The Influence Of Enteral Nutrition Upon Mesenteric Adipose Tissue In Patients With Crohn’s Disease

Background:Mesenteric adipose tissue hypertrophy is a hallmark of Crohn’s disease. It can express various kinds of inflammatory mediators, such as pro- and anti-inflammatory cytokines or chemokines and adipokines. Preadipocytes can convert into macrophage-like cells and display phagocytic and antimicrobial activities. Furthermore, adipocytes can express various innate immune receptors. Therefore, mesenteric fat may actively take part in the course of Crohn’s disease. On the other hand, enteral nutrition could effectively induce and maintain remission in Crohn’s disease and lead to mucosal healing with mechanisms largely unknown.Objective: This study aims to compare the changes of mesenteric adipose tissue in patients with Crohn’s disease, to investigate whether exclusive enteral nutrition could modify mesenteric fat in patients with active Crohn’s disease and to discuss the possible mechanism of enteral nutrition.Methods: Sixteen patients who underwent resection for ileum Crohn’s disease were studied. As a control group, eight patients without inflammatory bowel disease were enrolled. Before operation, eight Crohn’s disease patients received exclusive enteral nutrition for four weeks, and the other patients had no nutritional therapy. The mesenteric fat samples were obtained during operation. Adipocyte size, adipokine production and topical C-reactive protein level were assessed.Results: The adipocyte size from patients treated with exclusive enteral nutrition was much larger than that from Crohn’s disease patients without nutritional therapy. Furthermore, protein levels of proinflammatory adipokines such as TNF-alpha and leptin were lower while protein level of adiponectin was higher in these patients. As to mRNA level, the expression of adiponectin was up-regulated and leptin was down-regulated in the patients receiving enteral nutrition.Conclusions: Exclusive enteral nutrition could ameliorate mesenteric fat alterations which are associated with intestinal injury in patients with Crohn’s disease by restoring adipocyte morphology and diminishing the inflammatory environment of mesenteric fat. These improvements may provide additional beneficial therapeutic mechanisms of enteral nutrition.