Mechanisms of decreased food intake during weight loss in adult Crohn's disease patients without obvious malabsorption.

Because weight loss is common in colonic Crohn's disease and is poorly correlated with disease activity, we analyzed food intake in 63 patients without malabsorption, 30 patients with weight loss (9.2 +/- 4.2 kg), and 33 patients without weight loss. Energy and protein intakes were lower in patients with weight loss than in those with stable weight (P < 0.01). In the former group, food restrictions were more numerous (P < 0.01) and visual analog scales showed less hunger, decreased appetite, and fewer sensations of pleasure related to eating, as compared with the other group (P < 0.01). Food intake reduction was also related to depressive mood and medical advice. However, there was no difference between groups in fecal energy wasting and resting energy expenditure. Weight loss in Crohn's disease may be due to a decrease in food intake rather than to an increase in energy cost of the disease. Thus, focus of attention on the diet is crucial to prevent malnutrition.

[Increase of resting energy expenditure during flare-ups in Crohn disease]. / Augmentation de la dépense énergétique de repos lors des poussées de maladie de Crohn.

Crohn's disease is an inflammatory process commonly characterized by phases of flare-up. Weight loss and malnutrition are prominent features in the course of the disease, especially during acute episodes. It is therefore important to define energy needs. Curiously, resting energy expenditure (REE) has rarely been studied in Crohn's disease, and never in relation with the activity of the disease. We therefore determined REE together with body composition (fat free mass, FFM), Crohn's disease activity index (CDAI) and plasma acute phase proteins in 70 patients: during flare-up in 41 and during clinical remission (CDAI < 150) in 29. We found an increase in REE in patients with active disease (CDAI > 150), as compared with patients in remission, when REE was expressed as a function of FFM: 31.7 +/- 2.7 versus 29.4 +/- 3.3 kcal/kg FFM/day (P < 0.01). The mean REE/FFM was 8% higher during flare-up than during remission, and was correlated to both clinical (CDAI; P = 0.011) and biological inflammatory activity indices (C reactive protein, P = 0.018; orosomucoid, P = 0.024). In some patients, the REE was in the normal range, despite an increase in REE/FFM, because of a decrease in FFM due to hypermetabolism. In 8 patients treated successfully by total parenteral nutrition for a massive flare-up, REE/FFM was increased before TPN (36.6 +/- 3.0 kcal/kg/day), and decreased after 4 weeks of TPN (31.4 +/- 1.8 kcal/kg/day; P < 0.001), returning within normal values in 7 patients.

Enfermedad de Crohn y pérdida de peso: estudio comparativo de multicasualidad

Los pacientes con enfermedad de Crohn (EC) presentan frecuentemente crisis de pérdida de peso. Puede ser ocasionada por una reducción de los aportes calóricos y/o aumento de las pérdidas energéticas (aumento del metabolismo basal y de las pérdidas fecales). Fueron estudiados 26 enfermos consecutivos (12 H y 14 M) con EC del colon (n=7), ileal (n=9) y mixta (n=10), repartidos en dos grupos según que presentaran (grupo 1) o no (grupo 2) una pérdida de peso significativa (según criterios de Blackburn). Fueron estudiados en conjunto las causas probables de adelgazamiento: aportes alimenticios (encuesta de hábitos alimentarios y obseervación alimentaria), sensación de hambre(escala visual analógica), índice de depresión de Beck, actividad de la enfermedad (índice de Best 150), metabolismo basal (calorimetría indirecta), creatorrea, esteatorrea y pérdida energética en las heces (calorimetría directa). Fueron excluidos los pacientes con resección ileal mayor de 1 metro o con foco infeccioso. El peso de los pacientes del grupo 1 disminuyó en forma latamente significativa al compararlo con el grupo 2 (-13.3ñ6.1 por ciento versus -0.27ñ5.3 por ciento del peso usual, p<0.0001). Los aportes energéticos de los pacientes del grupo 1 fueron inferiores a los del grupo 2 (-2314 Kjul/d por el interrogatorio, p<0.03 y de -2407 Kjul/d por la observación alimentaria, p<0.04). La diferencia se debió principalmente a un menor consumo de glúcidos. La sensación de hambre era menor en los pacientes del grupo 1 (p<0.01) al evaluarla por EVA. Ninguna de las otras variables estudiadas difería de manera significativa entre los dos grupos. En la EC la pérdida de peso se asocia principalmente a una disminución de los aportes alimenticios como consecuencia de la norexia. La hipótesis de un aumento del metabolismo basal y/o de las pérdidas de enrgía por las heces no se confirmó en este estudio