Risk factors of Crohn’s Disease 報告者 : 謝璿 指導老師 : 翁慧玲營養師 報告日期 :12/21

1. Risk factors of Crohn’s Disease 報告者:謝璿指導老師:翁慧玲營養師報告日期:12/21

2. Ingested Matter Affects Intestinal Lesions in Crohn’s DiseaseGregor Bartel, Ilse Weiss, Karl Turetschek,Wolfgang Schima, Andreas Pu¨spo¨k,Thomas Waldhoer, and Christoph Gasche Inflamm Bowel Dis 2008;14:374 –382 2

3. Introduction 3 Environmental factors of the modern Western life- style may trigger Crohn’s disease in susceptible individuals. Because such factors could be part of ingested matter, they intended to improve intestinal Crohn’s lesions by exclusion thereof.

4. Patients Methods 4 • Located in the neoterminal ileum in 2 cases • In the upper small bowel in the remaining 3 cases • Judged by global physician assessment • 3 female, 2 male, median age 36, median duration of disease 7 years. 5 pilot cases with CD • Ulceration of the left-sided colon or a significant lesion of the small bowel or right-sided colon that was assessable by means of MRI. • Somepatientwillbeexcluded. 14 pt with mild-to-moderate CD Primary: Assesed by MRI and endoscopy Secondary: Sonography, the CDAI and the IBDQ

5. 3 intramuscular multivitamin injections at weeks 0, 3, and 6. • Keep a nutrition and symptom diary throughout the study. • Contacted by the dietician. 5 Diedary Intervention Active group Control group • Highly restricted diet composed of red meat, certain sourdough bread, rape oil, and fresh butter • Fruits and vegetables were excluded • Low-fat, high-carbohydrate diet that is complete in nutrients, but to avoid fiber-rich fruits and vegetables • Not to eat any red meat.

6. Result(Pilot Cases) 6 • All patients showed significant improvement of bowel symptoms within 4 to 6 weeks. • Due to their individual success, 4 patients continued on a broadened organic diet including fruits and vegetables and were successfully avoiding surgery during the following years.

7. Result 7 Assesed by MRI

8. Result 8 • Transabdominal bowel sonography(TABS) showed improvement in 4 out of 5 patients in the active and 1 out of 8 in the control group. • At the end of the follow-up period the TABS scores further improved in 1 case and worsened in 2 of the active group. • After 6 weeks the CDAI dropped in both groups.

9. Discussion 9 • Environmental factors with a Western lifestyle might cause CD in genetically susceptible individuals. • Complex nutritional changes, should be able to improve or heal intestinal lesions in CD.

10. Discussion 10 • High drop-out rate. • Difficult to relate our results to previous dietary studies in CD as they typically focused on single dietary factors such as sugar or fat and did not assess intestinal healing as an endpoint.

11. Conclusions 11 • Ingested matter as part of the modern Western lifestyle may cause persistence of intestinal Crohn’s lesions.

12. Dietary Patterns and Risk for Crohn’s Disease in Children 12 Savio DS, Emile Levy, David Mack, David Israel, Philippe Lambrette and Parviz Ghadirian. Inflamm Bowel Dis 2008;14:367–373

13. Introduction 13 • Some dietary foods are considered protective, whereas others are thought to enhance the risk for Crohn’s disease (CD). The evidence, however, is inconsistent.

14. Methods 14 Controls were patients visiting the orthopedic clinicsandrandom-digit dialing (RDD) Newly diagnosed CD cases(< 20 years of age) Using a validated food frequency questionnaire(FFQ)andYouth Adolescent Questionnaire (YAQ). Factor analyses and unconditional logistic regression.

15. Result 15

16. 16 16 patterns were identified, of which 4 patterns were retained. 15 patterns were identified. 4 patterns were interpretable and were retained.

17. 17 • Cronbach’s alphas: • Boys: 0.82, 0.65, 0.70, and 0.53 for patterns partial western, prudent, miscellaneous, and meat • Girls: 0.80, 0.60, 0.79, and 0.57 for patterns western, prudent, cheese- snack, and beverages

18. Discussion 18 • Dietary pattern studies have provided valuable information on the etiopathogenesis of diverse complex diseases. • Western pattern could confer risk for CD among girls and that a prudent pattern could protect both girls and boys from acquiring CD.

19. Conclusions 19 • Specific dietary patterns could be associated with higher or lower risks for CD in children.

20. Vitamin D-mediated calcium absorption in patientswith clinically stable Crohn’s disease: A pilot studyMeena K, Natasha B. Khazai, Thomas R. Ziegler, Mark S. NanesSteven A. Abrams and Vin Tangpricha Mol. Nutr. Food Res. 2010, 54, 1085–1091 20

21. Introduction 21 • Vitamin D is the critical hormone for intestinal absorption of calcium. • Crohn’s disease (CD), rheumatoid arthritis (RA) and menopause are examples of conditions associated with increased fracture risk, impaired calcium absorption and an increased inflammatory state.

22. Methods 22

23. 23

24. Result 24

25. Result 25

26. Conclusions 26 • CD patients have a normal response to vitamin D in enhancing the efficacy of calcium absorption.

27. Summary 27 • Western lifestyle and specific dietary patterns could be increase the risks for CD patient. We could use the dietary patterns that, characterized by fruit, vegetable and high amount of vitamin D to avoid them.

28. Thankyou 28