Measurement of nutrition status in Crohn's disease patients receiving infliximab therapy.
OBJECTIVE
There is limited information on the nutrition impact of antitumor necrosis factor-alpha treatment in adult Crohn's disease (CD). This study was performed to examine the effect of a 6-month course of infliximab on enterocyte function, nutrient status, metabolism, and body composition in these patients.


METHODS
Seven CD patients were assessed for disease activity, enterocyte function, and body composition prior to, after 6 weeks, and after 6 months of infliximab treatment. Measurements included (1) disease activity: Inflammatory Bowel Disease Questionnaire, Harvey Bradshaw Index, and C-reactive protein; (2) enterocyte function: folate, homocysteine, vitamin B(12), citrulline, vitamin D, beta-carotene, d-xylose absorption; (3) Prognostic Inflammatory and Nutritional Index (PINI); and (4) body composition and metabolism: body mass index (BMI), fat and lean body mass, resting energy expenditure (RRE), and respiratory quotient.


RESULTS
Most patients had improvement in disease activity with infliximab. PINI decreased in all patients (-3.35, P = .04). Plasma folate concentration significantly increased. There was an increase in BMI, fat mass, and lean body mass. The respiratory quotient increased in most patients. Changes in citrulline level and REE were inconsistent.


CONCLUSIONS
Crohn's disease patients have improvements in an index that measures both inflammation and nutrition (PINI) with infliximab therapy. Increases in plasma folate suggest improvement in enterocyte function and/or increased oral intake. The increase in respiratory quotient suggests decreased lipolysis and the lack of a starvation state. It was unclear whether weight gain was predominantly fat or lean muscle mass. These finding also support the use of PINI in Crohn's patients as an overall marker of inflammation and nutrition, and as a measure of response to infliximab therapy.
Lerner College of Medicine Cleveland Clinic, 9500 Euclid Avenue NA-24, Cleveland, OH 44195, USA. wiesed@ccf.org
Dawn
D
Wiese
Bret
B
Lashner
Douglas
D
Seidner
D000328:Adult; D000893:Anti-Inflammatory Agents / Q000627:therapeutic use*; D000911:Antibodies, Monoclonal / Q000627:therapeutic use*; D001481:Basal Metabolism / Q000502:physiology; D001823:Body Composition / Q000502:physiology; D003424:Crohn Disease / Q000097:blood / Q000188:drug therapy* / Q000378:metabolism; D020895:Enterocytes / Q000502:physiology; D005260:Female; D005492:Folic Acid / Q000008:administration & dosage / Q000097:blood; D006801:Humans; D000069285:Infliximab; D008297:Male; D008875:Middle Aged; D009752:Nutritional Status; D010101:Oxygen Consumption; D012720:Severity of Illness Index
D000893:Anti-Inflammatory Agents; D000911:Antibodies, Monoclonal; D005492:Folic Acid; D000069285:Infliximab