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Anti-Inflammatory and Growth-Stimulating Effects Precede Nutritional Restitution During Enteral Feeding in Crohn Disease

Bannerjee, Kaushik; Camacho-Hübner, Cecilia; Babinska, Katarzyna*; Dryhurst, Kay M.*; Edwards, Ray; Savage, Martin O.; Sanderson, Ian R.*; Croft, Nicholas M.*

Journal of Pediatric Gastroenterology and Nutrition: March 2004 - Volume 38 - Issue 3 - p 270-275
Original Articles—Hepatology and Nutrition

Objectives Exclusive enteral feeding reduces inflammation and improves well being, nutrition and growth in children with active Crohn disease. Whether improved growth and increases in growth-related proteins are a consequence of improved nutrition or a reduced inflammation is not known. This study was undertaken to test the hypothesis that changes in growth-related proteins are related to decreased inflammation, rather than improvement in nutritional status.

Methods Twelve children with active Crohn disease treated for 6-weeks with exclusive enteral feeding were studied at days 0, 3, 7, 14, 21, 28, and 56. The Paediatric Crohn's Disease Activity Index (PCDAI), weight, triceps skinfold thickness, and midupper arm circumference were recorded. C-reactive protein (CRP), erythrocyte sedimentation rate (ESR), interleukin-6 (IL-6), insulin-like growth factor (IGF-I), IGF-binding protein (IGFBP-3), and leptin were measured at each visit. Wilcoxon matched-pairs signed-rank test was used to compare day 0 with follow-up data.

Results Significant improvements (P < 0.05) occurred by day 3 in inflammatory parameters (ESR, IL-6) and by day 7 in PCDAI, CRP, and IGF-I. These changes preceded any significant changes in nutritional parameters (weight-for-age Z score and midupper arm circumference day 14, triceps skinfold thickness day 21).

Conclusions Early increases in IGF-I during treatment of Crohn disease are attributable to the anti-inflammatory effect of the enteral feed rather than nutritional restitution.

Departments of *Adult and Paediatric Gastroenterology, †Paediatric Endocrinology, and ‡NETRIA Unit, Barts and the London, Queen Mary's School of Medicine and Dentistry, University of London, London, United Kingdom.

Received: December 5, 2002; accepted: June 1, 2003.

Kay M. Dryhurst was supported by a grant from the Crohn's in Children Research Association. Nestlé, UK, contributed to the costs of the interleukin-6 assays.

Address correspondence and reprint requests to Dr. Nick M. Croft, Adult and Paediatric Gastroenterology, Barts and the London, Queen Mary's School of Medicine and Dentistry, St. Bartholomew's Hospital, London, EC1A 7BE, United Kingdom (e-mail:

© 2004 Lippincott Williams & Wilkins, Inc.