There was 1 female outlier with an initial BMI of 33
There was 1 female outlier with an initial BMI of 33.2 kg/m2. 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. test was used to analyze normally distributed continuous variables. Inasmuch as this was a Radioprotectin-1 hypothesis-generating study, error was set at .05 (2-sided), and we did not adjust for multiple comparisons. Results Disease Activity Age, sex, and disease activity in the 7 patients are presented in Table 1. Of the 7 patients, 5 had active disease defined by CRP 1.0, and 6 had active disease defined by HBI 5. All patients had a poor disease-related QOL at time of enrollment as evidenced by IBDQ 170. CRP improved significantly after 6 months of infliximab therapy (C0.120, = .03). The improvement in IBDQ and HBI after 6 months was not statistically significant (+38, = .06, and C6.07, = .22, respectively). Table 1 Radioprotectin-1 Patient Characteristics and Crohn’s Disease Activity Before and After Infliximab Treatment = .03 vs week 0. Enterocyte Function Levels of plasma folate increased after 6 months of infliximab therapy, with the greatest change in those with high CRP at time of enrollment (+2.14 ng/mL in all patients, = .04 and +3.30 ng/mL in high CRP patients, = .0015, respectively). Corresponding homocysteine levels decreased in 5 of 6 patients (C1.60 mmol/L, = .07). Changes in serum levels of vitamin B12, methylmalonic acid, citrulline, and the fat-soluble vitamins were inconsistent among patients. Changes in d-xylose absorption also varied among patients. Five of the 7 patients had an increase in iron levels and TIBC (+21.43 ug/dL, = Radioprotectin-1 .10 and +38.57 ug/dL, = .15, respectively; Table 2). Table 2 Mean Enterocyte Function Rabbit Polyclonal to ALS2CR8 Before and After Infliximab Treatment Value*= .04; Table 2, Figure 1). Those patients with active disease at time of enrollment had a greatest drop in PINI (C4.65, = .03) and experienced the greatest improvements in serum albumin and 1-AGP levels (+0.32 g/dL, = .24, and C113 mg/dL, = .06, respectively). Open in a separate window Figure 1 Changes in Prognostic Inflammatory Nutritional Index (PINI) with infliximab therapy. Body Composition There was little difference in body composition between the females and the male patient. There was 1 female outlier with an initial BMI of 33.2 kg/m2. Overall, patients experienced an increase in BMI after 6 months of infliximab (+2.21 kg/m2, = .03; Table 3, Figure 2). There was a nonsignificant increase in lean muscle mass and body fat percentage as calculated by DXA (+872.33 g, = 0.4, and +1.81%, = .1). Overall, body fat percentage estimated per bioelectrical impedance increased (+3.15%, = .08). Open in a separate window Figure 2 Changes in body mass index (BMI) with infliximab therapy. Table 3 Mean Body Composition and Metabolism Before and After Infliximab Treatment Value*= .6, and high CRP +0.05, = .02; Table 3). Discussion Treating both disease activity and nutrition deficiencies is an essential component for management of CD. Optimal care can affect the general well-being of patients as well as the mortality and morbidity of the disease.17 Identifying whether or not pharmacological therapy improves.