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The Effect of anti-TNFα Induction Therapy on the Nutritional Status and Dietary Intake in Inflammatory Bowel Disease

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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

DOI: http://dx.doi.org/10.15403/jgld.2014.1121.251.tnf


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