Doença de Crohn: efeito de suplemento alimentar sobre o estado nutricional de pacientes sob terapia com anti-TNF-alfa e azatioprina

Author(s)

Júlia Figueiredo Machado

• Document type: Master's Dissertation
• Press: Campinas, SP.
• Institution: Universidade Estadual de Campinas (UNICAMP). Faculdade de Ciências Médicas
• Defense date: 2013-07-31

Examining board members

Maria Marluce dos Santos Vilela; Roseli Oselka Saccardo Sarni; Antonio de Azevedo Barros Filho

• Advisor: Maria Marluce dos Santos Vilela

Abstract

Crohn's Disease (CD) is characterized by a chronic inflammation that affects any part of the gastrointestinal tract. In the acute phase, gastrointestinal symptoms may lead to malnutrition. During disease remission, some patients are overweight or obese; as adipose tissue produces proinflammatory cytokines, its excess may aggravate inflammation. To evaluate the effects of two supplements on nutritional status in CD patients, we performed a prospective, randomized, double-blind, parallel-arm trial. Participants received whey protein (WP) or soy protein (SP) supplement for 16 weeks. Nutritional assessment was performed by anthropometric measurements, bioelectrical impedance, 24-hour dietary recall, serum albumin and pre-albumin. The Crohn's Disease Activity Index (CDAI) and serum C-reactive protein (CRP) were used for the assessment of the disease activity. In the first evaluation (n = 68), 93% of the patients were in clinical remission (CDAI <150), 36% were overweight or obese and only 5% were malnourished. Over 50% of the patients had an inadequate intake of calcium, potassium, and vitamins A, C and D. Patients under treatment with anti-TNF- alpha had body mass index (BMI), body fat percentage (%BF) and triciptal skin fold (TSF) greater than those undergoing azathioprine therapy. Nineteen patients in the WP group and twenty-two in the SP group completed the 16 weeks of supplementation. The supplements had no effect on CDAI and CRP, but contributed to body composition change. The TSF and %BF decreased, whereas mid-arm muscle circumference (MAMC), corrected arm muscle area (CAMA) and body lean percentage (%BL) increased, in the two groups. Some patients in this study presented overweight, obesity or low intake of micronutrients, dietary advice is needed to correct these nutritional abnormalities. The supplementation with WP and SP may contribute to the reduction of overweight and obesity through reducing body fat and thus contributing to inflammatory control, preventing disease progression (AU)

• FAPESP's process: 11/04750-9 - Crohn's disease: effect of nutrition supplements on Disease Activity Index (CDAI) and nutritional state of the patients in therapy with anti-TNF-alpha and Azathioprine.
• Grantee: Júlia Figueiredo Machado
• Support Opportunities: Scholarships in Brazil - Master