Background and aims: Total enteral nutrition (TEN) with a liquid formula can suppress gut inflammation and induce remission in active Crohn’s disease. The mechanism is obscure. Studies have suggested that long term n...Background and aims: Total enteral nutrition (TEN) with a liquid formula can suppress gut inflammation and induce remission in active Crohn’s disease. The mechanism is obscure. Studies have suggested that long term nutritional supplementation with a liquid formula (partial enteral nutrition (PEN)) may also suppress inflammation and prevent relapse. The aim of this study was to compare PEN with conventional TEN in active Crohn’s disease. Patients and methods: Fifty children with a paediatric Crohn’s disease activity index (PCDAI) > 20 were randomly assigned to receive 50% (PEN) or 100% (TEN) of their energy requirement as elemental formula for six weeks. The PEN group was encouraged to eat an unrestricted dietwhile those receiving TEN were not allowed to eat. The primary outcome was achievement of remission (PCDAI < 10). Secondary analyses of changes in erythrocyte sedimentation rate (ESR), C reactive protein, albumin, and platelets were performed to look for evidence of anti-inflammatory effects. Results: Remission rate with PEN was lower than with TEN (15% v 42% ; p = 0.035). Although PCDAI fell in both groups (p = 0.001 for both), the reduction was greater with TEN (p = 0.005). Moreover, the fall in PCDAI with PEN was due to symptomatic and nutritional benefits. With both treatments there were significant improvements in relation to abdominal pain, “ sense of wellbeing", and nutritional status. However, only TEN led to a reduction in diarrhoea (p = 0.02), an increase in haemoglobin and albumin, and a fall in platelets and ESR. Conclusions: TEN suppresses inflammation in activeCrohn’s disease but PEN does not. This suggests that long term nutritional supplementation, although beneficial to some patients, is unlikely to suppress inflammation and so prevent disease relapse.展开更多
Objective: To determine whether metformin or placebo could,in conjunction with healthy lifestyle counseling,decrease serum testosterone levels and related aberrations in adolescents with hyperandrogenism,hyperinsuline...Objective: To determine whether metformin or placebo could,in conjunction with healthy lifestyle counseling,decrease serum testosterone levels and related aberrations in adolescents with hyperandrogenism,hyperinsulinemia,and polycystic ovarian syndrome. Design: Randomized,placebo-controlled,double-blind trial. Setting: Pediatric university teaching hospital. Participants: Twenty-two adolescents aged 13 to 18 years with hyperinsulinemia and polycystic ovarian syndrome. Intervention: Participants were randomly assigned to take a 12-week course of either metformin or placebo. Main Outcome Measures: Pretreatment and posttreatment oral glucose tolerance tests,fasting lipid profiles,and clinical measurements. Results: There was a significant decline in mean serum testosterone concentration with metformin (-38.3 ng/dL) compared with placebo (-0.86 ng/dL) (95% confidence interval,-∞ to -0.29 for the mean difference between groups). At completion,the relative risk of menses was 2.50 times higher in the metformin group compared with the placebo (95% confidence interval,1.12 to 5.58). Measures of insulin sensitivity,including insulin area under the curve and HOMA (homeostasis model assessment)-,demonstrated improvement only with metformin,but these did not reach statistical significance. High-density lipoprotein cholesterol levels increased by 6.98 mg/dL with metformin vs a decrease of -2.33 mg/dL with placebo (95% confidence interval,0.78 to 18.23 for the mean difference between groups). There were no significant changes in body mass index,hirsutism,triglyceride levels,or total and low-density lipoprotein cholesterol levels. Conclusion: Metformin significantly lowered total testosterone concentrations,increased the likelihood of menses,and improved high-density lipoprotein cholesterol levels without affecting measures of insulin sensitivity or body weight.展开更多
文摘Background and aims: Total enteral nutrition (TEN) with a liquid formula can suppress gut inflammation and induce remission in active Crohn’s disease. The mechanism is obscure. Studies have suggested that long term nutritional supplementation with a liquid formula (partial enteral nutrition (PEN)) may also suppress inflammation and prevent relapse. The aim of this study was to compare PEN with conventional TEN in active Crohn’s disease. Patients and methods: Fifty children with a paediatric Crohn’s disease activity index (PCDAI) > 20 were randomly assigned to receive 50% (PEN) or 100% (TEN) of their energy requirement as elemental formula for six weeks. The PEN group was encouraged to eat an unrestricted dietwhile those receiving TEN were not allowed to eat. The primary outcome was achievement of remission (PCDAI < 10). Secondary analyses of changes in erythrocyte sedimentation rate (ESR), C reactive protein, albumin, and platelets were performed to look for evidence of anti-inflammatory effects. Results: Remission rate with PEN was lower than with TEN (15% v 42% ; p = 0.035). Although PCDAI fell in both groups (p = 0.001 for both), the reduction was greater with TEN (p = 0.005). Moreover, the fall in PCDAI with PEN was due to symptomatic and nutritional benefits. With both treatments there were significant improvements in relation to abdominal pain, “ sense of wellbeing", and nutritional status. However, only TEN led to a reduction in diarrhoea (p = 0.02), an increase in haemoglobin and albumin, and a fall in platelets and ESR. Conclusions: TEN suppresses inflammation in activeCrohn’s disease but PEN does not. This suggests that long term nutritional supplementation, although beneficial to some patients, is unlikely to suppress inflammation and so prevent disease relapse.
文摘Objective: To determine whether metformin or placebo could,in conjunction with healthy lifestyle counseling,decrease serum testosterone levels and related aberrations in adolescents with hyperandrogenism,hyperinsulinemia,and polycystic ovarian syndrome. Design: Randomized,placebo-controlled,double-blind trial. Setting: Pediatric university teaching hospital. Participants: Twenty-two adolescents aged 13 to 18 years with hyperinsulinemia and polycystic ovarian syndrome. Intervention: Participants were randomly assigned to take a 12-week course of either metformin or placebo. Main Outcome Measures: Pretreatment and posttreatment oral glucose tolerance tests,fasting lipid profiles,and clinical measurements. Results: There was a significant decline in mean serum testosterone concentration with metformin (-38.3 ng/dL) compared with placebo (-0.86 ng/dL) (95% confidence interval,-∞ to -0.29 for the mean difference between groups). At completion,the relative risk of menses was 2.50 times higher in the metformin group compared with the placebo (95% confidence interval,1.12 to 5.58). Measures of insulin sensitivity,including insulin area under the curve and HOMA (homeostasis model assessment)-,demonstrated improvement only with metformin,but these did not reach statistical significance. High-density lipoprotein cholesterol levels increased by 6.98 mg/dL with metformin vs a decrease of -2.33 mg/dL with placebo (95% confidence interval,0.78 to 18.23 for the mean difference between groups). There were no significant changes in body mass index,hirsutism,triglyceride levels,or total and low-density lipoprotein cholesterol levels. Conclusion: Metformin significantly lowered total testosterone concentrations,increased the likelihood of menses,and improved high-density lipoprotein cholesterol levels without affecting measures of insulin sensitivity or body weight.
