Medical Nutrition Therapy in

Crohn’s Disease Patients

UNIVERSITY OF MARYLAND, COLLEGE PARK

DIETETIC INTERNSHIP PROGRAM
ANASTASIA MACZKO
MAY 6, 2015
Objectives

Define and differentiate the types of IBD

Identify the Medical Nutrition Therapy associated

with Crohn’s Disease patients

Discuss the implications of findings to the Dietetic

Practice
Inflammatory Bowel Disease

O IBD involves chronic inflammation of all or part of the

digestive tract

Crohn’s Disease Ulcerative Colitis

Inflammation may occur anywhere Large intestine (damage to large
along the digestive tract (damage to intestine and rectum)
large/small intestine)
Inflammation may occur in patches Continuous inflammation

Ulcers deeper into bowel wall Ulcers remain in inner lining

Abdominal pain, GI bleed, Abdominal pain, bloody diarrhea,
malabsorption, weight loss, diarrhea, dehydration, loss of appetite,
vomiting, stomach ulcers malabsorption, rectal bleeding, weight
loss, urgent bowel movement
Crohn’s Disease

Etiology – unknown
 Hereditary? Diet? Stress? Environment?
 Combination of clinical judgment, lab values, endoscopy/CT
scans
Treatment – variable
 Altered diet
 Bowel resection
 70% of CD patients require surgery
 30% of patients who have surgery will experience S/S in 3 years
 60% of patients who have surgery will experience S/S in 10 years
 Medication – suppress immune system
Alternative Therapies

Nutrition Supplements
 Zinc
 Folic Acid
 B12
 Vitamin D
 Calcium
 Omega-3 Fatty Acids
 Probiotics
 B-acetyl glucosamine
Acupuncture

Herbal Medications
 Slippery elm
 Marshmallow
 Turmeric
 Cat’s claw
Homeopathy
 Mercurius
 Podophyllum
 Veratrum album
Dietary Interventions

Increased risk of Malnutrition

 S/S: decreased appetite, nausea, abdominal pain, altered taste
buds, decreased absorption related to intestinal inflammation, need
for increased energy/protein needs
 60-75% of CD patients
Goal = maximize oral intake to prevent malnutrition and
dehydration
Varies
 Low-fiber/residue or low-fat diet
 Bowel rest (CLD)
 Bowel resection  enteral/parenteral nutrition
Nutrition Assessment
Meet Patient “X”

47-year-old Caucasian male

Signs/Symptoms x 1 week PTA
 Abdominal pain
 Poor appetite
 Persistent cough
 Postnasal drip
 Fever
 Chills
PCP started patient on Cipro and Flagyl
CT scan revealed pockets of abscess inflammation
Admitted October 2, 2014
Patient History

220-lbs, 6’0” BMI=29

 Weight remains stable at 220-lbs x 5 years
 124% IBW
Medications
 Ciprofloxacin, Fluticasone Nasal, Metronidazole, Protonix, Prednisone
No past medical history
Surgical history – Age 17, ileoascending colectomy
No allergies
Married w/ no children
Active Job
History of smoking (quit 2 ½ yrs ago)
Social drinking on weekend (6-10 beers)
Nutrition Diagnosis
Diagnosis

NC-1.4: Altered GI function related to compromised

function of GI tract as evidenced by Crohn’s disease
flare up and bowel inflammation via abdominal CT
scan.
NI-5.3: Inadequate protein, energy intake related to
restricted po intake as evidenced by…
 current clear liquid diet order not meeting patient’s energy needs.
(10/3/14)
 current clear liquid diet and PSS not meeting patient’s energy
needs. (10/6/14)
 current NPO diet order for bowel rest 2/2 Crohn’s Disease and PSS
not meeting patient’s energy needs. (10/8/14)
Nutrition Intervention
Energy & Nutrient Needs

Source Kcal Protein Fluid

Requirements Requirements Requirements
Facility Standards 2,187-2,417 kcals 100 g protein (1.0 1,296-2,495 mL
(Mifflin St Jeor) g/kg) (20-25 mL/kg)
EAL 2,187-2,417 kcals n/a 2,187-2,417 mL
(Mifflin St Jeor) (Adolph Method 1
mL/kcal)
Online Nutrition 2,500 kcals (25 100-150 g protein 2,187-2,417 mL
Care Manual kcal/kg) (1.0-1.5 g/kg) (Adolph Method 1
mL/kcal)
Dietary Regimen

24-hr diet recall

Diet Modifications Intake Nutrition Intake

Supplements
10/03/2014 Clear Liquid ------ 100% Ensure Plus 100%
Diet (3x/day)
10/04/2014 Clear Liquid ------ 100% PSS, Ensures ------
Diet discontinued
10/09/2014 NPO ------ ------ TPN, PSS ------
discontinued
Monitoring & Evaluation
Discharged on October 11, 2014
Home-TPN
 IV Cipro, IV Flagyl, Prednisone, Protonix, Fluctinase
Cycled 24-hours prior to discharge
Return to facility x 2-4 weeks for CT scan per MD
Continue to follow-up with MD every 6 months
Nutritional Implications to the Dietetic Practice

Every patient is different!

RDs play crucial role in identifying “trigger” foods
and examining 24-hr recall
Discuss with patient herbal-supplement interaction
Determining appropriate diet (i.e. soft, CLD, bowel
rest) and making recommendations for advancement
Coordinating with MD to discuss nutrition support
More research is needed
 Probiotics? Trickle feed? Enteral vs. Parenteral
Thank You!

What are your questions??

References

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http://www.nutritioncaremanual.org/topic.cfm?ncm_toc_id=19449
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http://www.nutritioncaremanual.org/topic.cfm?ncm_toc_id=19449