Christina Taalla

NTR 351 Summer 2012

Nutritional Therapy in the Maintenance of Remission of Crohns Disease
Crohns Disease is often associated with nutritional deficiencies due to impaired
absorption, nutrient loss, inadequate food intake and drug-nutrient interactions, emphasizing the
importance of correction of malnutrition as part of therapy. The management of Crohns Disease
in the medical world has occurred mostly through the use of medication. While common
medications used to treat the disease and promote remission are effective in decreasing disease
activity, this form of traditional therapy can further impact a deteriorating nutritional status
already exhausted by the symptoms of the disease itself. Nutritional intervention can play a
pivotal role in the clinical management of patients with Crohns Disease (CD), and supports the
restoration of nutritional status. (1) Nutritional supplementation in particular may address and aid
in the reduction of symptoms of the disease. Nutritional supplementation can play a beneficial
role in the maintenance of Crohns Disease.
Supplementation of Omega-3 Fatty acids may prove beneficial to CD patients due to its
anti-inflammatory effects. Interestingly, Japan is a country where the occurrence of Crohns
Disease is very low, as demonstrated by Belluzi et al in epidemiological observation. (2) The
Japanese diet is rich in fish and subsequently Omega-3s, which could be indicative of its
defensive role.
Belluzi et al demonstrated the beneficial effect of Fish oil supplementation on a group of
CD patients, already in remission. A special enteric coating was prepared and applied to the
supplement to alleviate unpleasant side effects whicheffects that have been traditionally
associated with fish oil, such as diarrhea and flatulence. This coating helped increase subject
daily compliance. Out of a total of 78 enrolled participants, 39 received the fish oil supplements,

while the remaining 39 receiving a placebo supplementation. Results of this study show promise
for the use of Omega-3 fish oils in maintenance of CD, with a total of 5959% percent of the
control group remaining in remission during the (time?) of trial period, compared to only 26%
percent in the placebo group. 69 percent of the placebo group experienced a relapse while only
28 percent of the control group replased.Although 28% of the control group did experience a
relapse, this is compared to 69% of the placebo group. Lab tests performed to determine
intestinal inflammation showed a significant reduction in all inflammation markers for the
control group, as opposed to the group receiving the placebo. A logistic regression analysis was
also completed to assure that fish oil only affected the likelihood of a relapse, versus age,
previous surgery, smoking status, etc. Although the subject population was small, this study does
demonstrate the effectiveness of supplementation by Omega-3 on the state of remission in CD
patients.
In a review performed by Akobeng, a sensitivity analysis on three separate research
studies examining Omega-3 supplementation and CD also revealed a statistically significant
favorable effect of enteric-coated supplementation. Geerling et al researched the effect of
supplementation through Omega-3 Fatty Acid and Antioxidants, which significantly altered the
eicosanoid precursor profile as well as increasing antioxidant levels. This research demonstrates
the ability of Omega-3 supplementation to play a part in treatment of CD. (3)
Enteral nutrition has also shown to be efficient in reducing intestinal inflammation as
well as improving nutritional status in controlled trial settings. (4) The importance of enteral
nutrition lies in its promotion of linear growth in pediatric patients, as well as improvement in
the gain and maintenance of lean body mass.

Wiese et al examined the impact of an enteral nutrition formula containing fish oil,
prebiotics and antioxidants on subjects in an active state of CD. The participants who complied
with the required daily serving, or close to, doubled their EPA levels, which was accompanied by
a significant improvement in the following areas of fat free mass, fat mass as well as a lower
Crohns Disease Activity Index (CDAI) score, indicating a higher quality of life and lower level
of disease activity as compared to the beginning of the trial period. Fatty acid levels did improve
as well, and an increase in Omega-3 was observed, paired with a decrease in Omega-6 levels. All
subjects did increase Vitamin D levels, regardless of any increase in EPA levels. Daily
consumption of the formula also improved soluble fiber intake and micronutrient levels.
Although this study followed a small patient size of 20 subjects, the nutritional benefits of
consuming enteral nutrition were demonstrated by those who did comply with the required
intake. Of worthy note, many studies researching the effect of enteral nutrition and CD have seen
a high percentage of non-compliance. This study reveals an alternate route for adding enteral
nutrition formula to a daily diet, thereby increasing likelihood of compliance and nutritional
benefit.
Finding alternate or adjunctive nutritional therapies which increase the nutrition profile of
CD patientstherapies that increase the nutrition profile of CD patients is an important part inof
maintenance of the disease. Nutritional supplementation can play a key role., as Ssupplements
such as Omega-3 are safe, and can alleviate symptoms to allow for adequate caloric
consumption. Enteral nutrition is also a nutritional supplement with no harmful effects, and
promotes continued growth, providing macro and micronutrients. These forms of
supplementation can influence and promote the maintenance of CD.