Anti-inflammatory and growth-stimulating effects precede nutritional restitution during enteral feeding in Crohn disease.
OBJECTIVE
Exclusive enteral feeding reduces inflammation and improves well being, nutrition and growth in children with active Crohn disease. Whether improved growth and increases in growth-related proteins are a consequence of improved nutrition or a reduced inflammation is not known. This study was undertaken to test the hypothesis that changes in growth-related proteins are related to decreased inflammation, rather than improvement in nutritional status.


METHODS
Twelve children with active Crohn disease treated for 6-weeks with exclusive enteral feeding were studied at days 0, 3, 7, 14, 21, 28, and 56. The Paediatric Crohn's Disease Activity Index (PCDAI), weight, triceps skinfold thickness, and midupper arm circumference were recorded. C-reactive protein (CRP), erythrocyte sedimentation rate (ESR), interleukin-6 (IL-6), insulin-like growth factor (IGF-I), IGF-binding protein (IGFBP-3), and leptin were measured at each visit. Wilcoxon matched-pairs signed-rank test was used to compare day 0 with follow-up data.


RESULTS
Significant improvements (P < 0.05) occurred by day 3 in inflammatory parameters (ESR, IL-6) and by day 7 in PCDAI, CRP, and IGF-I. These changes preceded any significant changes in nutritional parameters (weight-for-age Z score and midupper arm circumference day 14, triceps skinfold thickness day 21).


CONCLUSIONS
Early increases in IGF-I during treatment of Crohn disease are attributable to the anti-inflammatory effect of the enteral feed rather than nutritional restitution.
Bannerjee
Kaushik
K
Departments of Adult and Paediatric Gastroenterology, Barts and the London, Queen Mary's School of Medicine and Dentistry, University of London, London, United Kingdom.
Camacho-Hübner
Cecilia
C
Babinska
Katarzyna
K
Dryhurst
Kay M
KM
Edwards
Ray
R
Savage
Martin O
MO
Sanderson
Ian R
IR
Croft
Nicholas M
NM
D000293:Adolescent; D000886:Anthropometry; D015415:Biomarkers / Q000097:blood; D001799:Blood Sedimentation; D002097:C-Reactive Protein / Q000378:metabolism; D002648:Child; D003424:Crohn Disease / Q000097:blood* / Q000628:therapy*; D004750:Enteral Nutrition; D005260:Female; D006801:Humans; D007249:Inflammation / Q000097:blood / Q000628:therapy; D018972:Insulin-Like Growth Factor Binding Protein 3 / Q000097:blood / Q000378:metabolism; D007334:Insulin-Like Growth Factor I / Q000378:metabolism*; D015850:Interleukin-6 / Q000097:blood*; D020738:Leptin / Q000097:blood; D008297:Male; D009752:Nutritional Status; D018709:Statistics, Nonparametric; D013997:Time Factors; D016896:Treatment Outcome
D015415:Biomarkers; D018972:Insulin-Like Growth Factor Binding Protein 3; D015850:Interleukin-6; D020738:Leptin; D007334:Insulin-Like Growth Factor I; D002097:C-Reactive Protein