Susceptibility to Crohn's disease involves genetic and environmental factors. A new hypothesis proposes that excessive consumption of highly fermentable short-chain carbohydrates and polyols (FODMAPs) delivered to the distal small intestine and colon leads to increased intestinal permeability, a predisposing factor for the development of Crohn's disease. Evidence for this hypothesis includes the rising intake of FODMAPs in western societies, the association between increased sugar intake and Crohn's disease, and the previously documented effects of excessive FODMAP consumption on the bowel. This hypothesis provides a potential explanation for environmental factors influencing Crohn's disease susceptibility and a basis for preventive strategies.
The document summarizes research on the low FODMAP diet for managing symptoms of irritable bowel syndrome (IBS). It finds that dietary restriction of fermentable carbohydrates, known as the low FODMAP diet, shows efficacy for IBS symptoms based on uncontrolled and retrospective studies as well as three randomized controlled trials. However, more randomized trials are still needed to confirm its efficacy and examine effects on gut microbiota and nutrition. Placebo-controlled dietary trials are challenging due to difficulties incorporating a placebo. The diet works by restricting short-chain carbohydrates like fructans, GOS, lactose, fructose, and polyols that are poorly absorbed and increase luminal water and gas production when fermented
- Irritable bowel syndrome (IBS) affects 7-21% of the general population and is the most commonly diagnosed gastrointestinal condition. It is defined by abdominal pain or discomfort with altered bowel habits in the absence of underlying disease.
- Factors that contribute to IBS include alterations in the gut microbiome, intestinal permeability, immune function, motility, sensation, brain-gut interactions, and psychosocial status. Dietary triggers and a history of infection or antibiotics can also play a role.
- IBS substantially reduces quality of life and productivity. While some patients improve over time, it is generally a chronic relapsing condition. Diagnosis involves symptom evaluation and exclusion of other diseases through selected testing. Management
The document discusses the vicious cycle of diarrhea and malnutrition. It summarizes that underweight, stunting and wasting in children are risk factors for diarrhea mortality. Deficiencies in vitamin A and zinc increase the risk of diarrhea mortality, and zinc deficiency increases the risk of diarrhea incidence. Trials show that vitamin A and zinc supplementation can significantly reduce diarrhea mortality and incidence in children, demonstrating the substantial disease burden attributable to these nutritional risk factors.
Gastrointestinal toleracne and utlization of agave inulin by healthy adults 2014Leila Shinn
This study evaluated gastrointestinal tolerance and utilization of two doses of agave inulin (5.0 g and 7.5 g per day) compared to a placebo in 29 healthy adults over three 21-day periods. Slight increases in bloating, flatulence, and rumbling frequency were seen with both doses of agave inulin. Higher doses also increased abdominal pain and rumbling intensity. Number of bowel movements increased and stools were softer with the higher 7.5 g dose. Breath hydrogen levels increased after consuming agave inulin, indicating fermentation. Overall, both doses led to minimal gastrointestinal symptoms and improved laxation without increased diarrhea.
The document summarizes the vicious cycle between diarrhea and malnutrition and its lasting effects on growth, development, and health. It discusses:
1. How diarrhea increases the risk and duration of malnutrition, and malnutrition in turn increases the risk and duration of diarrhea.
2. Evidence that early childhood diarrhea is associated with stunting, impaired cognition, and reduced school performance that can persist into adulthood.
3. Potential long-term effects of early infections and stunting on risks for obesity, diabetes, and cardiovascular disease later in life.
1. Nutritional programming theories suggest that the prenatal and early life nutritional environment can influence long-term health by permanently programming physiological functions and disease risk.
2. Animal studies demonstrate a direct link between nutrient imbalance during fetal development and later diseases like hypertension, diabetes, and heart disease, independent of growth rates.
3. Exposure to glucocorticoids and alterations in gene expression from nutrient imbalance in early life are thought to be important mechanisms influencing tissue development and function long-term.
A gluten-free diet is recommended for patients with celiac disease to restrict gluten intake and prevent further damage to the small intestine. The diet aims to correct nutritional deficiencies, maintain a healthy BMI, and regulate fluids and electrolytes. Nurses educate patients on following a gluten-free diet according to the Eatwell plate guidelines, administer supplements, explain gluten restrictions, provide lists of gluten-free foods, and monitor input/output.
The document summarizes research on the low FODMAP diet for managing symptoms of irritable bowel syndrome (IBS). It finds that dietary restriction of fermentable carbohydrates, known as the low FODMAP diet, shows efficacy for IBS symptoms based on uncontrolled and retrospective studies as well as three randomized controlled trials. However, more randomized trials are still needed to confirm its efficacy and examine effects on gut microbiota and nutrition. Placebo-controlled dietary trials are challenging due to difficulties incorporating a placebo. The diet works by restricting short-chain carbohydrates like fructans, GOS, lactose, fructose, and polyols that are poorly absorbed and increase luminal water and gas production when fermented
- Irritable bowel syndrome (IBS) affects 7-21% of the general population and is the most commonly diagnosed gastrointestinal condition. It is defined by abdominal pain or discomfort with altered bowel habits in the absence of underlying disease.
- Factors that contribute to IBS include alterations in the gut microbiome, intestinal permeability, immune function, motility, sensation, brain-gut interactions, and psychosocial status. Dietary triggers and a history of infection or antibiotics can also play a role.
- IBS substantially reduces quality of life and productivity. While some patients improve over time, it is generally a chronic relapsing condition. Diagnosis involves symptom evaluation and exclusion of other diseases through selected testing. Management
The document discusses the vicious cycle of diarrhea and malnutrition. It summarizes that underweight, stunting and wasting in children are risk factors for diarrhea mortality. Deficiencies in vitamin A and zinc increase the risk of diarrhea mortality, and zinc deficiency increases the risk of diarrhea incidence. Trials show that vitamin A and zinc supplementation can significantly reduce diarrhea mortality and incidence in children, demonstrating the substantial disease burden attributable to these nutritional risk factors.
Gastrointestinal toleracne and utlization of agave inulin by healthy adults 2014Leila Shinn
This study evaluated gastrointestinal tolerance and utilization of two doses of agave inulin (5.0 g and 7.5 g per day) compared to a placebo in 29 healthy adults over three 21-day periods. Slight increases in bloating, flatulence, and rumbling frequency were seen with both doses of agave inulin. Higher doses also increased abdominal pain and rumbling intensity. Number of bowel movements increased and stools were softer with the higher 7.5 g dose. Breath hydrogen levels increased after consuming agave inulin, indicating fermentation. Overall, both doses led to minimal gastrointestinal symptoms and improved laxation without increased diarrhea.
The document summarizes the vicious cycle between diarrhea and malnutrition and its lasting effects on growth, development, and health. It discusses:
1. How diarrhea increases the risk and duration of malnutrition, and malnutrition in turn increases the risk and duration of diarrhea.
2. Evidence that early childhood diarrhea is associated with stunting, impaired cognition, and reduced school performance that can persist into adulthood.
3. Potential long-term effects of early infections and stunting on risks for obesity, diabetes, and cardiovascular disease later in life.
1. Nutritional programming theories suggest that the prenatal and early life nutritional environment can influence long-term health by permanently programming physiological functions and disease risk.
2. Animal studies demonstrate a direct link between nutrient imbalance during fetal development and later diseases like hypertension, diabetes, and heart disease, independent of growth rates.
3. Exposure to glucocorticoids and alterations in gene expression from nutrient imbalance in early life are thought to be important mechanisms influencing tissue development and function long-term.
A gluten-free diet is recommended for patients with celiac disease to restrict gluten intake and prevent further damage to the small intestine. The diet aims to correct nutritional deficiencies, maintain a healthy BMI, and regulate fluids and electrolytes. Nurses educate patients on following a gluten-free diet according to the Eatwell plate guidelines, administer supplements, explain gluten restrictions, provide lists of gluten-free foods, and monitor input/output.
The present study examines the difference in nutrition knowledge, attitudes, and dietary intake among college students based on the presence of vegetarianism. A Web-based survey using 702 college students at a Midwest university collected data about participants’ level of nutrition knowledge, attitudes toward nutrition and vegetarianism, and dietary patterns. Results showed vegetarians had a more positive attitude towards a vegetarian diet as opposed to non-vegetarians. Vegetarians also demonstrated greater nutrition knowledge specifically related to vegetarian nutrition as opposed to general nutrition, although their dietary intake did not prove to be of higher quality than nonvegetarians. Results from this study are applicable in the vegetarian community and those who work with vegetarians. Most notably, this study may be of great use to food service establishments, particularly college dining settings.
This document presents a case study of a 1-year-old male child presenting with 1 month of refusal to feed, 1 week of diarrhea and vomiting, and 6 days of body swelling. Upon examination, the child was found to be severely stunted, wasted, and dehydrated. He was diagnosed with severe chronic undernutrition with edema. His treatment included formula feeds, IV antibiotics, and nutritional counseling. He showed improvement and was discharged after 5 days. The document also provides relevant background information on the pathophysiology, epidemiology, risk factors, investigations and management of severe chronic undernutrition.
Early onset diabetes in children can lead to serious health problems. Studies show that diabetic children under 15 have a higher risk of developing high protein levels in the urine, which can lead to kidney failure. Younger diabetic children also have a greater chance of developing retinal damage. Research indicates paternal transmission may play a role in susceptibility to diabetes, with epigenetic factors involved. Proper treatment is important to manage risks, though current insulin injection therapy causes stress for children.
This document provides a narrative review of understanding the development of malnutrition in hemodialysis patients. It discusses malnutrition as having origins from both iatrogenic and non-iatrogenic factors. Iatrogenic factors refer to those resulting inadvertently from dialysis treatment itself, such as nutrient losses during dialysis and use of certain dialysis membranes and techniques. Non-iatrogenic factors include inadequate dietary intake due to poor appetite, diet quality issues, and psychosocial or financial barriers. Understanding the origin of factors contributing to malnutrition in dialysis patients is important for personalized patient care and determining treatment strategies.
This meta-analysis provides data on dietary intake of main macronutrients/foods and their role in the development of infammatory bowel diseases (Hou et al. 2011)
8 coast and jungle peruvian malnutritionJuan R Farro
Pedro Ruiz is taking a medical English course taught by Professor Rosa Gonzáles Llontop. The document discusses malnutrition, including its causes such as poverty and lack of access to food or healthcare, consequences like fatigue and increased risk of infection, and ways to prevent it like breastfeeding exclusively for the first 6 months and eating a balanced diet with foods from various groups. Chronic malnutrition in Peru has decreased in recent years but remains a problem, especially in rural areas and the jungle regions.
definition what is FPIES, what it defers from other food allergy, what are the signs and symptoms ,what are the different types of food allergy ,how to diagnose FPIES ,what are the oral food challenge (OFC) ,what is the treatment , the prognosis of FPIES
Celiac disease is a lifelong autoimmune disorder triggered by ingesting gluten, which damages the small intestine. Several studies examined factors that influence the risk and development of celiac disease. Introducing gluten at 12 months rather than 6 months had no long-term effect on risk. Gradually introducing gluten between 4-6 months while breastfeeding may reduce risk. A randomized controlled trial found introducing small amounts of gluten at 16-24 weeks did not reduce risk by age 3. Genetics play a role, as the HLA-DQ2 and HLA-DQ8 genes increase susceptibility. Ongoing education is important for managing the lifelong gluten-free diet required to treat celiac disease.
Chronic malnutrition is caused by long-term deficiencies in nutrients and can stunt physical and cognitive growth. It results from immediate factors like low birth weight, illness, and poor diet that are themselves influenced by underlying household determinants of food security, health care, and parenting quality, as well as basic socioeconomic determinants of a family's status, education, empowerment, and access to water/sanitation. Chronic malnutrition is clinically assessed and indicated by measurements of stunting, wasting, and underweight as well as physical signs. It requires preventive measures simultaneously targeting individuals, communities, and national policies.
This document discusses malnutrition in the state of Jharkhand, India. It finds that:
- Anaemia and underweight rates among children and women in Jharkhand are among the highest in India.
- Government runs supplementation programs for iron, folic acid, and Vitamin A, but coverage is low.
- It recommends focusing on proven interventions like breastfeeding, complementary feeding, and nutrition for women and children to reduce malnutrition.
- A multisectoral approach is needed across health, agriculture, education and other areas to effectively address the problem.
The journey of low birth weight infant Khaled Saad
Previously known as ‘failure to thrive’ (FTT), also known as weight faltering
Infant or children whose current weight or rate of weight gain is significantly below that expected of similar children of the same age, sex and ethnicity
Can occur in both infants (< 1 year of age) and in children (> 1 year of age)
Frequency of bulimia nervosa and binge eating disorder in obese females and t...Alexander Decker
This study examined the prevalence of bulimia nervosa (BN) and binge eating disorder (BED) among obese females in Iraq and compared individual characteristics between obese females with and without eating disorders. The study found that 21% of 190 obese females met criteria for BN or BED, with 16.84% having BED and 4.23% having BN. Obese females with eating disorders tended to be younger, live in cities, be married, and have higher education levels compared to obese females without eating disorders. They also reported greater body shape stress, history of diabetes, preferring fatty/mixed meals, and regular meal/snack consumption. The study aimed to better understand the relationship between obesity and eating disorders
This document summarizes a study that assessed the impact of supplementing the diets of severely malnourished children in Burkina Faso with Moringa oleifera leaf powder. 110 children aged 6-59 months were randomly assigned to two groups. Both groups received standard nutritional care, but one group received an additional 10g per day of Moringa leaf powder. Children receiving the Moringa supplement had higher average weight gain, a quicker recovery rate, but no significant difference in hemoglobin levels. The Moringa supplementation was found to be effective and safe in improving the nutritional recovery of severely malnourished children.
Nutritional Science Research: Celiac Disease & Risk of Subsequent Type I Diab...Mike Schiemer
Children with celiac disease have a 2-3 times greater risk of developing type 1 diabetes compared to children without celiac disease. The study found a statistically significant association between celiac disease diagnosis and later diagnosis of type 1 diabetes or diabetic ketoacidosis before age 20 using Swedish national hospital records. However, the age at initial celiac disease diagnosis did not impact subsequent diabetes risk. Shared genetic factors like HLA characteristics may partially explain the increased diabetes risk seen in children with celiac disease.
The document provides an overview of the field of nutritional anthropology through the perspective of an anthropologist. It discusses the author's background and early influences in human biology and energy flow studies. It then summarizes some key developments in the field, including early dietary studies by Atwater and Woods among African Americans in Tuskegee, Alabama in 1895. Richards' 1932 study of the Bemba is cited as generally beginning the anthropological study of food habits. The document also briefly discusses the work of Mead, Benedict and others on cross-cultural applications of dietary knowledge during World War II.
This document summarizes a presentation on enteral nutrition for pediatric patients with gastrointestinal impairment. It discusses various conditions that can cause GI impairment including short bowel syndrome, cystic fibrosis, and Crohn's disease. It reviews the available research on different formula types for these conditions, including elemental, semi-elemental, and polymeric formulas. Guidelines are provided on selecting the appropriate formula based on a patient's age, diagnosis and degree of GI impairment. Breast milk, hydrolyzed formulas, and elemental formulas are also discussed as options for infants and children with severe GI issues.
Fototerapia. Servicio Dermatología. VI Reunión Pacientes EII. Hospital Manises.hinova200
La fototerapia utiliza la radiación UV para tratar diversas afecciones cutáneas como la psoriasis, dermatitis atópica y vitíligo. Existen dos tipos principales: PUVA que usa fármacos fotosensibilizantes orales o tópicos junto con radiación UVA, y UVB que usa solo radiación de banda estrecha. La fototerapia puede mejorar los síntomas en el 50% de los pacientes con dermatitis atópica o psoriasis. Aunque es segura si se usa correct
¿Siempre debe operarse un paciente con estenosis Ileal?VI Reunión Pacientes E...hinova200
Este documento trata sobre las opciones de tratamiento para la estenosis ileal y la colitis ulcerosa. Respecto a la estenosis ileal, no siempre es necesaria la cirugía, pudiendo tratarse mediante dilatación con balón o medidas médicas dependiendo de la gravedad de la obstrucción. En cuanto a la colitis ulcerosa, se puede conservar el recto realizando una anastomosis ileorrectal en pacientes seleccionados, aunque existen riesgos como la displasia o resultados funcionales inciertos.
Calprotectina Fecal. VI Reunión Pacientes EII. Hospial Manises.hinova200
La calprotectina es una proteína ligada al calcio que se encuentra principalmente en neutrófilos y monocitos. Los niveles elevados de calprotectina fecal (CF) están asociados con la enfermedad inflamatoria intestinal (EII) y son superiores a otros marcadores como la proteína C reactiva (PCR) y la velocidad de sedimentación globular (VSG) para diagnosticar EII. La CF es útil para determinar pacientes que requieren exploraciones invasivas, para apoyar la sintomatología ante sospecha de brote
The present study examines the difference in nutrition knowledge, attitudes, and dietary intake among college students based on the presence of vegetarianism. A Web-based survey using 702 college students at a Midwest university collected data about participants’ level of nutrition knowledge, attitudes toward nutrition and vegetarianism, and dietary patterns. Results showed vegetarians had a more positive attitude towards a vegetarian diet as opposed to non-vegetarians. Vegetarians also demonstrated greater nutrition knowledge specifically related to vegetarian nutrition as opposed to general nutrition, although their dietary intake did not prove to be of higher quality than nonvegetarians. Results from this study are applicable in the vegetarian community and those who work with vegetarians. Most notably, this study may be of great use to food service establishments, particularly college dining settings.
This document presents a case study of a 1-year-old male child presenting with 1 month of refusal to feed, 1 week of diarrhea and vomiting, and 6 days of body swelling. Upon examination, the child was found to be severely stunted, wasted, and dehydrated. He was diagnosed with severe chronic undernutrition with edema. His treatment included formula feeds, IV antibiotics, and nutritional counseling. He showed improvement and was discharged after 5 days. The document also provides relevant background information on the pathophysiology, epidemiology, risk factors, investigations and management of severe chronic undernutrition.
Early onset diabetes in children can lead to serious health problems. Studies show that diabetic children under 15 have a higher risk of developing high protein levels in the urine, which can lead to kidney failure. Younger diabetic children also have a greater chance of developing retinal damage. Research indicates paternal transmission may play a role in susceptibility to diabetes, with epigenetic factors involved. Proper treatment is important to manage risks, though current insulin injection therapy causes stress for children.
This document provides a narrative review of understanding the development of malnutrition in hemodialysis patients. It discusses malnutrition as having origins from both iatrogenic and non-iatrogenic factors. Iatrogenic factors refer to those resulting inadvertently from dialysis treatment itself, such as nutrient losses during dialysis and use of certain dialysis membranes and techniques. Non-iatrogenic factors include inadequate dietary intake due to poor appetite, diet quality issues, and psychosocial or financial barriers. Understanding the origin of factors contributing to malnutrition in dialysis patients is important for personalized patient care and determining treatment strategies.
This meta-analysis provides data on dietary intake of main macronutrients/foods and their role in the development of infammatory bowel diseases (Hou et al. 2011)
8 coast and jungle peruvian malnutritionJuan R Farro
Pedro Ruiz is taking a medical English course taught by Professor Rosa Gonzáles Llontop. The document discusses malnutrition, including its causes such as poverty and lack of access to food or healthcare, consequences like fatigue and increased risk of infection, and ways to prevent it like breastfeeding exclusively for the first 6 months and eating a balanced diet with foods from various groups. Chronic malnutrition in Peru has decreased in recent years but remains a problem, especially in rural areas and the jungle regions.
definition what is FPIES, what it defers from other food allergy, what are the signs and symptoms ,what are the different types of food allergy ,how to diagnose FPIES ,what are the oral food challenge (OFC) ,what is the treatment , the prognosis of FPIES
Celiac disease is a lifelong autoimmune disorder triggered by ingesting gluten, which damages the small intestine. Several studies examined factors that influence the risk and development of celiac disease. Introducing gluten at 12 months rather than 6 months had no long-term effect on risk. Gradually introducing gluten between 4-6 months while breastfeeding may reduce risk. A randomized controlled trial found introducing small amounts of gluten at 16-24 weeks did not reduce risk by age 3. Genetics play a role, as the HLA-DQ2 and HLA-DQ8 genes increase susceptibility. Ongoing education is important for managing the lifelong gluten-free diet required to treat celiac disease.
Chronic malnutrition is caused by long-term deficiencies in nutrients and can stunt physical and cognitive growth. It results from immediate factors like low birth weight, illness, and poor diet that are themselves influenced by underlying household determinants of food security, health care, and parenting quality, as well as basic socioeconomic determinants of a family's status, education, empowerment, and access to water/sanitation. Chronic malnutrition is clinically assessed and indicated by measurements of stunting, wasting, and underweight as well as physical signs. It requires preventive measures simultaneously targeting individuals, communities, and national policies.
This document discusses malnutrition in the state of Jharkhand, India. It finds that:
- Anaemia and underweight rates among children and women in Jharkhand are among the highest in India.
- Government runs supplementation programs for iron, folic acid, and Vitamin A, but coverage is low.
- It recommends focusing on proven interventions like breastfeeding, complementary feeding, and nutrition for women and children to reduce malnutrition.
- A multisectoral approach is needed across health, agriculture, education and other areas to effectively address the problem.
The journey of low birth weight infant Khaled Saad
Previously known as ‘failure to thrive’ (FTT), also known as weight faltering
Infant or children whose current weight or rate of weight gain is significantly below that expected of similar children of the same age, sex and ethnicity
Can occur in both infants (< 1 year of age) and in children (> 1 year of age)
Frequency of bulimia nervosa and binge eating disorder in obese females and t...Alexander Decker
This study examined the prevalence of bulimia nervosa (BN) and binge eating disorder (BED) among obese females in Iraq and compared individual characteristics between obese females with and without eating disorders. The study found that 21% of 190 obese females met criteria for BN or BED, with 16.84% having BED and 4.23% having BN. Obese females with eating disorders tended to be younger, live in cities, be married, and have higher education levels compared to obese females without eating disorders. They also reported greater body shape stress, history of diabetes, preferring fatty/mixed meals, and regular meal/snack consumption. The study aimed to better understand the relationship between obesity and eating disorders
This document summarizes a study that assessed the impact of supplementing the diets of severely malnourished children in Burkina Faso with Moringa oleifera leaf powder. 110 children aged 6-59 months were randomly assigned to two groups. Both groups received standard nutritional care, but one group received an additional 10g per day of Moringa leaf powder. Children receiving the Moringa supplement had higher average weight gain, a quicker recovery rate, but no significant difference in hemoglobin levels. The Moringa supplementation was found to be effective and safe in improving the nutritional recovery of severely malnourished children.
Nutritional Science Research: Celiac Disease & Risk of Subsequent Type I Diab...Mike Schiemer
Children with celiac disease have a 2-3 times greater risk of developing type 1 diabetes compared to children without celiac disease. The study found a statistically significant association between celiac disease diagnosis and later diagnosis of type 1 diabetes or diabetic ketoacidosis before age 20 using Swedish national hospital records. However, the age at initial celiac disease diagnosis did not impact subsequent diabetes risk. Shared genetic factors like HLA characteristics may partially explain the increased diabetes risk seen in children with celiac disease.
The document provides an overview of the field of nutritional anthropology through the perspective of an anthropologist. It discusses the author's background and early influences in human biology and energy flow studies. It then summarizes some key developments in the field, including early dietary studies by Atwater and Woods among African Americans in Tuskegee, Alabama in 1895. Richards' 1932 study of the Bemba is cited as generally beginning the anthropological study of food habits. The document also briefly discusses the work of Mead, Benedict and others on cross-cultural applications of dietary knowledge during World War II.
This document summarizes a presentation on enteral nutrition for pediatric patients with gastrointestinal impairment. It discusses various conditions that can cause GI impairment including short bowel syndrome, cystic fibrosis, and Crohn's disease. It reviews the available research on different formula types for these conditions, including elemental, semi-elemental, and polymeric formulas. Guidelines are provided on selecting the appropriate formula based on a patient's age, diagnosis and degree of GI impairment. Breast milk, hydrolyzed formulas, and elemental formulas are also discussed as options for infants and children with severe GI issues.
Fototerapia. Servicio Dermatología. VI Reunión Pacientes EII. Hospital Manises.hinova200
La fototerapia utiliza la radiación UV para tratar diversas afecciones cutáneas como la psoriasis, dermatitis atópica y vitíligo. Existen dos tipos principales: PUVA que usa fármacos fotosensibilizantes orales o tópicos junto con radiación UVA, y UVB que usa solo radiación de banda estrecha. La fototerapia puede mejorar los síntomas en el 50% de los pacientes con dermatitis atópica o psoriasis. Aunque es segura si se usa correct
¿Siempre debe operarse un paciente con estenosis Ileal?VI Reunión Pacientes E...hinova200
Este documento trata sobre las opciones de tratamiento para la estenosis ileal y la colitis ulcerosa. Respecto a la estenosis ileal, no siempre es necesaria la cirugía, pudiendo tratarse mediante dilatación con balón o medidas médicas dependiendo de la gravedad de la obstrucción. En cuanto a la colitis ulcerosa, se puede conservar el recto realizando una anastomosis ileorrectal en pacientes seleccionados, aunque existen riesgos como la displasia o resultados funcionales inciertos.
Calprotectina Fecal. VI Reunión Pacientes EII. Hospial Manises.hinova200
La calprotectina es una proteína ligada al calcio que se encuentra principalmente en neutrófilos y monocitos. Los niveles elevados de calprotectina fecal (CF) están asociados con la enfermedad inflamatoria intestinal (EII) y son superiores a otros marcadores como la proteína C reactiva (PCR) y la velocidad de sedimentación globular (VSG) para diagnosticar EII. La CF es útil para determinar pacientes que requieren exploraciones invasivas, para apoyar la sintomatología ante sospecha de brote
Este documento presenta un protocolo para el manejo de líquidos en pediatría. Describe la deshidratación, sus causas y clasificación según el déficit. Explica los planes A, B y C para la rehidratación ambulatoria, de observación e hospitalización, respectivamente. También cubre temas como el shock, la punción intraósea, el cálculo de pérdidas por deshidratación y el método de Holliday-Segar. Brevemente aborda el politraumatismo, las quemaduras pediátricas y el
Este documento describe la fototerapia neonatal, incluyendo su objetivo de disminuir la bilirrubina mediante foto-oxidación, su mecanismo de acción a través de la isomerización y foto-oxidación de la bilirrubina, y los factores que afectan su eficacia como la concentración inicial de bilirrubina, la superficie corporal expuesta, la dosis y tipo de luz irradiada. La enfermera debe conocer los cuidados del recién nacido sometido a fototerapia y sus posibles complicaciones.
La fototerapia utiliza la luz natural o artificial para tratar ciertos problemas de salud. La helioterapia usa la luz solar y tiene indicaciones como el raquitismo, cicatrización de heridas y enfermedades de la piel. La actinoterapia usa rayos ultravioleta con efectos como la pigmentación de la piel, producción de vitamina D y efectos bactericidas. La fototerapia infrarroja usa calor local para estimular la circulación y tratar afecciones como foliculitis, abcesos y ar
The document discusses nutrigenomics and nutrigenetics. It begins with important terms related to omics fields like genomics, nutrigenomics, and epigenetics. It then provides a basic understanding of nutrigenomics and nutrigenetics, including how genetic diversity and environmental factors affect nutrient metabolism and health outcomes. The goals of nutrigenomics are discussed, including customizing nutrition based on an individual's genetics. Experimental approaches like genomics, transcriptomics and metabolomics are used to study these fields. Examples are provided on how nutrigenomics has clarified roles of specific dietary factors and potential applications in disease prevention.
The term “inflammatory bowel disease” (IBD) refers to a collection of gastrointestinal tract illnesses marked by both acute and chronic inflammation. These are complicated, multiple illnesses that are partially inherited. IBD is becoming more common in developing nations, though, which shows that environmental variables like food are potentially important contributors to disease risk. According to the evidence, eating a Western diet high in saturated fat, processed carbs, and food additives increases the risk of IBD. While dietary components like omega-3 fatty acids, medium chain triglycerides, and non-digestible carbohydrates improve these parameters and intestinal health, dietary components like omega-6 fatty acids, long chain fatty acids, protein, and digestible carbohydrates may contribute to IBD pathogenesis by altering intestinal microbiota, increasing intestinal permeability, and promoting inflammation.
The Journal of NutritionSymposium Nutritional Experiences.docxarnoldmeredith47041
1. Poor growth in utero is associated with increased risk of diseases like type 2 diabetes later in life. Studies in humans and animals provide evidence that early nutrition plays an important role in this relationship.
2. A study of twins found that the twin with lower birth weight was more likely to develop type 2 diabetes, indicating the importance of prenatal environmental factors over genetics. Studies of people born during the Dutch famine linked maternal malnutrition to impaired glucose tolerance in offspring.
3. In animal models, maternal protein restriction in rats leads to low birth weight offspring that develop insulin resistance and type 2 diabetes. This is associated with changes in the expression of genes related to insulin signaling and may represent an early risk factor for metabolic
The document discusses gene-environment interactions related to obesity. It provides the example of the Pima Indians, noting that the Pimas in Arizona have experienced an obesity epidemic in recent decades due to lifestyle changes including a higher fat diet and more sedentary lifestyle compared to their genetic relatives in Mexico who maintain a traditional diet and active lifestyle and have lower obesity rates. While genetics play a role in obesity susceptibility, the rapid increase in obesity cannot be explained by genetics alone and is likely due to environmental factors, with certain genetic profiles making individuals more vulnerable to weight gain in obesogenic environments.
This study evaluated the self-reported effects of dairy products on symptoms of Crohn's disease (CD) in 165 patients in New Zealand. The key findings were:
1) Dairy products had no effect on symptoms for most patients (67.3%), but dairy products high in fat like cream and ice cream were most likely to worsen symptoms.
2) Disease activity status (active vs quiescent CD) did not influence responses to dairy, but colonic inflammation was more often associated with adverse effects than ileal involvement.
3) Symptom worsening from dairy was highly individual, influenced more by fat content and disease location than by lactose or disease activity status.
This document discusses nutrigenomics and nutrigenetics, which are two related but distinct fields that examine the relationship between genetics and nutrition. Nutrigenomics looks at how foods and nutrients influence gene expression, while nutrigenetics focuses on how genetic variations impact an individual's response to specific foods and nutrients. The document provides examples of how knowledge in these fields can help identify personalized diets and nutritional interventions tailored to one's genetic profile that may help prevent or treat chronic diseases like obesity, cardiovascular disease, and cancer. It also discusses some specific genetic disorders like lactose intolerance and phenylketonuria where restricting certain foods can benefit affected individuals.
Severe acute malnutrition remains a major cause of childhood mortality worldwide, with 19 million preschool children affected each year. While treatment guidelines have incorporated ready-to-use therapeutic foods and antibiotics in outpatient settings, some children still fail to recover. A 2013 study found that adding amoxicillin or cefdinir to outpatient treatment significantly improved recovery rates. However, a 2016 study found no clear benefit of routine antibiotic use and raised concerns about increasing antibiotic resistance, calling for further research before changing treatment guidelines.
This document provides an overview of nutrition therapy for eating disorders. It discusses how nutrition professionals are essential members of multidisciplinary clinical teams treating eating disorders, possessing knowledge of nutrition, physiology, and skills for promoting behavior change. The document reviews nutrition assessment, interventions, monitoring, and considerations regarding professional boundaries in the treatment of eating disorders. It emphasizes that training and experience in nutrition therapy specific to eating disorders can help achieve positive patient outcomes.
The document summarizes key information about functional gastrointestinal disorders (FGIDs):
- FGIDs affect 40% of patients seen in GI settings and are a leading cause of emergency referrals. They are defined by symptoms in the absence of structural abnormalities and involve motility, sensitivity, immune, and central nervous system abnormalities.
- Food can trigger FGID symptoms in many patients. Dietary triggers may involve immune activation, direct effects of food chemicals, or carbohydrate malabsorption. Low FODMAP and gluten-free diets can provide relief.
- A multidisciplinary approach including a gastroenterologist, psychologist, dietician, and others results in significantly reduced anxiety and depression in FGID patients
Bariatric surgery mechanisms, indications and outcomesMerqurio
1) Obesity is a growing global epidemic causing major health problems and costs. Only bariatric surgery has proven able to achieve substantial and durable weight loss.
2) Gastric banding and gastric bypass are the most common bariatric procedures. Choice depends on availability of long-term follow up support.
3) Bariatric surgery leads to 30-35kg weight loss on average, resolving many obesity-related diseases and improving quality of life. It is indicated for adults with BMI over 30 who have failed lifestyle methods.
THE EFFECTS OF LOW GLYCEMIC INDEX FOODS ON THE POLYCYSTIC OVARIAN SYNDROME.pptxNabanitaDas33
Recent studies have shown that a low-carbohydrate, ketogenic diet can lead to
weight loss and improvements in insulin resistance cause weight loss and improving
insulin resistance may be beneficial for PCOS, we performed this pilot study using a
LCKD (Low-carbohydrate ketogenic diet) in women with PCOS. Together, the
analyzed data indicate that proper control of carbohydrate intake provides beneficial effects
on some aspects of PCOS and may represent one of the important interventions improving
the clinical symptoms of affected patients.
Gasto Symptoms is your health guide to GI related issues: colonoscopy screening, abdominal pain, heartburn, acid reflux, and other gastrointestinal symptoms.
Here In this slide research work on Crohn's disease , we hope it much help to know about crohn's disease.
1. Caesarean section delivery disrupts the normal pattern of microbial colonization in infants, dominating their gut with bacteria from the human skin and oral cavity rather than vaginal and enteric bacteria acquired during a vaginal birth.
2. Microbial dysbiosis resulting from C-section delivery has been associated with increased risk of conditions like asthma, obesity, food allergies, and inflammatory bowel disease later in life.
3. Restoring a healthy gut microbiota in infants born by C-section through breastfeeding and probiotic supplementation may help reduce the risk of these long-term health issues, though more research is still needed.
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This document discusses the field of nutrigenomics, which examines the relationship between genes, nutrition, and health. It notes that nutrigenomics can provide personalized nutrition advice by understanding how genetic variants affect an individual's response to different foods. The document also discusses how epigenetics and early life nutrition can influence gene expression and lifelong health, and how nutrigenomics may help address inconsistent responses to general dietary recommendations and help develop more individualized diets.
This document reviews approaches for colon-specific drug delivery (CDDS). It compares earlier approaches like prodrugs, pH-dependent systems, and microbial-triggered systems, which had limitations, to newer approaches like pressure-controlled colonic delivery capsules, CODESTM, and osmotic controlled drug delivery (ORDS-CT) systems. These novel approaches are unique in achieving in vivo site specificity and feasibility of manufacturing. Factors that must be considered in colon targeted drug delivery system design include anatomy and physiology of the colon, pH levels in different colon regions, colonic microflora and enzymes, transit of materials through the colon, and drug absorption in the colon.
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This document discusses the individualization of drug dosage regimens to account for variability between patients. It notes that while humans are alike as a species, there are differences between individuals that impact their responsiveness to drugs. Failing to tailor drug administration to each patient can lead to ineffective therapy in some or toxicity in others. The document outlines the main sources of variability in pharmacokinetics as biological factors like age, weight, gender and genetics, environmental factors like drug interactions and disease states, and cultural factors. It discusses approaches to designing individualized dosage regimens based on estimating pharmacokinetic parameters in individual patients or using population averages with adjustments. The key parameters that can be adjusted are dose size and dosing frequency.
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1. Aliment Pharmacol Ther 2005; 21: 1399–1409. doi: 10.1111/j.1365-2036.2005.02506.x
Personal view: food for thought – western lifestyle and susceptibility
to Crohn’s disease. The FODMAP hypothesis
P. R. GIBSON* & S. J. SHEPHERD
*Department of Gastroenterology, Box Hill Hospital, Victoria, Australia; Department of Medicine, Monash University,
Victoria, Australia
Accepted for publication 1 April 2005
permeability, a predisposing factor to the development of
SUMMARY
Crohn’s disease. Evidence supporting this hypothesis
Susceptibility to the development of Crohn’s disease includes the increasing intake of FODMAPs in western
involves a combination of genetic and environmental societies, the association of increased intake of sugars
factors. The association of Crohn’s disease with west- in the development of Crohn’s disease, and the previ-
ernization has implicated lifestyle factors in pathogene- ously documented effects of the ingestion of excessive
sis. While diet is a likely candidate, evidence for specific FODMAPs on the bowel. This hypothesis provides
changes in dietary habits and/or intake has been lacking. potential for the design of preventive strategies and
A new hypothesis is proposed, by which excessive raises concern about current enthusiasm for putative
delivery of highly fermentable but poorly absorbed short- health-promoting effects of FODMAPs.
chain carbohydrates and polyols (designated FODMAPs One of the greatest challenges in defining the patho-
– Fermentable Oligo-, Di- and Mono-saccharides And genesis of Crohn’s disease is to identify predisposing
Polyols) to the distal small intestinal and colonic lumen environmental factors. Such an achievement might lead
is a dietary factor underlying susceptibility to Crohn’s to the development of preventive strategies for, and the
disease. The subsequent rapid fermentation of FODMAPs definition of, possible target for changing the natural
in the distal small and proximal large intestine induces history of this serious disease. The present paper describes
conditions in the bowel that lead to increased intestinal a new hypothesis for one such environmental factor.
BACKGROUND INFORMATION observing the marked increase in incidence seen in
western countries four decades earlier, an observation
Crohn’s disease is associated with the western lifestyle
that has been linked, correctly or incorrectly, to the
Since the mid-20th century, the incidence of Crohn’s ‘westernization’ of the developing countries.4 Migrants
disease has steadily risen in western Europe and North from countries of low prevalence are tending to take on
America from a rare condition to one that affects up to the prevalence of their adopted country.5–7 Hence, it is
0.2% of the population.1 Furthermore, the incidence intuitive that environmental factors that predispose
may still be rising as shown by recent studies of children individuals to Crohn’s disease are linked to the western
in northern Europe and Australia.2, 3 Countries previ- lifestyle.
ously of very low incidence, such as Japan, are now
Diet as a candidate
Correspondence to: Prof. P. Gibson, Department of Gastroenterology, Box
Hill Hospital, Box Hill, Victoria 3128, Australia. One of the candidate areas of western life that has
E-mail: peter.gibson@med.monash.edu.au changed considerably in concert with the emergence of
Ó 2005 Blackwell Publishing Ltd 1399
2. 1400 P. R. GIBSON & S. J. SHEPHERD
Crohn’s disease is diet. Several case–control dietary difficulty has been experienced in identifying a biologic-
surveys have been performed in an attempt to identify ally plausible mechanism for the relationship prior to
putative dietary factors. Accurately determining dietary the onset of Crohn’s disease. The findings have gener-
intake retrospectively in a patient with established ally been attributed to an associated dietary perturba-
Crohn’s disease is problematic. Recall of dietary intake tion, such as deficient fresh fruit and vegetables,17, 25
prior to developing the illness is fraught with inaccur- excess in the intake of fast food,11 or food additives,13 or
acies, particularly when the onset of the disease is not to be related to disturbed perception of sweet taste in
easily determined and current diet might be influenced patients with Crohn’s disease.19 The evidence for these,
by illness-induced changes. Despite these methodologi- however, is not good. The other approach to dealing
cal limitations, such studies do offer potential insights with consistent observations that defy simple explan-
into dietary factors of importance, particularly if the ation is to dismiss them as artefacts due to methodo-
findings are reproducible and biologically plausible. logical deficiencies and limitations.33 A fresh look at the
Several dietary factors have been documented to be data is needed and a new explanation of the association
associated with Crohn’s disease. These include the of sugars with Crohn’s disease is offered below.
quantity and quality of fat intake,8–10 fast food inges-
tion,11 and total protein and energy intake.12 However,
Changing patterns of food intake and dietary behaviour
the validity of such findings is uncertain as they have
not been reproduced or conflicting results have been Changes have occurred in multiple aspects of dietary
reported. In marked contrast, a large number of case– behaviour and some of the more relevant observations
control studies have examined the association of refined are presented in Table 1.
sugar intake with Crohn’s disease, either by examining
the intake of selected sugar-containing foods or of total
Biomarkers of susceptibility to Crohn’s disease
dietary sugars. Eleven of fifteen studies 11, 13–26 have
reported a significant increase in intake in patients with Gaining direct support for an effect of a particular
Crohn’s disease when attempts have been made to dietary component on susceptibility to Crohn’s disease is
examine diet pre-illness or pre-diagnosis. Likewise, 12 of difficult as the disease is likely to result from a complex
13 13, 15, 17–21, 27–32 studies examining current intake interaction of environment and genes. A single envi-
of sugars have shown significantly greater intake in ronmental factor is unlikely to act alone. Furthermore,
patients with Crohn’s disease than in controls. This interventions based on a putative dietary factor cannot
association seems to apply to populations of disparate realistically be tested with the development of Crohn’s
geographical location and ethnicity. disease as the end point. A biomarker of susceptibility –
While the remarkable consistency of this observation that is, a physiological abnormality that might mechan-
suggests that it represents a real relationship, a major istically be involved in the increase of the likelihood of
Table 1. Changing patterns of food intake
Changes observed Details
and dietary behaviour over the last
Spectrum of sugars consumed Sucrose less, lactose stable, fructose increased 20 years
(fourfold in 10-year-old children,34 nearly
20% in population35)
Location of food intake Increase in away-from-home food
(fast food outlets or restaurants); >35%
food consumed away from home36
Pattern of eating Nearly 50% increase in proportion of energy
from snacks compared with meals across
all age groups37
Food selection Increase in salty snacks, pizza, sweetened
beverages doubled in 20 years;36 increase
in consumption of pasta, cakes, breads,
cereals, high fruit products37–39
Use of caloric sweeteners Increase, particularly in beverages40, 41
Ó 2005 Blackwell Publishing Ltd, Aliment Pharmacol Ther 21, 1399–1409
3. PERSONAL VIEW: DIET AND SUSCEPTIBILITY TO CROHN’S DISEASE 1401
developing Crohn’s disease, is needed. Then, the influ- which they increase permeability might provide clues
ence of the dietary factor on that biomarker of as to a mechanism by which diet might change in
susceptibility can be directly examined. permeability (see below).
To date, the only putative biomarker of susceptibility to There is a paucity of studies linking dietary factors
Crohn’s disease recognized is an elevated intestinal with alterations of intestinal permeability. When the
permeability.42 The concept has biological plausibility epithelial barrier is impaired in non-physiological con-
in that inefficiencies in the intestinal barrier may lead to ditions, such as consuming a diet completely devoid of
increased mucosal exposure to luminal pro-inflamma- fibre, or following small intestinal injury from alcohol,
tory molecules and micro-organisms, and to subsequent dietary fibre corrects or ameliorates increased epithelial
potential modulation of the mucosal immune respon- permeability.54–57 Whether dietary fibre influences
siveness. Increased intestinal permeability has been epithelial barrier function in more physiological situa-
demonstrated in 10–20% of first-degree relatives of tions has not been reported. However, high luminal
patients with Crohn’s disease. This has been consis- concentrations of short-chain fatty acids can reversibly
tently demonstrated using different techniques of impair barrier function,58, 59 presumably by inducing
assessment in patients from several centres from North apoptosis of epithelial cells, as do NSAIDs. Short-chain,
America and Europe.43–48 The hyper-responsiveness of poorly absorbed carbohydrates increase the permeabil-
intestinal permeability to aspirin or ibuprofen observed ity of the colon in rats60 (see below). Dietary fats may
in patients with Crohn’s disease is also found in a higher also potentially play a role. Rats on a high-fat diet have
proportion of first-degree relatives than in controls.49, 50 higher distal colonic paracellular permeability61 and
Elevated expression by peripheral blood B cells of transcellular transport and efflux mechanisms are
CD45RO was reported in a proportion of relatives with altered in the jejunum of rats fed different long-chain
increased intestinal permeability but not in those where fatty acids.62
permeability was normal,51 supporting the notion that
the permeability probes used are reflecting barrier
THE FODMAP HYPOTHESIS
competence and antigen exposure in the mucosa. The
development of Crohn’s disease in a first-degree relative Excessive delivery of highly fermentable but poorly
many years after the demonstration of elevated intes- absorbed short-chain carbohydrates and polyols (desig-
tinal permeability further supports the concept.52 nated FODMAPs – Fermentable Oligo-, Di- and Mono-
A key question is whether this abnormality reflects saccharides And Polyols) to the distal small intestinal
genetic factors or the influence of environmental and proximal colonic lumen is a dietary factor under-
factors. Three studies from different investigating groups lying susceptibility to Crohn’s disease. Such elevated
have shown that increased intestinal permeability is delivery can occur as a consequence of excessive intake
also found in 13–36% of spouses of patients with of FODMAPs and/or malabsorption of fructose by the
Crohn’s disease.46, 47, 53 By contrast, hyper-responsive- small intestine. The passage of these substances and
ness to non-steroidal anti-inflammatory drugs (NSAIDs) their subsequent rapid fermentation induces conditions
appeared restricted to the first-degree relatives.47 Thus, in the bowel and systemically leads to increased
the evidence supports the involvement of environmental intestinal permeability, a predisposing factor to the
factors in the pathogenesis of general ‘background’ development of Crohn’s disease in a genetically sus-
permeability abnormalities, while NSAID-induced abnor- ceptible host. The hypothesis is illustrated in Figure 1.
malities might have a stronger genetic basis.
The spectrum of FODMAPs
Dietary factors and intestinal permeability
The characteristics and common dietary sources of
Unfortunately, few environmental factors that increase FODMAPs are summarized in Table 2. They comprise
intestinal permeability have been identified. The most five main dietary components.
notable is the intake of NSAIDs including aspirin.47, 54
While the intake of NSAIDs is not a viable candidate as Fructose. This is present in the diet as a free monosac-
a major environmental factor in the pathogenesis of charide, as a constituent of the disaccharide, sucrose, or
Crohn’s disease, understanding the mechanism by polymerized as fructans (see below). When fructose is
Ó 2005 Blackwell Publishing Ltd, Aliment Pharmacol Ther 21, 1399–1409
4. 1402 P. R. GIBSON & S. J. SHEPHERD
Absorptive capacity limited when in excess of glucose – low in
Dietary
FODMAPs
No suitable small intestinal hydrolases – absorption <5%
Epithelial
30% (considered to have fructose malabsorption)
irritation/
No human a-galactosidase – minimal absorption
injury
Digestion &/or small intestinal absorption
Rapid
Fermentation
No absorption if lactase deficient
Passive absorption only (<20%)
Passive absorption only (<20%)
B ac t
• Surfactant activity
erial ov
ergrowth
Luminal changes
• Organic acids
• Distension
Bact
• Other
erial o
vergrowth
Table 2. Dietary FODMAPs, their common sources in the diet and the physiology of their delivery to the large bowel lumen
Susceptibility to Increased intestinal
Crohn’s disease permeability
Figure 1. The FODMAP hypothesis of the link between diet and
Wheat, onions, added for putative
susceptibility to Crohn’s disease. Dietary FODMAPs delivered to
Fruits, honey, high fructose corn
the distal small intestine and proximal colon are rapidly
Apples, pears, plums, reduced
fermented. In the distal small intestine, this leads to an expansion
Reduced caloric sweetener
Legumes, beans, cabbage,
of bacterial populations with secondary increase in intestinal
Milk, yoghurt, ice cream
Brussels sprouts, onions
Common sources/uses
permeability. In the proximal colon, changes in the luminal
syrup (sweetener)
caloric sweetener
content and distension (not shown) have epithelial, neural and
health benefit
hormonal effects, one consequence of which is to irritate or injure
the epithelium and impair its barrier function. In Crohn’s disease,
there is an increased delivery of FODMAPs to the colon because of
excessive intake that might be compounded by fructose malab-
sorption. The response to the rapid fermentation of a greater load
of FODMAPs in the distal small intestine and proximal colon may
be exaggerated in patients susceptible to Crohn’s disease because
Fructooligosaccharide (oligofructose)
of genetic or other environmental factors.
Sorbitol, xylotol, mannitol, maltilol
ingested as sucrose, or in equimolar combination with
glucose, it is absorbed with an efficiency estimated to be
85% that of glucose because it is of high capacity and
Polydextrose, isomalt
Raffinose, stachyose
glucose-facilitated.63 Fructose in excess of glucose (free
fructose) can also be absorbed by a low-capacity
glucose-independent facilitated transport.63 If the load
Dietary form
of free fructose is sufficiently large, malabsorption of
fructose is universal. However, about 30% of the
population exhibits very limited ability to absorb free
fructose64, 65 and are considered to have ‘fructose
Galactooligosaccharides
malabsorption’.
Food component
Fructans. These are oligo- and polysaccharides of
fructose units with a glucose terminal end.66 Fructans
are classified according to the fructose–fructose bonds,
Fructans
Fructose
Lactose
Polyols
Other
being either inulins (b1-2 bond) or levans (b2-6 bond).
Most dietary sources are of the former. Inulin termin-
Ó 2005 Blackwell Publishing Ltd, Aliment Pharmacol Ther 21, 1399–1409
5. PERSONAL VIEW: DIET AND SUSCEPTIBILITY TO CROHN’S DISEASE 1403
ology is confusing in that those with a chain length The intake of FODMAPs is increasing in western societ-
[degree of polymerisation (DP)] <10 are generally ies. As outlined above, urbanization has been associated
referred to as fructooligosaccharides (FOS or oligofruc- with increased consumption of fructose as a proportion
tose), while molecules with DP of 10 or greater are of sugars. This has been the result of changes in food
generally called ‘inulins’. Dietary fructans are mostly selection and patterns of eating, and the use of caloric
FOS, the major sources being wheat and onion (average sweeteners, principally in beverages and fruit drinks,
DP 5), but FOS is increasingly being added to food for compounded by the widespread use of high fructose corn
putative health benefits.67 Average daily intake of syrups as sweeteners in soft drinks and many other
fructans in USA has been estimated as 10 g per day.68 packaged snack food in the USA. While there are no
As the human small intestine does not produce a direct studies of time trends in fructan ingestion, indirect
hydrolase capable of breaking the b1-2 bond, more than evidence indicates changes in the patterns of fructan
90% of dietary fructans are delivered to the large bowel, ingestion. As shown in Table 1, the intake of major
where they are readily fermented.69 sources of fructans, such as pasta and pizza, has
increased.35–40 The type of fructans in the diet is also
Lactose. This is effectively digested and absorbed only if changing. Fructans offer unique technological benefits
the disaccharide, lactase, has sufficient activity in the in food manufacture and are being added to improve
small intestine.70 Lactase deficiency has a wide vari- palatability and stability of foods,76 while offering
ation in prevalence across ethnic groups and countries, putative nutritional benefits as ‘functional foods’.67
from 2% in Scandinavian countries to >90% in some There are no data available on trends in intake of
Asian countries. polyols, but it is likely that exposure of the population to
them as food additives has increased with the desire to
Polyols. These are sugar alcohols and include sorbitol, have ‘sugar-free’ products to lower energy intakes and
xylitol, mannitol and maltitol.71, 72 While naturally to protect dentition.41
occurring in foods such as apples, pears and stone fruits,
they are often added to food as humectants and artificial The association of increased intake of sugars and the
sweeteners. Polyols are poorly absorbed in the small development of Crohn’s disease. As outlined above, one
intestine and are readily fermented. Polydextrose and of the few highly consistent associations between
isomalt, used as food additives, behave in a similar way. Crohn’s disease and both current and pre-illness diet
has been the intake of sugars. As most of the studies
Galactooligosaccharides (GOS). These are oligosaccha- particularly addressed sucrose intake, they almost
rides with a beta-fructosidic linkage and an alpha- certainly indicate increased fructose intake as part of
galactosidic linkage.73 The main dietary forms are this disaccharide. As free fructose is increasing as a
raffinose, which comprises one fructose, one glucose proportion of total sugars, at least in USA, it is likely
and one galactose molecule, and stachyose, which is that free fructose intake by patients with Crohn’s
raffinose with one more galactose molecule. Humans disease is also elevated. However, the opposite was
lack a-galactosidase that hydrolyses the galactosidic found in the only study (from UK) reporting fructose
linkages of stachyose and raffinose to their simple sugar intake.17 This was not surprising as assessment of free
constituents. GOS are rapidly fermented and induce gas fructose intake appeared to be determined purely on the
formation.74, 75 Significant dietary sources include basis of fruit ingestion, which was low in those affected
legumes (such as soya beans, mung beans, chickpeas, by Crohn’s disease. Ingestion of other FODMAPs,
lupin and split peas), common beans, cabbage, Brussels especially fructans, has not been investigated and
sprouts, onions, chicory and salsify. Cooking generally cannot be derived from published dietary data.
reduces the GOS content in legume foods.
Excessive intake of FODMAPs creates conditions in the
bowel that predispose it to Crohn’s disease. FODMAPs may
Evidence to support the hypothesis
be associated with physiological effects in the distal
There are three main lines of evidence for the involve- small intestine and colon. First, by virtue of their small
ment of FODMAPs in the pathogenesis of Crohn’s molecular size, they have a considerable osmotic effect
disease. and are associated with the delivery of increased
Ó 2005 Blackwell Publishing Ltd, Aliment Pharmacol Ther 21, 1399–1409
6. 1404 P. R. GIBSON & S. J. SHEPHERD
amounts of fluid to the colon.77 Secondly, they are Effects on the colon. When healthy rats were fed FOS or
fermented by intestinal bacteria to short-chain fatty lactulose, evidence for injury to, or irritation of, the
acids, including butyrate, and the gases, carbon dioxide colonic epithelium was found, in addition to prebiotic
and hydrogen.78 Hydrogen is absorbed into the circu- effects.60 Epithelial cell proliferation and mucin output
lation and excreted in the breath, but varying amounts increased in these rats. Of perhaps more relevance to
may also be further metabolized in the lumen to Crohn’s disease, intestinal permeability was also
sulphides by sulphate-reducing bacteria, methane by increased as shown by increased bacterial transloca-
methagens, or acetic acid via acetogens. As a substrate tion60 and permeation of the paracellular permeability
for bacterial metabolism, FODMAPs induce relatively probe, EDTA.93 When the rats were experimentally
selective bacterial proliferation, especially of bifidobac- infected with a salmonella species, the rats fed
teria.78, 79 This is the so-called prebiotic effect that FODMAPs developed severe colitis in comparison with
conceptually carries health benefits.67 The combination the mild colonic inflammation in the control ani-
of the delivery to the large bowel of fluid that might mals.60 Furthermore, the effect seemed to be a dose-
flush the bowel, the luminal production of short-chain dependent. A recent study in healthy human subjects
fatty acids such as butyrate, and the prebiotic effects (2-week exposure to FOS) led to a doubling of mucin
would seemingly add up to a healthier colon. Consid- output, although no change in permeability (using
erable enthusiasm for these concepts has been expressed EDTA as the probe) was detected.94 This was consis-
in numerous reviews.67, 80, 81 Indeed, ingestion of FOS tent with injury to, or irritation of, the colonic
suppresses carcinogenesis in rats or mice exposed to the mucosa.
powerful carcinogens, dimethylhydrazine or azoxy- From a mechanistic point of view, rapid fermentation
methane,82–86 and reduced the mortality of mice of carbohydrates in the proximal large bowel may lead
following the systemic or oral delivery of pathogens86 to high concentrations of short-chain fatty acids and
compared with animals receiving no or non-fermenta- lactic acid in the lumen, which can disrupt the mucosal
ble fibre. barrier,58, 59 and increased surfactant activity in the
Paradoxically, FODMAPs may exert adverse effects on faecal water, activity associated with increased epithe-
the distal small intestine, the colon and systemically, as lial turnover. Oral calcium reduced both the surfactant
outlined below. activity of faecal water and the severity of salmonella-
induced colitis in FODMAP-fed rats.95 FOS also increa-
Effect on the distal small intestine. FODMAPs might be ses the propensity for colonic epithelial cells to undergo
considered the ‘fast food’ for bacteria. Experiments with apoptosis, demonstrated in an acute DNA injury
faecal slurries in vitro have shown that FODMAPs of small model.96 This is presumably the reason why FOS was
molecular size are very rapidly fermented compared with able to suppress carcinogenesis in carcinogen-treated
those of long-chain carbohydrates.78 Similar observa- rats and mice. The balance between pro-apoptotic
tions have been made in vivo utilizing the rapidity of suppression of carcinogenesis on the one hand and loss
increases in breath hydrogen after carbohydrates reach of barrier function due to epithelial apoptosis on the
the colon as a marker of the rate of fermentation. Thus, other is well documented in association with NSAIDs.97
the rate by which breath hydrogen rose was greatest for Support for a pathogenic role of the rapidity of
lactulose, less for inulin and least for resistant starch.87 fermentation comes from experiments in healthy rats
Delivery of fast food to the distal small intestinal lumen where rapidly-fermentable fibres were delivered in the
potentially can lead to expansion of bacterial populations. absence of other fibres.98–101 Concurrent ingestion of
Such distal small intestinal bacterial overgrowth has rapidly fermentable with slowly and non-fermentable
been indirectly, but convincingly,88 demonstrated to be substrates contained within wheat bran slowed the rate
common in patients with irritable bowel syndrome, of fermentation and shifted it more distally in rats,99
coeliac disease and Crohn’s disease.89–92 Bacterial over- pigs100 and humans.101 Following the ingestion of raw
growth in the small intestine has been associated with potato starch, guar gum and arabinoxylan in the
increased small intestinal permeability. An association absence of other fibres, the distal colonic epithelium
between excessive delivery of FODMAPs and distal small shows evidence of injury/irritation, with striking increa-
intestinal bacterial overgrowth might reveal a mechan- ses in epithelial cell turnover and in the activities of
ism for increased epithelial permeability. brush border hydrolases and urokinase.99, 102, 103
Ó 2005 Blackwell Publishing Ltd, Aliment Pharmacol Ther 21, 1399–1409
7. PERSONAL VIEW: DIET AND SUSCEPTIBILITY TO CROHN’S DISEASE 1405
Exposure to a colonic carcinogen under these conditions FODMAPs, including fructans, is required from the
led to accelerated carcinogenesis. All these effects were community in general and from Crohn’s disease patients
abolished by the addition of wheat bran.99 Thus, and their first-degree relatives specifically. Likewise,
epithelial injury was associated with the site and studies of the absorption of fructose are needed in patients
rapidity of fermentation. with Crohn’s disease and their first-degree relatives.
Information on the effect of modifying FODMAP intake on
Systemic effects of FODMAPs. The ingestion of FOS the natural history of Crohn’s disease might also be
induced greater gastro-oesophageal reflux and concom- instructive. Even if FODMAPs do not prove to be
itant motility changes as well as increased heartburn aetiologically relevant as proposed in this hypothesis,
than did placebo in human volunteers with gastro- they might provide a ready target for improving sym-
oesophageal reflux disease.104 This was associated with ptoms and for reducing the current reliance on drug
hormonal changes that potentially altered motility therapy. Issues such as the effects of FODMAPs on small
patterns.104 There is also a reported association of mild intestinal permeability and their postulated relationship
depression with fructose malabsorption and lactose with excessive growth of bacteria in the distal small
intolerance in women with irritable bowel syndrome.105 intestine, and whether effects of FODMAPs observed in
The depression associated with fructose malabsorption the colon of rats apply to humans also await clarifica-
appeared to improve when free fructose was eliminated tion. Other issues of interacting dietary factors such as
from the diet.106 Subjects with fructose malabsorption fat and calcium intake require evaluation.
and an unrestricted diet have low circulating trypto- If further evidence does support this hypothesis, there
phan levels,107 suggesting secondary deficiency in are critical public health implications. The development
serotonin synthesis. of Crohn’s disease might potentially be prevented by
Thus, rapid fermentation of FODMAPs might lead to modification of both eating behaviour and the nature of
changes in luminal ecology in the distal small intestine food eaten. FODMAPs are dietary components that are
and injurious effects on the colonic epithelium with already being actively manipulated by the food industry.
consequent increase in epithelial permeability in both Issues in food production such as the amount of
the small and the large intestine, and has effects FODMAPs and the chain length of carbohydrates being
distant from the bowel on organs such as the added to foods, and the ongoing use of polyols might be
oesophagus and the brain. These observations impli- addressed. Modification of eating behaviour, such as in
cate excessive delivery of FODMAPs to the distal small the selection of foods and beverages, would also be
intestine and proximal colonic lumen as potentially important for any preventive approach. While this
harmful and set up conditions that might predispose to might seem an insurmountable challenge, success has
Crohn’s disease. been seen in the related challenge of reducing the intake
of saturated fats across communities.38–40
Implications of the hypothesis
ACKNOWLEDGEMENTS
This hypothesis provides a link between changes in
western dietary intake and the incidence of Crohn’s This work has been supported by the CASS Foundation.
disease. It is novel in defining a biologically feasible SJS is a recipient of the Dora Lush Scholarship from
mechanism underlying both the consistent observation the National Health & Medical Research Council of
that patients with Crohn’s disease consume increased Australia.
amounts of refined sugars and the biomarker of
susceptibility, elevated intestinal permeability. Of
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