 | A Equipe do CDC esteve presente no DDW 2017 que aconteceu em Maio em Chicago (EUA). Este é o maior congresso de Gastroenterologia do mundo, organizado pela AGA (American Gastroenterology Association). A Equipe conferiu atualizações no tratamento de Doença Inflamatórias intestinais e também apresentou um trabalho desenvolvido no CDC. Confira abaixo fotos e o abstracta to trabalho apresentado. O trabalho também foi publicado na edição suplementar do Gastroenterology. |
Nutritional Profile of Patients with Crohn's Disease and Chronic Inflammatory Conditions Receiving Anti-TNF Therapy
Background: Tumor necrosis factor alpha (TNF-alpha) is an important determinant of body composition in patients with Crohn’s Disease (CD) and other chronic inflammatory disorders. Even though anti-TNF medications have revolutionized the treatment of these conditions, their impact in patient’s nutritional profile has been poorly explored.
Aim: To assess the nutritional profile of patients undergoing anti-TNF therapy for CD and other chronic inflammatory conditions.
Methods: Patients with CD, rheumatoid arthritis (RA) and spondyloarthritis (SpA) were prospectively enrroled for a nutritional evaluation from July 2015 to July 2016. Patients with less than 6 months of biologic therapy, active disease, history of prior intestinal resection and on concomitant nutritional supplementation were excluded from the study. Patients receiving anti-TNF therapy were compared between disease groups as well as to healthy controls, matched for age and gender. The nutritional profile assessment comprised: body mass index (BMI), abdominal circumference (AC), mid-upper arm circumference (MUAC) and triceps skifold measurement (TSM).
Results: A total of 131 subjects were included in the study: 43 with CD (20 on biologic therapy); 44 with RA (21 on biologic therapy); and 44 with SpA (23 on biologic therapy). The mean age (years) was 45.4 ± 12 in the CD group, 54.8 ± 11.1 in RA and 50.2 ± 13.5 in SpA. Females were 51% in the CD cohort, 80% in RA and 48% in SpA. Controls groups pared to CD, RA and SpA included 63, 79 and 62 patients, respectively.
Overweight (BMI >25) and Obesity (BMI >30) was prevalent on all three groups. BMI was >25 in 55.7% of CD patients when compared to 41.25% of healthy controls (p<0,0001); in 74,9% of RA patients when compared to 49.2% of controls (p<0.0005); and in 68.1% of SpA patients compared to 43.5% controls (p<0.0001). Central obesity was significantly associated with the three disease groups when compared to healthy controls, with mean CA 93.6±13,0cm (p=0,02) in CD; 97.08±13,4cm (p=0.01) in RA; and median CA 95.5cm (p=0.004) in SpA. There was no statistically significant difference on nutritional parameters in patients using or not anti-TNF alpha medications, except in patients with SpA, in which biologic therapy was associated with a significantly lower BMI (p<0.0001) and AC (p=0.02), when compared to other therapies.
Conclusion: Overweight, obesity and an elevated AC were more prevalent in patients with CD and chronic
inflammatory disorders undergoing remission on anti-TNF and other immunosupressive therapies, when compared to healthy controls. The use of biologic therapy was associated with a lower BMI and CA in patients with SpA. Additional studies with extended follow-up are warranted to further characterize the impact of biologic therapy in the nutritional profile of these patients.
DOI: http://dx.doi.org/10.1016/S0016-5085(17)32762-2
Background: Tumor necrosis factor alpha (TNF-alpha) is an important determinant of body composition in patients with Crohn’s Disease (CD) and other chronic inflammatory disorders. Even though anti-TNF medications have revolutionized the treatment of these conditions, their impact in patient’s nutritional profile has been poorly explored.
Aim: To assess the nutritional profile of patients undergoing anti-TNF therapy for CD and other chronic inflammatory conditions.
Methods: Patients with CD, rheumatoid arthritis (RA) and spondyloarthritis (SpA) were prospectively enrroled for a nutritional evaluation from July 2015 to July 2016. Patients with less than 6 months of biologic therapy, active disease, history of prior intestinal resection and on concomitant nutritional supplementation were excluded from the study. Patients receiving anti-TNF therapy were compared between disease groups as well as to healthy controls, matched for age and gender. The nutritional profile assessment comprised: body mass index (BMI), abdominal circumference (AC), mid-upper arm circumference (MUAC) and triceps skifold measurement (TSM).
Results: A total of 131 subjects were included in the study: 43 with CD (20 on biologic therapy); 44 with RA (21 on biologic therapy); and 44 with SpA (23 on biologic therapy). The mean age (years) was 45.4 ± 12 in the CD group, 54.8 ± 11.1 in RA and 50.2 ± 13.5 in SpA. Females were 51% in the CD cohort, 80% in RA and 48% in SpA. Controls groups pared to CD, RA and SpA included 63, 79 and 62 patients, respectively.
Overweight (BMI >25) and Obesity (BMI >30) was prevalent on all three groups. BMI was >25 in 55.7% of CD patients when compared to 41.25% of healthy controls (p<0,0001); in 74,9% of RA patients when compared to 49.2% of controls (p<0.0005); and in 68.1% of SpA patients compared to 43.5% controls (p<0.0001). Central obesity was significantly associated with the three disease groups when compared to healthy controls, with mean CA 93.6±13,0cm (p=0,02) in CD; 97.08±13,4cm (p=0.01) in RA; and median CA 95.5cm (p=0.004) in SpA. There was no statistically significant difference on nutritional parameters in patients using or not anti-TNF alpha medications, except in patients with SpA, in which biologic therapy was associated with a significantly lower BMI (p<0.0001) and AC (p=0.02), when compared to other therapies.
Conclusion: Overweight, obesity and an elevated AC were more prevalent in patients with CD and chronic
inflammatory disorders undergoing remission on anti-TNF and other immunosupressive therapies, when compared to healthy controls. The use of biologic therapy was associated with a lower BMI and CA in patients with SpA. Additional studies with extended follow-up are warranted to further characterize the impact of biologic therapy in the nutritional profile of these patients.
DOI: http://dx.doi.org/10.1016/S0016-5085(17)32762-2
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