CLINICAL-EPIDEMIOLOGICAL PROFILE OF PATIENTS WITH FISTULIZING PERIANAL CROHN'S DISEASE

Introduction Patients with Crohn's disease (CD) may present with nutritional deficits. Symptoms such as diarrhea, malabsorption, and an increased resting energy expenditure (REE) can lead to greater weight loss, resulting in secondary protein-energy malnutrition. Assessing energy needs is part of the therapeutic management, as both overfeeding and underfeeding negatively impact nutritional status. Although indirect calorimetry (IC) is the gold standard for quantifying energy needs in critically ill patients, it is rarely performed in practice, and alternatives such as formula-based methods are used. There is inconsistent evidence on the use of IC in outpatient patients and the relationship between total energy expenditure (TEE) and disease activity. Furthermore, the agreement between methods, with IC plus 20% (responsible for diet-induced thermogenesis and daily energy expenditure) and the TEE estimated by the Pocket Formula (PF) in CD, led to the study.

Objective To evaluate the agreement of REE measured by IC plus 20% with TEE calculated by PF and to investigate the relationship between energy expenditure and disease activity, as well as other clinical and laboratory variables.

Method A cross-sectional, single-center study in adult patients with CD. REE measurements using IC and PF were conducted simultaneously. Laboratory exams, sociodemographic data, anthropometric assessments, and clinical activity evaluations using the Harvey Bradshaw index were collected. Statistical analyses were performed (5% significance).

Results A total of 100 patients participated in the study. The mean age was 42.6 years, with 49% being male. Men had higher TEE than women (p<0.0001). PF showed low agreement with IC (CCI<0.4). A statistically significant inverse correlation was found between TEE and both age and age at diagnosis (r=-0.217 and r=-0.244 respectively; p<0.05). The difference in energy expenditure between methods was inversely correlated with age, BMI, and age at diagnosis (r<-0.5 and p<0.05). No relationship was found between energy expenditure and disease activity.

Conclusion The findings highlight the need for nutritional health monitoring in individuals with CD. Greater attention should be given to men and younger individuals, as they have higher energy expenditure. Although TEE is not related to disease activity, the use of IC, even in outpatient patients, is essential for proper nutritional management.

No conflict of interest has been declared by the author(s).

Publication History

Article published online:
25 April 2025