that a full nutritional recovery is possible after this surgery.
Aged↗
Effects of hypocaloric feeding and refeeding on myocardial Ca and ATP cycling in the rat.
Hypocaloric feeding (HCF) depresses heart function causing cardiac atrophy, bradycardia, and decreased cardiac output. We tested the hypothesis that HCF results in decreased myocardial Ca- and ATP cycling. We reduced protein-calorie intake of adult rats by 20% for 7 days and then allowed them to recover for 3 days. Changes in ionized Ca concentration (nM/s) of 2.5% myocardial homogenates that were attributable to the Ca-ATPase pump and Ca-release channel (CRC), respectively, of the sarcoplasmic reticulum (SR) were depressed 41 and 85% by HCF from 61.6 +/- 9.4 and 24.7 +/- 3.3, to 36.1 +/- 2.8 and 3.6 +/- 2.9. Activity of the Ca-pump was restored after 3 days of refeeding, whereas the CRC remained 23% depressed (all p < 0.05). Additionally, the CRC activity was inhibited to a 3-fold greater extent than controls by HCF, but was disinhibited within one day of refeeding. The greater effect on CRC than Ca-pump activity resulted in net Ca-uptake being unaffected by HCF. In addition to depression of Ca-cycling, ATP sythetase and total ATPase activities (IU/g), respectively, were depressed 20 and 15% by HCF from 174 +/- 19 and 51.3 +/- 3.8 to 140 +/- 15 and 43.7 +/- 4.7, but were restored to control values within one day of refeeding. We conclude that HCF produces a compensatory, reversible, and asymmetric downregulation and inhibition of Ca-cycling, with the CRC being preferentially affected.
Adenosine Triphosphate↗
Effect of tumor necrosis factor-alpha on triglyceride and phospholipid content and fatty acid composition of liver and carcass in rats.
We have previously shown that a continuous infusion of tumor necrosis factor-alpha (TNF-alpha) in rats results in an increase in plasma triglyceride (TG), liver protein and DNA, and at the same time a reduction in muscle protein. However, there is no information on the associated effects of TNF-alpha on liver and muscle lipids. The present study, therefore, determined the effect of TNF-alpha on the TG and phospholipid (PL) content and their fatty acid composition, in the liver and carcass of rats and correlated with the plasma levels of insulin, corticosterone, and catecholamines. Total parenteral nutrition that met the daily nutrient requirements was continuously infused for 10 d through a central vein catheter in two groups of rats, one receiving infused TNF-alpha (100 micrograms/kg/d) and a control group. Hepatic TG and PL, expressed either as mg/g dry weight or total organ content, were significantly increased in the TNF-alpha-infused group compared with controls. Livers of TNF-alpha infused rats contained significantly less saturated and monounsaturated fatty acids and significantly more polyunsaturated fatty acids (PUFA) of the omega 3 and omega 6 series than controls. The carcass, on the other hand, contained significantly more monounsaturated and significantly less polyunsaturated fatty acids of the omega 6 series than controls. There were no changes in corticosterone level. Although plasma glucose levels were comparable between control and TNF-alpha infused rats, the latter had a marked increase in insulin levels, demonstrating insulin resistance. In addition TNF-alpha infused rats had raised norepinephrine levels.(ABSTRACT TRUNCATED AT 250 WORDS)
Animals↗
Quality of life, nutritional status, and gastrointestinal hormone profile following the Whipple procedure.
BACKGROUND: To compare the quality of life, nutritional status, and gastrointestinal profiles of post-Whipple patients and postcholecystectomy patients. METHODS: A cross-sectional survey of post-Whipple procedure patients and age- and sex-matched postcholecystectomy patients was performed. Quality of life was assessed using six instruments: Time Trade-off Technique, Direct Questioning of Objectives, Gastrointestinal Quality of Life Index, Sickness Impact Profile, Physician Global Assessment, and Visick Scale. A gastrointestinal symptomatology questionnaire was completed. Nutritional status was assessed by weight, the Subjective Global Assessment instrument, and skin anthropometry. Fasting and postprandial serum gastrin, somatostatin, insulin, pancreatic glucagon, enteroglucagon, and pancreatic polypeptide were measured. RESULTS: The quality of life and gastrointestinal function of the Whipple patients was excellent and was not significantly different from that of the control subjects. There were no significant differences in gastrointestinal symptomatology although 5 Whipple patients complained of greasy bowel movements, and 1 patient reported difficulty maintaining weight. Despite this, nutritional status was within normal limits in all subjects. Six patients in the Whipple group followed a diabetic diet, 1 required insulin, and 3 required an oral hypoglycemic agent, whereas none of the control subjects were diabetic. There were no significant differences in the mean basal, peak, or integrated postprandial responses of the gut hormones with the exception of pancreatic polypeptide and gastrin (in patients having a standard Whipple procedure only). CONCLUSION: Quality of life and nutritional status are excellent in patients following a Whipple procedure.
Adult↗
Stability of high-energy substrates in fast- and slow-twitch muscle: comparison of enzymatic assay of biopsy with in vivo 31P nuclear magnetic resonance spectroscopy.
The purpose of this study was to investigate the stability of ATP and PCr levels in stored muscle samples and extracts. ATP and PCr levels were measured by fluorimetric analysis in freeze-clamped biopsies of soleus, extensor digitorum longus, and gastrocnemius muscles of the rat after storage in a freezer at -70 degrees C as (i) intact wet muscle, (ii) freeze-dried muscle, and (iii) an extract of freeze-dried muscle. Assays were performed within 24 h of taking the biopsy and after variable periods of storage from 1 to 4 weeks. The data for the gastrocnemius muscles were compared with those obtained, in the same rat, by in vivo 31P NMR spectroscopy. In the biopsies, the ATP levels were stable irrespective of the duration or method of storage. The PCr levels fell by 13-16% compared with the values obtained from the assay done within 24 h of taking the biopsy, irrespective of the method of storage, but could be corrected in the freeze-dried stored muscle by expressing the data in relation to the total creatine levels. The fluorimetrically measured PCr, in whole muscle extracts of the gastrocnemius, assayed within 24 h, were comparable to those obtained from 31P NMR spectroscopy. We concluded that PCr levels in muscle are not stable during storage at -70 degrees C and should be assayed within 24 h of taking a muscle biopsy to ensure that the values are the same as those obtained by 31P NMR.
Adenosine Triphosphate↗
Advances in clinical nutrition.
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Digestive System Diseases↗
Colonic fermentation and nutritional recovery in rats with massive small bowel resection.
BACKGROUND/AIMS: After massive small bowel resection, malabsorbed carbohydrates reach the colon and undergo fermentation. This study investigates the role of colonic fermentation in rats with 80% small bowel resection on weight gain, nitrogen balance, body composition, and intestinal adaptation. METHODS: Resected or transected rats were fed a liquid diet enterally for 16 days with or without 30 mg/kg metronidazole to reduce fermentation. Weight gain was monitored until the rats were killed. Carcass composition, short-chain fatty acids in cecal content, total nitrogen output, and intestinal mucosal dry weight, protein, and DNA were measured. RESULTS: Resected rats without metronidazole had a significantly better weight gain, carcass protein, nitrogen balance, and mucosal dry weight, protein, and DNA compared with that of resected rats receiving metronidazole. There were no significant differences between the two transected groups. CONCLUSIONS: Decreasing colonic fermentation, measured by short-chain fatty acids in cecal content, reduced intestinal adaptation and nutritional recovery in rats with massive small bowel resection.
Animal Nutritional Physiological Phenomena↗
Critical assessment of body-composition measurements in malnourished subjects with Crohn's disease: the role of bioelectric impedance analysis.
Bioelectric impedance analysis (BIA) has been widely used for assessment of body composition in healthy subjects but has not been validated in malnourished patients. This study compared calculation of fat-free mass (FFM) by five methods to determine whether the currently used equations for total body water (TBW) as assessed by BIA were applicable to 19 malnourished patients with Crohn's disease. When compared with TBW assessed by H2(18)O dilution, BIA was higher by 5.9 +/- 1.1% (P < 0.005). A stepwise-multiple-regression equation was derived to validate BIA: TBW (kg) = 0.25 (ht2/resistance) + 0.29 (wt) + 3.63 (r = 0.97, SEE = 0.28). Comparison of the hydration of FFM (TBW by 18O dilution/FFM) between methods showed that total body potassium (TBK) gave a significantly higher value when compared with the reference method of body protein, mineral, and 18O analysis. Dual-energy x-ray absorptiometry (DXA) provided a value for TBW/FFM in close agreement with the reference method. We conclude that BIA overestimates TBW, and TBK underestimates FFM in malnourished patients. DXA provides an accurate measurement of body fat in malnutrition.
Absorptiometry, Photon↗