Resting Energy Expenditure and Nutritional Status in IBD (CEDERN-1)

October 22, 2014 updated by: Dr. med. Hauke Heinzow, University Hospital Muenster

Influence of Disease Activity of Inflammatory Bowel Disease on Resting Energy Expenditure and Nutritional Status

Nutrient deficiencies occur frequently in IBD patients. The absorption rate of nutrients in IBD is often limited by chronic inflammation, but is also commonly reduced by missing intestinal segments due to previous operations. Patients are predominantly affected by malnutrition, which is often resembled by weight loss, specific micronutrient deficits such as iron deficiency, vitamin B12 deficiency, folic acid deficiency, vitamin D deficiency and zinc depletion. The etiology of nutritional problems is multifactorial and not exclusively limited to active phases of the disease. Causes of malnutrition can be inadequate food intake, maldigestion, malabsorption or increased nutritional requirement. Malnutrition itself is associated with a delayed recovery of impaired wound healing, reduced quality of life and longer hospital stays. Therefore, observation and modification of the nutritional status should be an integral part of therapy in IBD patients.

The primary objective of our study is to investigate the influence of the disease on the resting energy expenditure and nutritional status during acute inflammation and clinical remission of the disease. Secondary objectives are to assess possible nutritional deficiencies. On the other hand it is well known that patients with IBD are at increased risk for coronary heart disease. Therefore, another secondary focus of our observational study is whether the composition of the HDL proteins is changed towards pro-atherogenic HDL-proteins and whether possible changes occur in patients in clinical remission or with active disease.

Study Overview

Detailed Description

Primary objective of the study is to investigate the influence of the disease activity on the resting energy expenditure and the nutritional status in patients with chronic inflammatory bowel disease (IBD). The impact of IBD on the nutritional status and the resting energy expenditure is currently not fully understood. IBD includes two different disease entities, Crohn's disease and ulcerative colitis. Both are characterized by diarrhea, loss of weight, rectal bleeding and abdominal discomfort (abdominal pain, flatulence). In patients with IBD malabsorption, one-sided nutritional behavior, food abandonment, malnutrition, nutrient deficiency and weight loss are common issues. Malnutrition is associated with delayed recovery, impaired wound healing, reduced quality of life and prolonged hospital stay. The malnutrition is not limited to active disease state. Rates for malnutrition in patients with Crohn's disease range from 20 - 85%. Hence, the assessment of the nutritional status is important in the treatment of patients with IBD. Different methods are used to assess the impact of the disease activity on the nutritional status. To investigate the resting energy expenditure the well evaluated indirect calorimetry is used. The principle of the measurement is based on determination of the oxygen absorption during inspiration and the simultaneous determination of the release of carbon dioxide during expiration. The use of bioelectrical impedance analysis (BIA) is a widespread measurement to assess the composition of the body. BIA allows the determination of the fat-free mass, total body water, body cell mass, fat mass and extracellular mass.

Both measurements are non-invasive and reproducible. Additionally different blood parameters are determined such as HDL-subgroups, vitamin b12, folic acid, vitamin K, vitamin D, 25-hydroxy-vitamin D3, zinc, ferritin, albumin, citrulline and routine laboratory (blood count, serum chemistry, coagulation) . Moreover the quality of life is measured through a suitable questionnaire (Gastrointestinal Life Quality Index) as well as the subjective global assessment to estimate the nutritional status.

Furthermore, a secondary aim of the study is to investigate the correlation of HDL-subgroups and the severity of the IBD activity. High-Density-Lipoproteins are a heterogeneous group of lipoproteins with both anti-atherogenic and multiple anti-inflammatory properties. Recent research showed that the quality of HDL-particle is even more important than the quantity. It could be shown that changes in the composition of the HDL could cause an inflammatory status and thus affect the activity of chronic inflammatory disease. Therefore, it is the aim of the study to investigate if changes in the composition of HDL-proteins towards pro-atherogenic HDL-proteins exist.

The study will take place at the University Hospital of Muenster, Germany. Patients who are suitable for participating in the study will be measured and counseled during their regular out-clinic visits. Each patient has to undergo the procedure while they are in an active state of the disease and during remission. It is expected to include 200 patients over 2 years.

Study Type

Observational

Enrollment (Anticipated)

200

Contacts and Locations

This section provides the contact details for those conducting the study, and information on where this study is being conducted.

Study Contact

Study Contact Backup

Study Locations

      • Muenster, Germany, 48149
        • Recruiting
        • University Hospital Muenster
        • Principal Investigator:
          • Frank Lenze, Dr.
        • Principal Investigator:
          • Hauke Heinzow, Dr.

Participation Criteria

Researchers look for people who fit a certain description, called eligibility criteria. Some examples of these criteria are a person's general health condition or prior treatments.

Eligibility Criteria

Ages Eligible for Study

18 years to 80 years (Adult, Older Adult)

Accepts Healthy Volunteers

No

Genders Eligible for Study

All

Sampling Method

Non-Probability Sample

Study Population

Patients with active or inactive inflammatory bowel disease at our medical tertiary referral center, Muenster Germany

Description

Inclusion Criteria:

  • inflammatory bowel disease
  • male and female between 18-80 years
  • patient fully able to understand the study concept and to give his or her written consent

Exclusion Criteria:

  • underlying malignant disease
  • Diabetes mellitus, Type I or II
  • Pregnancy
  • Lactating
  • chronic alcohol or drug abuse
  • known anorexia nervosa or binge eating disorder
  • known metabolic disorders, such as e.g. Cushing disease, hypothyroidism
  • Participation in other interventional studies within the last 6 months prior to study enrollment
  • patient not fully able to understand the study concept and to give his or her written consent

Study Plan

This section provides details of the study plan, including how the study is designed and what the study is measuring.

How is the study designed?

Design Details

Cohorts and Interventions

Group / Cohort
Intervention / Treatment
Inflammatory bowel disease
Patients with active and inactive inflammatory bowel disease

What is the study measuring?

Primary Outcome Measures

Outcome Measure
Measure Description
Time Frame
change in bioelectrical impedance analysis (BIA)
Time Frame: change from baseline in BIA at 6 month and at 12 month
e.g. fat free mass, total body water, body cell mass
change from baseline in BIA at 6 month and at 12 month
Change in resting energy expenditure (REE)
Time Frame: change from baseline in REE at 6 month and at 12 month
Resting energy expenditure measured by indirect calorimetry (kcal per day)
change from baseline in REE at 6 month and at 12 month

Secondary Outcome Measures

Outcome Measure
Measure Description
Time Frame
change in HDL subgroup analysis
Time Frame: day 1, every 6 month up to 12 month
day 1, every 6 month up to 12 month
change in plasma citrulline level
Time Frame: day 1, every 6 month up to 12 month
day 1, every 6 month up to 12 month
change in plasma vitamine levels and plasma zinc level
Time Frame: day 1, every 6 month up to 12 month
Vitamin B12, Vitamin K, Vitamin D
day 1, every 6 month up to 12 month

Other Outcome Measures

Outcome Measure
Measure Description
Time Frame
change in fecal Calprotectin level
Time Frame: day 1, every 6 month up to 12 month
day 1, every 6 month up to 12 month
change in live quality questionnaire
Time Frame: day 1, every 6 month up to 12 month
Gastrointestinal Quality of Life Index by Eypasch
day 1, every 6 month up to 12 month

Collaborators and Investigators

This is where you will find people and organizations involved with this study.

Investigators

  • Principal Investigator: Frank Lenze, Dr., University Hospital Muenster, Germany
  • Principal Investigator: Hauke Heinzow, Dr., University Hospital Muenster, Germany

Study record dates

These dates track the progress of study record and summary results submissions to ClinicalTrials.gov. Study records and reported results are reviewed by the National Library of Medicine (NLM) to make sure they meet specific quality control standards before being posted on the public website.

Study Major Dates

Study Start

September 1, 2014

Primary Completion (Anticipated)

September 1, 2016

Study Completion (Anticipated)

September 1, 2016

Study Registration Dates

First Submitted

October 13, 2014

First Submitted That Met QC Criteria

October 22, 2014

First Posted (Estimate)

October 27, 2014

Study Record Updates

Last Update Posted (Estimate)

October 27, 2014

Last Update Submitted That Met QC Criteria

October 22, 2014

Last Verified

October 1, 2014

More Information

This information was retrieved directly from the website clinicaltrials.gov without any changes. If you have any requests to change, remove or update your study details, please contact register@clinicaltrials.gov. As soon as a change is implemented on clinicaltrials.gov, this will be updated automatically on our website as well.

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