الفهرس 
INTRODUCTIONOnly 14 pages are availabe for public view
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Abstract
Crohn’s disease is a chronic relapsing inflammatory disease that can affect any part of the gastrointestinal tract. It has unknown etiology, however it is influenced by complex interactions between genetic factors, environmental factors, and gut microbiota.
The diagnosis of CD is established when clinical presentation is combined with endoscopic characteristic lesions and histo-pathological assessment, in addition to specific radiological features and the complementary laboratory investigations.
Malnutrition is a highly prevalent problem affecting 20–85% of CD patients, particularly, but not confined to, those with small bowel disease. Different contributing factors include poor oral intake, malabsorption, adverse effects from different treatment strategies, increased energy expenditure and increased gastrointestinal loss. Malnutrition is strongly associated with poor clinical outcomes and lower quality of life.
Patients with CD are at higher risk of protein energy malnutrition and some specific micronutrients deficiencies such as iron, vitamin D, vitamin B12, zinc, magnesium and calcium.
Prealbumin is a preferred marker for protein malnutrition. Although it does not reflect the overall protein status, prealbumin might be used to evaluate the early response to nutritional support due to its short half-life (2 days) that can reflect recent food intake.
The subjective global assessment (SGA) is a validated and widely used nutritional assessment tool that provides important prognostic information for different populations of patients, In addition to diagnosing malnutrition.
The goal of this study was to assess the prevalence of malnutrition in CD patients and its prognostic significance regarding the severity of the disease, the number of relapses, the number of hospital admissions, the length of hospital stays, and response to treatment.
One hundred patients with CD participated in our study in which any patient above 18 years old diagnosed with CD for at least 6 month and was receiving treatment regime either conventional or biological, was included.
Patients with chronic renal, chronic liver diseases, diabetes, gastrointestinal malignancies, recent gastrointestinal surgical intervention, recent use of high dose corticosteroids were all excluded, in addition to pregnant females, children below 18 years old and those who refused to participate.
All candidates in the study had a comprehensive history taking, clinical examination, and laboratory tests, which included CBC, ESR, CRP, albumin, and FC. Serum levels of prealbumin, zinc, magnesium, calcium, iron, ferritin and TIBC were measured. Ileocolonoscopy was performed for all cases and CTE were also performed on all participants (only if needed). CDAI was used to evaluate clinical disease activity in CD patients initially and after 6 month of follow up, while SES-CD was used to measure the endoscopic activity.
In all patients, body weight and height were measured to calculate the BMI. Waist circumference was also measured. SGA was used to evaluate the nutritional status of the patients and classify them according to their score into well nourished (class A), mild to moderately malnourished (class B) and severely malnourished (class C).
When the 100 participants were classified according to the prevalence of malnutrition assessed by SGA, it was found that 69% were class A, 31% were class B and there was no patients representing class C.
In class B, BMI was significantly lower than in class A, and weight loss was significantly more common.
In addition to hemoglobin levels, serum levels of zinc, magnesium, calcium, albumin and prealbumin were all significantly more decreased in class B.
Regarding laboratory markers of disease activity, class B had significantly higher levels of CRP, ESR, ferritin, and FC.
According to CDAI, the disease was significantly more active in class B at the initial evaluation and at the follow up evaluation after 6 month.