The Effect of anti-TNFα Induction Therapy on the Nutritional Status and Dietary Intake in Inflammatory Bowel Disease
Ágnes Anna Csontos1, Andrea Molnár2, Zsolt Piri1, Balázs Katona1, Sarolta Dakó3, Erzsébet Pálfi3, Pál Miheller1
1) 2nd Department of Medicine;
2) School of PhD Studies, Pathological Sciences, Health Science Research;
3) Faculty of Health Sciences Department of Dietetic and Nutrition Sciences, Semmelweis University, Budapest, Hungary
Background & Aims: Patients suffering from inflammatory bowel disease (IBD) are at a high risk of malnutrition and retain an altered body composition. We hypothesized that anti-tumor necrosis factor (anti-TNF) alpha therapy may improve dietary intake and have a beneficial influence on body composition in these patients.
Methods: Our study involved 40 IBD outpatients (33 Crohn’s disease, 7 ulcerative colitis); 24 of these received adalimumab (160/80/40EOW) and 16 were treated with infliximab (5 mg/kg at week 0, 2, 6, and subsequently every 8 weeks). Body composition was measured with bioelectrical impedance analysis, while dietary intake was recorded prior to initiating biologicals and 3 months afterwards. Body composition indexes: fat-free mass index [FFMI], body fat mass index [BFMI]) were calculated in kg/m2.
Results: Baseline BMI (kg/m2) and muscle parameters increased significantly at the end of the observational period (BMI: 23.81±7.19 vs. 24.52±7.34, p<0.001; FFMI: 17.64±3.00 vs. 18.14±3.08, p<0.001; at week 0 vs. 12, respectively). However, no significant changes were detected in the fat parameters (BFMI: 6.21±5.20 vs. 6.44±5.27, respectively). We found no significant difference between the effects of adalimumab vs. infliximab on body composition (deltaFFMI: 0.55±0.82 vs. 0.43±0.69; deltaBFMI: 0.23±0.85 vs. 0.21±1.01, respectively). No significant difference was observed in the extent of changes in parameters whether the patients were on corticosteroids (n=15) or not (n=25) at week 0 (deltaFFMI: 0.44±0.84 vs 0.59±0.72; deltaBFMI: 0.36±1.12 vs. 0.09±0.71, respectively).
Conclusion: Our findings suggest that muscle parameters improved during the anti-TNF induction therapy, while fat parameters did not change significantly. Thus, induction anti-TNF therapy might have a beneficial effect on body composition.
Key words: TNF-alpha – body composition – malnutrition – inflammatory bowel diseases – nutritional status.
Abbreviations. ADA: adalimumab; BCM: body cell mass; BFM: body fat mass; BFMI: body fat mass index; BIA: bioelectrical impedance analysis; BMI: body mass index; CD: Crohn’s disease; ECW: extracellular water; FFM: fat-free mass; FFMI: fat-free mass index; IBD: inflammatory bowel disease; ICW: intracellular water; IFX: infliximab; NF-κB: nuclear factor kappa-B; PDAI: perianal disease activity index; RA: rheumatoid arthritis; SMI: skeletal muscle mass index; SMM: skeletal muscle mass; TBW: total body water; TNF-alpha: tumor necrosis factor alpha; UC: ulcerative colitis