P547 Inadequate vitamin C status and association with inflammatory biomarkers in adults with active Crohn’s disease

Abstract Background Micronutrient deficiencies are common in inflammatory bowel disease (IBD) due to the inflammatory burden and changes in dietary intake. Vitamin C, an essential water-soluble antioxidant required for tissue repair and immune function, is found primarily in fresh fruit and vegetables however, this food group is more often avoided by people with IBD compared with the general population. This research aimed to determine serum vitamin C status in subjects with active Crohn’s disease, measure urinary vitamin C excretion in healthy controls (HC) and Crohn’s disease patients before and after exclusive enteral nutrition (EEN) and assess associations between inflammatory markers and vitamin C. Methods Stored serum and random urine samples prospectively collected from adults with mild to moderately active Crohn’s disease and adult HC were analysed. Both HC and Crohn’s disease groups received EEN with a known vitamin C content for two weeks. Serum and urinary vitamin C were measured using high-performance liquid chromatography with electrochemical detection. Urinary vitamin C was standardised to urinary creatinine. Non-parametric t-tests and correlations were performed. Results EEN was initiated in 38 patients (aged 16 to 39 years old). Inadequate serum vitamin C (<50 µmol/l) was present in 36/38 patients with active Crohn’s disease and 45% had hypovitaminosis C. Baseline C-reactive protein (CRP) was 12 mg/l (range, 3 to 158 mg/l) and faecal calprotectin was 1065 µg/g (range, 60 to 3838 µg/g). Serum vitamin C correlated weakly with CRP (r = −0.30 95% CI: −0.58 to 0.03, p = 0.06) but not with faecal calprotectin. Two weeks of EEN was completed by 30 (79%) patients and 17 (81%) HC. The average vitamin C intake was 168mg/day (range, 108–252 mg/day). Baseline urinary excretion of vitamin C was low in both Crohn’s disease and HC. Following EEN urinary vitamin C excretion increased significantly in both groups (Figure 1). Conclusion Patients with active Crohn’s disease had inadequate vitamin C status. EEN increased urinary vitamin C excretion in both Crohn’s disease and HC, suggesting low baseline dietary vitamin C intake and potentially enhanced utilisation. Further research with a larger patient cohort would provide a greater understanding of vitamin C metabolism in active Crohn’s disease.

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Increased Urinary Excretion of Iohexol after Enteral Administration in Patients with Ileal Crohn's Disease

Acta Radiologica ◽

10.1177/028418519303400307 ◽

1993 ◽

Vol 34 (3) ◽

pp. 237-241 ◽

Cited By ~ 8

Author(s):

L. Halme ◽

J. Edgren ◽

K. von Smitten ◽

H. Linden

Keyword(s):

Crohn’S Disease ◽

Small Bowel ◽

Crohn's Disease ◽

Urinary Excretion ◽

High Performance ◽

Cell Damage ◽

Oral Intake ◽

Reversed Phase ◽

Water Soluble ◽

Mucosal Cell

Iohexol is a water-soluble contrast medium that is partly absorbed/permeated through mucosa of the small bowel and excreted unchanged in the urine. Iohexol was administered orally to 12 patients with Crohn's disease of the ileum and to 10 healthy controls to measure its excretion in the urine. The location and activity of Crohn's disease were determined by barium double-contrast radiography in all patients and by ileoscopy and biopsy in 9 patients. Iohexol concentrations in serum and 24-hour urine were measured using reversed phase high-performance liquid chromatography. Urinary excretion of iohexol was significantly greater in patients with active Crohn's disease than in controls. We suggest this method as a new way of measuring Crohn's disease activity and mucosal damage in the small bowel. Bowel inflammation and mucosal cell damage are strongly indicated if the iohexol excreted in the urine is over 1% of the oral intake.

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Letter: reproducible evidence shows that exclusive enteral nutrition significantly reduces faecal calprotectin concentrations in children with active Crohn's disease

Alimentary Pharmacology & Therapeutics ◽

10.1111/apt.14351 ◽

2017 ◽

Vol 46 (11-12) ◽

pp. 1119-1120 ◽

Cited By ~ 3

Author(s):

M. Logan ◽

U. Z. Ijaz ◽

R. Hansen ◽

K. Gerasimidis ◽

R. K. Russell

Keyword(s):

Crohn’S Disease ◽

Crohn's Disease ◽

Enteral Nutrition ◽

Faecal Calprotectin ◽

Exclusive Enteral Nutrition

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The Medical Management of Paediatric Crohn’s Disease: an ECCO-ESPGHAN Guideline Update

Journal of Crohn s and Colitis ◽

10.1093/ecco-jcc/jjaa161 ◽

2020 ◽

Cited By ~ 1

Author(s):

Patrick F van Rheenen ◽

Marina Aloi ◽

Amit Assa ◽

Jiri Bronsky ◽

Johanna C Escher ◽

...

Keyword(s):

Crohn’S Disease ◽

Crohn's Disease ◽

Treatment Response ◽

Medical Management ◽

Therapeutic Drug ◽

Close Monitoring ◽

Faecal Calprotectin ◽

Exclusive Enteral Nutrition ◽

Medical Librarian ◽

Paediatric Crohn’S Disease

Abstract Objective We aimed to provide an evidence-supported update of the ECCO-ESPGHAN guideline on the medical management of paediatric Crohn’s disease [CD]. Methods We formed 10 working groups and formulated 17 PICO-structured clinical questions [Patients, Intervention, Comparator, and Outcome]. A systematic literature search from January 1, 1991 to March 19, 2019 was conducted by a medical librarian using MEDLINE, EMBASE, and Cochrane Central databases. A shortlist of 30 provisional statements were further refined during a consensus meeting in Barcelona in October 2019 and subjected to a vote. In total 22 statements reached ≥ 80% agreement and were retained. Results We established that it was key to identify patients at high risk of a complicated disease course at the earliest opportunity, to reduce bowel damage. Patients with perianal disease, stricturing or penetrating behaviour, or severe growth retardation should be considered for up-front anti-tumour necrosis factor [TNF] agents in combination with an immunomodulator. Therapeutic drug monitoring to guide treatment changes is recommended over empirically escalating anti-TNF dose or switching therapies. Patients with low-risk luminal CD should be induced with exclusive enteral nutrition [EEN], or with corticosteroids when EEN is not an option, and require immunomodulator-based maintenance therapy. Favourable outcomes rely on close monitoring of treatment response, with timely adjustments in therapy when treatment targets are not met. Serial faecal calprotectin measurements or small bowel imaging [ultrasound or magnetic resonance enterography] are more reliable markers of treatment response than clinical scores alone. Conclusions We present state-of-the-art guidance on the medical treatment and long-term management of children and adolescents with CD.

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Dietary Triggers of Gut Inflammation Following Exclusive Enteral Nutrition in Children with Crohn’s Disease: A Pilot Study

10.21203/rs.3.rs-646699/v1 ◽

2021 ◽

Author(s):

Konstantinos Gkikas ◽

Michael Logan ◽

Ben Nichols ◽

Umer Z. Ijaz ◽

Clare M. Clark ◽

...

Keyword(s):

Crohn’S Disease ◽

Pilot Study ◽

Crohn's Disease ◽

Enteral Nutrition ◽

Processed Meat ◽

Faecal Calprotectin ◽

Exclusive Enteral Nutrition ◽

Group A ◽

Group B ◽

Red And Processed Meat

Abstract Objectives:The anti-inflammatory effect of exclusive enteral nutritionon thegut of children with Crohn’s disease is rapidly lost after food reintroduction. This study assessed disease dietary triggers following successful treatment with exclusive enteral nutrition.Methods: Nutrient intake, dietary patterns and dietary biomarkers in faeces (gluten immunogenic peptides, undigestible starch, short chain fatty acids) were assessed in 14 children with Crohn’s disease during early food reintroduction, following exclusive enteral nutrition. Groups above (Group A) and below (Group B) the median levels of faecal calprotectin after food reintroduction were assigned for comparative analysis. Results:Intakes of fibre, gluten-containing cereals and red and processed meat were significantly higher in Group A than Group B;(median [Q1, Q3], grams; Fibre: 12.1 [11.2, 19.9] vs 9.9 [7.6, 12.1], p=0.03; Red and processed meat: 151 [66.7, 190] vs 63.3[21.7, 67], p=0.02; gluten-containing cereals: 289 [207, 402] vs 203 [61, 232], p=0.035). A diet consisting ofcereals and meat products was predictive (92% accuracy) of higher faecal calprotectin levels after food reintroduction. In faeces, butyrate levels, expressed as absolute concentration and relative abundance,were higher in Group A than Group B by 28.4 μmol/g (p=0.015)and 6.4% (p=0.008), respectively.Levels of gluten immunogenic peptide and starch in faeces did not differ between the two groups. Conclusions:This pilot study identified potential dietary triggers of gut inflammation in children with Crohn’s disease after food reintroduction following treatment with exclusive enteral nutrition.Trial registration: Clinical trials.gov registration number: NCT02341248; Clinical trials.gov URL:https://clinicaltrials.gov/ct2/show/NCT02341248 (retrospectively registered)

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Predictors of Response to Exclusive Enteral Nutrition in Newly Diagnosed Crohn´s Disease in Children: PRESENCE Study from SEGHNP

Nutrients ◽

10.3390/nu12041012 ◽

2020 ◽

Vol 12 (4) ◽

pp. 1012

Author(s):

Melinda Moriczi ◽

Gemma Pujol-Muncunill ◽

Rafael Martín-Masot ◽

Santiago Jiménez Treviño ◽

Oscar Segarra Cantón ◽

...

Keyword(s):

Crohn’S Disease ◽

Crohn's Disease ◽

Enteral Nutrition ◽

Disease Activity ◽

Clinical Remission ◽

Activity Index ◽

Newly Diagnosed ◽

Faecal Calprotectin ◽

Exclusive Enteral Nutrition ◽

Paediatric Crohn’S Disease

Exclusive enteral nutrition (EEN) has been shown to be more effective than corticosteroids in achieving mucosal healing in children with Crohn´s disease (CD) without the adverse effects of these drugs. The aims of this study were to determine the efficacy of EEN in terms of inducing clinical remission in children newly diagnosed with CD, to describe the predictive factors of response to EEN and the need for treatment with biological agents during the first 12 months of the disease. We conducted an observational retrospective multicentre study that included paediatric patients newly diagnosed with CD between 2014–2016 who underwent EEN. Two hundred and twenty-two patients (140 males) from 35 paediatric centres were included, with a mean age at diagnosis of 11.6 ± 2.5 years. The median EEN duration was 8 weeks (IQR 6.6–8.5), and 184 of the patients (83%) achieved clinical remission (weighted paediatric Crohn’s Disease activity index [wPCDAI] < 12.5). Faecal calprotectin (FC) levels (μg/g) decreased significantly after EEN (830 [IQR 500–1800] to 256 [IQR 120–585] p < 0.0001). Patients with wPCDAI ≤ 57.5, FC < 500 μg/g, CRP >15 mg/L and ileal involvement tended to respond better to EEN. EEN administered for 6–8 weeks is effective for inducing clinical remission. Due to the high response rate in our series, EEN should be used as the first-line therapy in luminal paediatric Crohn’s disease regardless of the location of disease and disease activity.

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Dietary triggers of gut inflammation following exclusive enteral nutrition in children with Crohn’s disease: a pilot study

BMC Gastroenterology ◽

10.1186/s12876-021-02029-4 ◽

2021 ◽

Vol 21 (1) ◽

Author(s):

Konstantinos Gkikas ◽

Michael Logan ◽

Ben Nichols ◽

Umer Z. Ijaz ◽

Clare M. Clark ◽

...

Keyword(s):

Crohn’S Disease ◽

Pilot Study ◽

Crohn's Disease ◽

Enteral Nutrition ◽

Processed Meat ◽

Faecal Calprotectin ◽

Exclusive Enteral Nutrition ◽

Group A ◽

Group B ◽

Red And Processed Meat

Abstract Background The anti-inflammatory effect of exclusive enteral nutrition on the gut of children with Crohn’s disease is rapidly lost after food reintroduction. This study assessed disease dietary triggers following successful treatment with exclusive enteral nutrition. Methods Nutrient intake, dietary patterns and dietary biomarkers in faeces (gluten immunogenic peptides, undigestible starch, short chain fatty acids) were assessed in 14 children with Crohn’s disease during early food reintroduction, following exclusive enteral nutrition. Groups above (Group A) and below (Group B) the median levels of faecal calprotectin after food reintroduction were assigned for comparative analysis. Results Intakes of fibre, gluten-containing cereals and red and processed meat were significantly higher in Group A than Group B; (median [Q1, Q3], g/day; Fibre: 12.1 [11.2, 19.9] vs. 9.9 [7.6, 12.1], p = 0.03; Red and processed meat: 151 [66.7, 190] vs. 63.3 [21.7, 67], p = 0.02; gluten-containing cereals: 289 [207, 402] vs. 203 [61, 232], p = 0.035). A diet consisting of cereals and meat products was predictive (92% accuracy) of higher faecal calprotectin levels after food reintroduction. In faeces, butyrate levels, expressed as absolute concentration and relative abundance, were higher in Group A than Group B by 28.4 µmol/g (p = 0.015) and 6.4% (p = 0.008), respectively. Levels of gluten immunogenic peptide and starch in faeces did not differ between the two groups. Conclusions This pilot study identified potential dietary triggers of gut inflammation in children with Crohn’s disease after food reintroduction following treatment with exclusive enteral nutrition. Trial registration: Clinical trials.gov registration number: NCT02341248; Clinical trials.gov URL: https://clinicaltrials.gov/ct2/show/NCT02341248 (retrospectively registered).

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Letter: reproducible evidence shows that exclusive enteral nutrition significantly reduces faecal calprotectin concentrations in children with active Crohn's disease-Authors' reply

Alimentary Pharmacology & Therapeutics ◽

10.1111/apt.14360 ◽

2017 ◽

Vol 46 (11-12) ◽

pp. 1121-1121

Author(s):

A. Feathers ◽

A. Swaminath ◽

A. N. Ananthakrishnan ◽

L. Falzon ◽

S. Li Ferry

Keyword(s):

Crohn’S Disease ◽

Crohn's Disease ◽

Enteral Nutrition ◽

Faecal Calprotectin ◽

Exclusive Enteral Nutrition

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LEVELS OF VITAMIN C IN CHAIN SMOKERS

International Journal of Medical and Biomedical Studies ◽

10.32553/ijmbs.v4i7.1436 ◽

2020 ◽

Vol 4 (7) ◽

Author(s):

Simerpreet Kukreja

Keyword(s):

Cigarette Smoking ◽

Vitamin C ◽

Dietary Intake ◽

Serum Vitamin ◽

Inverse Correlation ◽

Serum Levels ◽

Negative Association ◽

Alcoholic Beverages ◽

Vitamin Supplementation ◽

Dietary Vitamin

Introduction: Cigarette smoking induces many chronic illnesses, but in developed countries it is a preventable risk factor. However, by increasing the protective protection mechanism, it may be possible to alleviate the smoke-induced damage. As smoking risk is minimised by vitamin C intake, it is recommended that smokers should take more vitamin C. This inverse correlation between both vitamin C intake and serum levels and smoking was independent of age, sex, body weight, ethnicity, and consumption of alcoholic beverages. The negative association between cigarette smoking and serum vitamin C levels continued, following further adjustment for dietary vitamin C intake. The risk of severe hypovitaminosis C, especially when not accompanied by vitamin supplementation, has been increased in smokers. These data indicate that the inverse relationship between smoking and serum vitamin C levels exists independently of dietary intake, while smoking adversely affects preferences for vitamin C rich foods. Methods: A survey method was performed, with 50 smokers (S) receiving either 500 mg of vitamin C or placebo (P) daily for 4 weeks, and 50 non-smokers receiving vitamin C without supplementation. All finished the hearing. Both groups were equal and C: 14.2 + /- 1.8 pack-years was the amount of cigarettes smoked. Concentrations of plasma vitamin C increased significantly (p < 0.005) only in the vitamin C supplement community. Results: At SMHRC Hospital Nagpur, we examined the relationship between smoking and vitamin C status, dietary and serum vitamin C levels of 100 participants. Smokers of 20 cigarettes a day had the lowest dietary intake of vitamin C and serum levels, whereas smokers of 1-19 cigarettes a day had lower intake of vitamin C and serum levels (compared to respondents who had never smoked. This inverse correlation between vitamin C and smoking intake and serum levels was independent of age, sex, body weight, race, and consumption of alcoholic beverages. The negative association between cigarette smoking and serum vitamin C levels continued, following further adjustment for dietary vitamin C intake. In smokers, the risk of severe hypo-vitaminosis C, particularly when not accompanied by vitamin supplementation, has increased. Conclusion: These data indicate that the inverse relationship between smoking and serum vitamin C levels exists independently of dietary intake, while smoking adversely affects preferences for vitamin C rich foods. A balanced diet for smokers will obtain a hearty recommendation at this time, but guidelines should remain cautious about high-dose nutrition supplements. Keywords: Chain Smoker, Vitamin C, hypo-vitaminosis C and cigarette.

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