Nutrición Hospitalaria ISSN: 0212-1611 info@nutriciónhospitalaria.com Grupo Aula Médica España Davanço, T.; Oya, V.; Rodrigues Coy, Saddy; Franco Leal, R.; Setsuko Ayrizono, M.a de L.; Sgarbieri, V. C.; dos Santos Vilela, M.a M.; Lomazi, E. A. Nutritional supplementation assessment with whey proteins and TGF-B in patients with Crohn's disease Nutrición Hospitalaria, vol. 27, núm. 4, julio-agosto, 2012, pp. 1286-1292 Grupo Aula Médica Madrid, España Available in: http://www.redalyc.org/articulo.oa?id=309226790047 How to cite Complete issue Scientific Information System More information about this article Network of Scientific Journals from Latin America, the Caribbean, Spain and Portugal Journal's homepage in redalyc.org Non-profit academic project, developed under the open access initiative 45. NUTRITIONAL SUPPLEMENTATION:01. Interacción 04/06/12 12:19 Página 1286 Nutr Hosp. 2012;27(4):1286-1292 ISSN 0212-1611 • CODEN NUHOEQ S.V.R. 318 Original Nutritional supplementation assessment with whey proteins and TGF-β in patients with Crohn’s disease T. Davanço1, V. Oya1, C. Saddy Rodrigues Coy2, R. Franco Leal2, M.ª de L. Setsuko Ayrizono2, V. C. Sgarbieri3, M.ª M. dos Santos Vilela1 and E. A. Lomazi1 1Centre for Research in Pediatrics and Pediatrics Department.School of Medical Sciences. UNICAMP. 2Surgery Department. School of Medical Sciences. UNICAMP. 3Department of Food and Nutrition. School of Food Engineering. UNICAMP. Brazil. Abstract EVALUACIÓN DEL EFECTO DE LA SUPLEMENTACIÓN CON PROTEÍNAS DEL SUERO Crohn’s disease (CD) is a chronic inflammatory disorder DE LA LECHE Y EL TGF-β, EN PACIENTES CON that primarily affects the intestines, resulting in breakage SÍNDROME DE CROHN of the intestinal barrier, pathological inflammation and nutritional disorders that encompass from trace elements deficiency to severe malnutrition. Nutritional interven- Resumen tions either alone or associated to drug therapy may be La enfermedad de Crohn (EC) es un desorden inflama- effective to achieve and maintain inflammation remis- torio crónico, que afecta principalmente el intestino, sion. resultando en el rompimiento de la barrera intestinal, Objective: To evaluate usual food intake as quantitative inflamación patológica y disturbios nutricionales que and qualitatively, in CD patients; and describe the effect pueden variar de la deficiencia de oligoelementos a la des- of a supplement containing whey proteins and TGF- on nutrición grave. Intervenciones nutricionales pueden ser their body composition. eficaces para alcanzar y mantener la remisión del proceso Patients and methods: Dietary intake was assessed inflamatorio, aisladamente, o en combinación con terapia considering 42 consecutive patients, followed in a tertiary farmacológica. center, and by using the 3-day food recall and food intake Objetivo: Evaluar el consumo alimentario cuantitativo frequency questionnaire. Body composition was assessed y cualitativo en pacientes con EC y el efecto de la suple- previously and 8 weeks after supplementation with a diet mentación nutricional con dieta conteniendo proteínas containing whey proteins and TGF-β (N = 22). del suero de leche y TGF-β, en la composición corporal de Results and discussion: Considering carbohydrates los pacientes. and lipids, most patients had adequate dietary intake Pacientes y métodos: La ingestión alimentaria fue eva- according recommendations. Protein, saturated fat, B12 luada en 42 pacientes, aplicando el registro alimentario vitamin and zinc intakes were higher than the recom- de 3 días y el cuestionario de frecuencia alimentaria. La mended values. The dietary fiber, A, D, C and E vitamins, composición corporal fue evaluada en esos pacientes, calcium, iron, folate, potassium and sodium intakes did siendo que 22 recibieron la dieta conteniendo proteínas not reach the recommended requirements in most del suero de leche y TGF-β y 20 pacientes no fueron suple- patients. Patients supplemented with the whey protein mentados (grupo control). and TGF-β dietary presented a positive increment in Resultados y discusión: La mayoría de los pacientes pre- their lean body mass, when compared to non-supple- sentó ingestión alimentaria adecuada de carbohidratos y mented group. lípidos. El consumo de proteína, grasa saturada, vitamina Conclusion: CD patients require nutritional orienta- B12 y zinc fue superior a los valores recomendados. El con- tion. Whey protein intake resulted in significant diffe- sumo de fibras alimentarias, vitamina A, D, C, y E, calcio, rences, such as improvement in Lean Body Mass and hierro, folato, potasio y sodio no satisfizo las necesidades reduction in Fat percentage. recomendadas en la mayoría de los pacientes. Hubo un (Nutr Hosp. 2012;27:1286-1292) aumento de la masa magra de los pacientes suplementados con la proteína del suero de leche y TGF-β. DOI:10.3305/nh.2012.27.4.5795 Conclusión: El grupo de pacientes con enfermedad de Key words: Chron’s disease. Nutritional assessment. Food Crohn presentó, en su mayoría, un consumo adecuado de consumption. Food intake. Body composition. Supplementation. carbohidratos y lípidos, y el consumo de proteína fue superior al recomendado en más de la mitad de los pacientes. Se encontró una ingesta inadecuada de vitami- nas A, C, D y E, fibras, calcio, folato, hiero y zinc. La ingestión de proteína del suero de leche mejoró la compo- sición corporal de los pacientes. Correspondence: Elizete Aparecida Lomazi. (Nutr Hosp. 2012;27:1286-1292) University of Campinas – Unicamp. Brazil. DOI:10.3305/nh.2012.27.4.5795 E-mail: [email protected] Palabras clave: Enfermedad de Crohn. Evaluación nutricio- Recibido: 12-II-2012. nal. Consumo alimentario. Ingesta de alimentos. Composición Aceptado: 2-III-2012. corporal. Suplementación. 1286 45. NUTRITIONAL SUPPLEMENTATION:01. Interacción 04/06/12 12:19 Página 1287 Abbreviations tal. Patients who agreed to participate were included when according with the following inclusion criteria: CD: Crohn’s Disease. 1. Patients of both genders; 2. Prescribed with bio- GSH: Glutathione. logical therapy: anti-TNF-α, 5-10 mg/kg, every 2 TEV: Total energy value. months (REMICADE®-Mantecorp-Brazil) and used BMR: Basal metabolic rate. in combination with azathioprine; 3. Small bowel BMI: Body mass index. inflammatory involvement was established on colonoscopy and biopsy; 4. No smoking or drug or other medication use; and 5. Have a previous history Introduction of regular adherence to outpatient follow-up, accord- ing to service records. Over the years, nutritional therapy has taken an Nutritional assessments were performed in three increasingly role in CD therapy, exerting a nutri- stages, in the group of patients who received supple- tional restorative action over body compartments, mentation. Times were set according to the following: and minimizing catabolic effects caused by the dis- ease. The importance of food was enhanced by the – T0: immediately before anti-TNF-α infusion. ability of inducing inflammatory remission by exclu- – T1: 8 weeks after T0, immediately before anti- sive ingestion of elemental formulas, which reduces TNF-α infusion. the stimulus of food antigens. More currently, the – T2: 8 weeks after T1. nutritional focus on CD has been the immunomodu- latory capacity of some specific nutritional elements Those patients who were eligible to study but who that act by modulating the immunoinflammatory did not agree on supplementation trial were assessed in response and by maintaining the integrity of intesti- two stages: nal mucosa.1 Thus, a rational nutritional therapeutic plan to CD – T0: immediately before anti-TNF-α infusion. patients should include nutrients to supply calories, – T2: 16 weeks after T0. reduce food antigenic stimulation, regulate inflamma- tory and immune response, and stimulate the mucosal Supplementation product contains whey protein tropism.2 concentrate plus TGF-β, the prescribed doses consisted Whey concentrate contains significant amounts of of 50% of Recommended Dietary Allowances for pro- cysteine and glutamylcysteine amino acids, glutathione teins in whey protein concentrate.8 The concentrate forerunners (GSH), and the mixture of these proteins was donated by Hilmar Cheese Company, 9001 (North plays an important role in maintaining cellular levels of Lander Avenue Hilmar, California 95324 USA). GSH.3 Further, whey proteins showed specific physio- Data reported at this paper comes from a prospec- logical actions and are associated with many biological tive and interventional study whit the main objective effects, such as anticancer activity, improved digestive was to investigate the effect of a whey protein con- function, improved physical performance and immune centrate containing TGF-β, administered for 16 system modulation.4,5,6,7 So, it seems to be worth to evalu- weeks, on the inflammatory response of Crohn’s dis- ate this therapy effects on CD patients as being followed ease, with focus in oxidant system vs. the antioxidant in a Brazilian specialized center for IBD. system, so, authors did not define a specific nutri- The objectives of this study were to evaluate food tional status as supplementation criteria for including intake in Crohn’s disease patients and the effect of subjects (table I). whey proteins and TGF- on body composition. Table I Materials and methods Composition characteristics of whey protein supplement are presented in table below Prospective study based on clinical and nutritional trial intervention with a whey concentrate enriched Whey proteins supplement composition with TGF-β.