{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,10]],"date-time":"2026-08-10T14:25:21Z","timestamp":1786371921329,"version":"build-2736575974"},"reference-count":48,"publisher":"MDPI AG","issue":"23","license":[{"start":{"date-parts":[[2024,11,29]],"date-time":"2024-11-29T00:00:00Z","timestamp":1732838400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"name":"Italian Ministry of Health (Ricerca Corrente)"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Nutrients"],"abstract":"<jats:p>Background: More than half of patients with Crohn\u2019s disease develop intestinal fibrosis induced intestinal obstruction with debilitating symptoms throughout their disease course. The incidence of stricture formation in CD has remained unchanged over the last several decades. Factors promoting intestinal fibrosis are currently unclear, but diet may represent an underestimated risk factor for intestinal fibrosis by modification of both the host immune response and intestinal microbial composition. Evaluating the impact of diet on the course of IBD is very complex. Sarcopenia is a common problem in IBD patients and correlates with an increased rate of disease. Skeletal muscle index (SMI) is an important parameter to measure sarcopenia and is an easily accessible tool for evaluating the likelihood of complications in individuals with CD. Methods: Using a randomized and controlled pilot design, we aimed to investigate the efficacy of 12 months of short-term dietary intervention based on essential amino acid (EAA) and sodium butyrate (NaB) supplementation in the management of stricturing Crohn\u2019s disease patients. Results: After the treatment in the diet EAA\/NaB group, we revealed a statistically significant improvement of muscle mass (61.49 \u00b1 5.47 vs. control 86 \u00b1 10.70, p = 0.01) and SMI index (9.97 \u00b1 1.79 vs. control 7.60 \u00b1 2.29, p = 0.02). In addition, the measurement of skeletal muscle mass in CD patients has been suggested to be crucial for predicting the disease course. Indeed, after one year, surgery was required in 4\/10 control group patients (40%) and 1\/10 study group (10%) patients, underlining the importance of body composition alterations and adequate dietary intake in the management of these patients. Conclusions: Further prospective studies are needed to confirm these results; nonetheless this nutritional approach could become an integral part in the treatment of stricturing CD patients to improve disease outcomes and increase the quality of life in these patients.<\/jats:p>","DOI":"10.3390\/nu16234153","type":"journal-article","created":{"date-parts":[[2024,12,2]],"date-time":"2024-12-02T03:50:57Z","timestamp":1733111457000},"page":"4153","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":5,"title":["Nutritional Management in Stricturing Crohn\u2019s Disease: A Pilot Study"],"prefix":"10.3390","volume":"16","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-2952-0053","authenticated-orcid":false,"given":"Elisabetta","family":"Cavalcanti","sequence":"first","affiliation":[{"name":"IBD Unit, National Institute of Gastroenterology-IRCCS, 70013 Castellana Grotte, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Antonella","family":"Marra","sequence":"additional","affiliation":[{"name":"IBD Unit, National Institute of Gastroenterology-IRCCS, 70013 Castellana Grotte, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alessia","family":"Mileti","sequence":"additional","affiliation":[{"name":"IBD Unit, National Institute of Gastroenterology-IRCCS, 70013 Castellana Grotte, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9140-673X","authenticated-orcid":false,"given":"Rossella","family":"Donghia","sequence":"additional","affiliation":[{"name":"Data Science Unit, National Institute of Gastroenterology-IRCCS, 70013 Castellana Grotte, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Margherita","family":"Curlo","sequence":"additional","affiliation":[{"name":"IBD Unit, National Institute of Gastroenterology-IRCCS, 70013 Castellana Grotte, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mauro","family":"Mastronardi","sequence":"additional","affiliation":[{"name":"IBD Unit, National Institute of Gastroenterology-IRCCS, 70013 Castellana Grotte, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2024,11,29]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"1072","DOI":"10.1136\/gutjnl-2012-304353","article-title":"Crohn\u2019s disease complicated by strictures: A systematic review","volume":"62","author":"Rieder","year":"2013","journal-title":"Gut"},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"2419","DOI":"10.1007\/s00384-021-03930-w","article-title":"Crohn\u2019s disease: A population-based study of surgery in the age of biological therapy","volume":"36","author":"Berlet","year":"2021","journal-title":"Int. J. Color. Dis."},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"293","DOI":"10.1007\/s004280000226","article-title":"Significant association of strictures and internal fistula formation in Crohn\u2019s disease","volume":"437","author":"Oberhuber","year":"2000","journal-title":"Virchows Arch."},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"1583","DOI":"10.1007\/s00261-017-1398-7","article-title":"Penetrating Crohn disease: Does it occur in the absence of stricturing disease?","volume":"43","author":"Orscheln","year":"2018","journal-title":"Abdom. Radiol."},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"777","DOI":"10.1136\/gut.49.6.777","article-title":"Behaviour of Crohn\u2019s disease according to the Vienna classification: Changing pattern over the course of the disease","volume":"49","author":"Louis","year":"2001","journal-title":"Gut"},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"144","DOI":"10.5217\/ir.2020.00015","article-title":"Differentiation of fibrotic and inflammatory component of Crohn\u2019s disease-associated strictures","volume":"18","author":"Rimola","year":"2020","journal-title":"Intestig. Res."},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"246","DOI":"10.1093\/ecco-jcc\/jjw137","article-title":"Evolving concepts in phases I and II drug development for Crohn\u2019s disease","volume":"11","author":"Jairath","year":"2017","journal-title":"J. Crohn\u2019s Colitis"},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"269","DOI":"10.1038\/nrgastro.2016.208","article-title":"Current and emerging therapeutic targets for IBD","volume":"14","author":"Neurath","year":"2017","journal-title":"Nat. Rev. Gastroenterol. Hepatol."},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"3647","DOI":"10.1007\/s00394-020-02198-0","article-title":"Evaluation of nutritional adequacy in adult patients with Crohn\u2019s disease: A cross-sectional study","volume":"59","author":"Cioffi","year":"2020","journal-title":"Eur. J. Nutr."},{"key":"ref_10","doi-asserted-by":"crossref","unstructured":"Balestrieri, P., Ribolsi, M., Guarino, M.P.L., Emerenziani, S., Altomare, A., and Cicala, M. (2020). Nutritional aspects in inflammatory bowel diseases. Nutrients, 12.","DOI":"10.3390\/nu12020372"},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"352","DOI":"10.1016\/j.clnu.2022.12.004","article-title":"ESPEN guideline on Clinical Nutrition in inflammatory bowel disease","volume":"42","author":"Bischoff","year":"2023","journal-title":"Clin. Nutr."},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"53","DOI":"10.1016\/j.clnesp.2020.12.023","article-title":"Effects of glutamine supplementation on inflammatory bowel disease: A systematic review of clinical trials","volume":"42","author":"Severo","year":"2021","journal-title":"Clin. Nutr. ESPEN"},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"101393","DOI":"10.1016\/j.molmet.2021.101393","article-title":"Impacts of essential amino acids on energy balance","volume":"57","author":"Xiao","year":"2022","journal-title":"Mol. Metab."},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"1000","DOI":"10.1007\/s10620-011-1947-9","article-title":"Glutamine and whey protein improve intestinal permeability and morphology in patients with Crohn\u2019s disease: A randomized controlled trial","volume":"57","author":"Benjamin","year":"2012","journal-title":"Dig. Dis. Sci."},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"1386","DOI":"10.52586\/5032","article-title":"Amino acids in nutrition, health, and disease","volume":"26","author":"Wu","year":"2021","journal-title":"Front. Biosci."},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"140","DOI":"10.1007\/s11306-018-1439-4","article-title":"Italian cohort of patients affected by inflammatory bowel disease is characterised by variation in glycerophospholipid, free fatty acids and amino acid levels","volume":"14","author":"Murgia","year":"2018","journal-title":"Metabolomics"},{"key":"ref_17","doi-asserted-by":"crossref","unstructured":"Cioffi, I., Di Vincenzo, O., Imperatore, N., Fisco, M., Testa, A., Scial\u00f2, F., Castiglione, F., Ruoppolo, M., Pasanisi, F., and Santarpia, L. (2023). Amino acid profiles, disease activity, and protein intake in adult patients with Crohn\u2019s disease. Front. Nutr., 10.","DOI":"10.3389\/fnut.2023.1245574"},{"key":"ref_18","doi-asserted-by":"crossref","unstructured":"Recharla, N., Geesala, R., and Shi, X.-Z. (2023). Gut Microbial Metabolite Butyrate and Its Therapeutic Role in Inflammatory Bowel Disease: A Literature Review. Nutrients, 15.","DOI":"10.20944\/preprints202304.0501.v1"},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"47","DOI":"10.1016\/j.intimp.2017.07.023","article-title":"Sodium butyrate inhibits the NF-kappa B signaling pathway and histone deacetylation, and attenuates experimental colitis in an IL-10 independent manner","volume":"51","author":"Lee","year":"2017","journal-title":"Int. Immunopharmacol."},{"key":"ref_20","doi-asserted-by":"crossref","unstructured":"Dou, X., Gao, N., Yan, D., and Shan, A. (2020). Sodium butyrate alleviates mouse colitis by regulating gut microbiota dysbiosis. Animals, 10.","DOI":"10.3390\/ani10071154"},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"507","DOI":"10.1177\/0148607114566656","article-title":"Self-screening for malnutrition risk in outpatient inflammatory bowel disease patients using the Malnutrition Universal Screening Tool (MUST)","volume":"40","author":"Sandhu","year":"2016","journal-title":"J. Parenter. Enter. Nutr."},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"7","DOI":"10.1016\/j.crohns.2009.12.002","article-title":"The second European evidence-based consensus on the diagnosis and management of Crohn\u2019s disease: Definitions and diagnosis","volume":"4","author":"Dignass","year":"2010","journal-title":"J. Crohn\u2019s Colitis"},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"465","DOI":"10.1038\/ajg.2008.168","article-title":"Practice Parameters Committee of American College of Gastroenterology. Management of Crohn\u2019s disease in adults","volume":"104","author":"Lichtenstein","year":"2009","journal-title":"Am. J. Gastroenterol."},{"key":"ref_24","unstructured":"Lohman, T.G., Roche, A.F., and Martorell, R. (1988). Anthropometric Standardization Reference Manual, Human Kinetics Books."},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"465","DOI":"10.1152\/jappl.2000.89.2.465","article-title":"Estimation of skeletal muscle mass by bioelectrical impedance analysis","volume":"89","author":"Janssen","year":"2000","journal-title":"J. Appl. Physiol."},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"412","DOI":"10.1093\/ageing\/afq034","article-title":"Sarcopenia: European consensus on definition and diagnosis: Report of the European working group on sarcopenia in older people","volume":"39","author":"Baeyens","year":"2010","journal-title":"Age Ageing"},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"592","DOI":"10.1177\/0148607115612054","article-title":"Prevalence of Sarcopenia and Its Impact on Postoperative Outcome in Patients With Crohn\u2019s Disease Undergoing Bowel Resection","volume":"41","author":"Zhang","year":"2017","journal-title":"JPEN J. Parenter. Enter. Nutr."},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"126","DOI":"10.1007\/s00384-023-04413-w","article-title":"Imaging-based assessment of body composition in patients with Crohn\u2019s disease: A systematic review","volume":"38","author":"Tang","year":"2023","journal-title":"Int. J. Color. Dis."},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"1475","DOI":"10.1093\/ecco-jcc\/jjac041","article-title":"Systematic review: The impact and importance of body composition in inflammatory bowel disease","volume":"16","author":"Ding","year":"2022","journal-title":"J. Crohn\u2019s Colitis"},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"2663","DOI":"10.1002\/jcsm.13341","article-title":"Impact of malnutrition and sarcopenia on quality of life in patients with inflammatory bowel disease: A multicentre study","volume":"14","author":"Zhang","year":"2023","journal-title":"J. Cachexia Sarcopenia Muscle"},{"key":"ref_31","doi-asserted-by":"crossref","unstructured":"Tang, W., Xie, G., Li, J., Tan, W., Yi, R., Yang, L., Zhang, L., Deng, J., Zhang, Y., and Li, K. (2023). Body composition parameters correlate with the endoscopic severity in Crohn\u2019s disease patients treated with infliximab. Front. Nutr., 10.","DOI":"10.3389\/fnut.2023.1251448"},{"key":"ref_32","doi-asserted-by":"crossref","first-page":"4154","DOI":"10.2174\/1381612824666181001153605","article-title":"Protective Mechanisms of Butyrate on Inflammatory Bowel Disease","volume":"24","author":"Silva","year":"2018","journal-title":"Curr. Pharm. Des."},{"key":"ref_33","first-page":"545","article-title":"Variable effects of short chain fatty acids and lactic acid in inducing intestinal mucosal injury in newborn rats","volume":"35","author":"Lin","year":"2002","journal-title":"J. Pediatr. Gastroenterol. Nutr."},{"key":"ref_34","doi-asserted-by":"crossref","first-page":"3","DOI":"10.1016\/j.humic.2016.09.001","article-title":"Diet influence on the gut microbiota and dysbiosis related to nutritional disorders","volume":"1","author":"Lagier","year":"2016","journal-title":"Hum. Microbiome J."},{"key":"ref_35","first-page":"8646495","article-title":"Nutrition and IBD: Malnutrition and\/or Sarcopenia? A Practical Guide. Gastroenterol","volume":"2017","author":"Scaldaferri","year":"2017","journal-title":"Res. Pract."},{"key":"ref_36","doi-asserted-by":"crossref","first-page":"830","DOI":"10.3945\/ajcn.115.113357","article-title":"Whey protein, amino acids, and vitamin D supplementation with physical activity increases fat-free mass and strength, functionality, and quality of life and decreases inflammation in sarcopenic elderly","volume":"103","author":"Rondanelli","year":"2016","journal-title":"Am. J. Clin. Nutr."},{"key":"ref_37","doi-asserted-by":"crossref","first-page":"117955221879117","DOI":"10.1177\/1179552218791173","article-title":"Plasma-free amino acid profiles in Crohn\u2019s disease: Relationship with the Crohn disease activity index","volume":"11","author":"Chiba","year":"2018","journal-title":"Clin. Med. Insights Gastroenterol."},{"key":"ref_38","doi-asserted-by":"crossref","first-page":"17","DOI":"10.1007\/s11306-017-1311-y","article-title":"Alterations in lipid, amino acid, and energy metabolism distinguish Crohn\u2019s disease from ulcerative colitis and control subjects by serum metabolomic profiling","volume":"14","author":"Scoville","year":"2018","journal-title":"Metabolomics"},{"key":"ref_39","doi-asserted-by":"crossref","unstructured":"Nishikawa, H., Nakamura, S., Miyazaki, T., Kakimoto, K., Fukunishi, S., Asai, A., Nishiguchi, S., and Higuchi, K. (2021). Inflammatory bowel disease and sarcopenia: Its mechanism and clinical importance. J. Clin. Med., 10.","DOI":"10.3390\/jcm10184214"},{"key":"ref_40","doi-asserted-by":"crossref","first-page":"25","DOI":"10.1186\/s40001-017-0266-9","article-title":"A study on relationship between elderly sarcopenia and inflammatory factors IL-6 and TNF-alpha","volume":"22","author":"Bian","year":"2017","journal-title":"Eur. J. Med. Res."},{"key":"ref_41","doi-asserted-by":"crossref","unstructured":"Nardone, O.M., de Sire, R., Petito, V., Testa, A., Villani, G., Scaldaferri, F., and Castiglione, F. (2021). Inflammatory bowel diseases and sarcopenia: The role of inflammation and gut microbiota in the development of muscle failure. Front. Immunol., 12.","DOI":"10.3389\/fimmu.2021.694217"},{"key":"ref_42","doi-asserted-by":"crossref","first-page":"1","DOI":"10.11005\/jbm.2013.20.1.1","article-title":"Sarcopenia: Definition, epidemiology, and pathophysiology","volume":"20","author":"Kim","year":"2013","journal-title":"J. Bone Metab."},{"key":"ref_43","doi-asserted-by":"crossref","first-page":"518","DOI":"10.1002\/ibd.21017","article-title":"Potential for amino acids supplementation during inflammatory bowel diseases","volume":"16","year":"2010","journal-title":"Inflamm. Bowel Dis."},{"key":"ref_44","doi-asserted-by":"crossref","first-page":"e123","DOI":"10.1016\/j.archger.2010.09.005","article-title":"Effects of oral amino acid supplementation on long-term-care-acquired infections in elderly patients","volume":"52","author":"Aquilani","year":"2011","journal-title":"Arch. Gerontol. Geriatr."},{"key":"ref_45","first-page":"403","article-title":"How accurate are clinical activity indices for scoring of disease activity in inflammatory bowel disease (IBD)?","volume":"43","author":"Fredholm","year":"2005","journal-title":"Clin. Chem. Lab. Med."},{"key":"ref_46","doi-asserted-by":"crossref","first-page":"512","DOI":"10.1053\/gast.2002.31072","article-title":"A review of activity indices and efficacy endpoints for clinical trials of medical therapy in adults with Crohn\u2019s disease","volume":"122","author":"Sandborn","year":"2002","journal-title":"Gastroenterology"},{"key":"ref_47","doi-asserted-by":"crossref","unstructured":"Wu, W.-T., Lee, T.-M., Han, D.-S., and Chang, K.-V. (2021). The Prevalence of Sarcopenia and Its Impact on Clinical Outcomes in Lumbar Degenerative Spine Disease\u2014A Systematic Review and Meta-Analysis. J. Clin. Med., 10.","DOI":"10.3390\/jcm10040773"},{"key":"ref_48","first-page":"799","article-title":"Exploring the causal relationship between inflammatory bowel disease and sarcopenia-related traits: A two-sample Mendelian randomization analysis","volume":"16","author":"Lin","year":"2023","journal-title":"Aging"}],"container-title":["Nutrients"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2072-6643\/16\/23\/4153\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,10]],"date-time":"2025-10-10T16:43:10Z","timestamp":1760114590000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2072-6643\/16\/23\/4153"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2024,11,29]]},"references-count":48,"journal-issue":{"issue":"23","published-online":{"date-parts":[[2024,12]]}},"alternative-id":["nu16234153"],"URL":"https:\/\/doi.org\/10.3390\/nu16234153","relation":{},"ISSN":["2072-6643"],"issn-type":[{"value":"2072-6643","type":"electronic"}],"subject":[],"published":{"date-parts":[[2024,11,29]]}}}