Exclusive enteral nutrition ameliorates mesenteric adipose tissue alterations in patients with active Crohn's disease

Abstract

Background & aims: Mesenteric adipose tissue hypertrophy is a hallmark of Crohn's disease and can express various adipokines. Exclusive enteral nutrition could effectively induce remission in Crohn's disease with mechanisms largely unknown. We investigated whether exclusive enteral nutrition could modify mesenteric fat in patients with active Crohn's disease.

Methods: Sixteen patients who underwent resection for ileum Crohn's disease were studied. As a control group, eight patients without inflammatory bowel disease were enrolled. Before operation, eight Crohn's disease patients received exclusive enteral nutrition for four weeks, and the other patients had no nutritional therapy. The mesenteric fat samples were obtained during operation. Adipocyte size, adipokine production and topical C-reactive protein level were assessed.

Results: The adipocyte size from patients treated with exclusive enteral nutrition was much larger than that from Crohn's disease patients without nutritional therapy. Furthermore, protein levels of proinflammatory adipokines such as TNF-alpha and leptin were lower while protein level of adiponectin was higher in these patients. As to mRNA level, the expression of adiponctin was up-regulated and leptin was down-regulated in the patients received enteral nutrition.

Conclusions: Exclusive enteral nutrition could ameliorate mesenteric fat alterations which are associated with intestinal injury in patients with Crohn's disease by restoring adipocyte morphology and diminishing the inflammatory environment of mesenteric fat.

Keywords: Adipokines; Crohn's disease; Enteral nutrition; Mesenteric adipose tissue.