Modulen Ibd Latte Polvere 400g

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Levine et al., Crohn’s Disease Exclusion Diet plus partial enteral nutrition induces sustained remission in a randomized controlled trial. Gastroenterology. 2019;157:440-450 D Chan, et al. Inflammatory bowel disease and exercise: results of a Crohn's and Colitis UK survey. Frontline Gastroenterol. 2014 Jan;5(1):44-48. Median Pediatric Ulcerative Colitis Activity Index (PUCAI) decreased from a baseline of 35 (30–40) to 12.5 (5–30) at week 6 (p=0.001). Both groups will receive 9 mg oral budesonide. Primary endpoint: remission at week 12. Where CDED + PEN studies used Modulen, in the new UCED + PEN study, a novel specifically designed formula in compliance with the UCED will be used.

The return of symptoms during the maintenance phase can pose a challenge; however, this can often be related to the level of patient compliance and can be managed by a careful dietetic follow-up.

Footnotes

Other than intestinal symptoms, CD can lead to extra-intestinal ones such as bone, skin, ocular, and thromboembolic complications. These events were not investigated after EN and more specifically Modulen ® therapy. This goes along with other organ consequences. The most alarming repercussion is steatosis as non-alcoholic fatty liver disease is common in IBD. Considering TGF-β2 content, and the risk of hepatic fibrosis, hepatologists could avoid Modulen ® therapy for CD patients. While several specialized diets may be helpful for some IBD patients, no one plan has been proven to prevent or control IBD with the exception of enteral nutrition, which is delivered in a nutrient-rich formula. Clinical studies using Modulen IBD® as PEN show that CDED + PEN was as effective as the current EEN standard in achieving remission, but the CDED + PEN was better tolerated and superior for sustaining remission.

A second study looked at the effect of UCED in pediatric patients with mild-to-moderate active disease. 29 Patients were introduced to UCED for the first 6 weeks, and those in remission at week 6 received a step-down diet for another 6 weeks.TNF-α is a prototypic member of a large family of cytokines that play important roles in inflammation, apoptosis, proliferation, invasion, etc. ( 71) Overexpression of TNF-α can cause chronic inflammation and lead to autoimmune diseases and tissue damage. Anti-TNF-α monoclonal antibodies, such as Infliximab (IFX) and Adalimumab (ADA), exert therapeutic effects by inhibiting TNF-α-associated inflammatory responses and tissue damage. Crohn’s disease (CD) and ulcerative colitis (UC) are chronic intestinal inflammatory diseases of unknown aetiology, characterized by a recurrent inflammatory condition. The pathophysiology is multifactorial and complex, involving an inappropriate immune activation of the gut mucosa in genetically susceptible individuals, triggered by an altered composition of the gut microbiota. The incidence of inflammatory bowel disease (IBD) has increased worldwide in developed nations and more recently in developing countries. 1, 2 This rapid increase in the incidence of IBD over the last half-century, particularly in developing countries, clearly points to the role of changing environmental factors intrinsically implicated in disease development. 1 Genes cannot change within such a short time frame, thus disease susceptibility remains almost identical over several generations. The differing role of genetics and the environment in disease development is clearly reflected by epidemiological data on immigrants from low- to high-IBD-incidence regions: where, the second generation of immigrants has the same risk of developing IBD as the local population living for generations in the same area. 3 A western lifestyle, including changes in dietary habits, urbanization and industrialization, has been proposed as one explanation for this worldwide increase in IBD. 4

A patient with an ileostomy was referred for CDED postoperatively to reduce his risk of postoperative recurrence as he was at risk of short bowel syndrome if he required further surgery and had failed multiple drug therapies. The patient reported feeling unwell (likely due to obstructive episodes). The decision was made to move to a liquid only diet (400 g Modulen) until symptoms settled, followed by softer texture food from phase 1 and 2 diets to reduce obstruction risk and symptoms. This list is not comprehensive, and there are several studies of various diets that are ongoing. Many of these dietary plans are focused on inducing remission while some include maintaining remission. Long term, most of these approaches involve reintroduction of foods that are rich in vitamins, minerals, and other nutrients. It is important to keep in mind that these diets may require changes based on the individual patient and nutrition-related factors. Szczubelek et al, Effectiveness of Crohn’s disease exclusion diet for induction of remission in Crohn’s disease adult patients. Nutrients. 2021;12:4112.

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B6, B1, A, B2, folic acid, K, biotin, D, B12) and choline bitartrate. MODULEN® (400 g powder) Nutrition Information Serve size: 50 g (made up volume 250 ml) Serves per container: 8Nutrient Units Per serve Per 100 mlEnergy kJ / kcal 1037 / 250 415 / 100Protein (14% kcal) g 9.0 3.6Carbohydrate (44% kcal) of which: g 27 10.8- Sugars g 10.5 4.2Fat (42% kcal) of which: g 11.5 4.6- Saturated g 6.6 2.6- Monounsaturated fatty acids g 2.0 0.78- Polyunsaturated fatty acids g 1.2 0.48- MCT g 3.0 1.2Fibre (0% kcal) g 0 0Sodium mg 85 34VitaminsBiotin μg 8.0 3.2Folic acid μg 60 24Niacin mg 2.9 1.2mg NE 4.9 2.0Pantothenic acid mg 1.2 0.48Vitamin A μg 210 84Vitamin B1 mg 0.29 0.12Vitamin B2 mg 0.32 0.13Vitamin B6 mg 0.41 0.16Vitamin B12 μg 0.80 0.32Vitamin C mg 23 9.2Vitamin D μg 2.5 1.0Vitamin E mg TE 3.3 1.3Vitamin K μg 13 5.2MineralsCalcium mg 222 89Chloride mg 182 73Chromium μg 12 4.8Copper mg 0.24 0.10Iodine μg 24 10Iron mg 2.7 1.1Magnesium mg 50 20Manganese mg 0.49 0.20Molybdenum μg 18 7.2Phosphorus mg 150 60Potassium mg 300 120Selenium μg 8.5 3.4Zinc mg 2.3 0.92Other NutrientsCholine mg 17 6.8 Modulen (400g powder) Racine A, et al. Dietary patterns and risk of inflammatory bowel disease in Europe: Results from the EPIC Study. Inflamm Bowel Dis. 2016 Feb;22(2):345-54.

Compared to other available therapies, these results were very encouraging. As a result, guidelines set by the European Society for Clinical Nutrition and Metabolism (ESPEN) 26 recommend that: “CD exclusion diet (plus partial EN) should be considered as an alternative to exclusive EN in pediatric patients with mild to moderate CD to achieve remission.” For adults, a lower grade recommendation suggests that: “A CD exclusion diet can be considered with or without EN in mild to moderate active CD.” The expert panel commented that this should be further demonstrated with additional studies. Sarbagili-Shabat C, Albenberg L, Van Limbergen J, et al. A novel UC exclusion diet and antibiotics for treatment of mild to moderate pediatric ulcerative colitis: a prospective open-label pilot study. Nutrients 2021:13:3736. Doi:10.3390/nu13113736. A first study 28 was conducted in adult patients with clinical endoscopic disease (29% steroid-refractory patients, 55% biologic-refractory patients). Patients were randomized to one of three groups: The therapeutic efficacy of aminosalicylic acid preparations for CD remains controversial. A review has suggested that oral 5-ASA preparations have no significant advantage in maintaining remission in patients with CD ( 17). However, a retrospective study in the UK found that 5-ASA was widely used as a long-term treatment for CD as about a quarter of patients continued to use 5-ASA for more than 10 years ( 18). 5-ASA therapy for more than a year could reduce the consumption of related medical resources (including referrals, hospitalization, and surgery) ( 18). Gjuladin-Hellon et al. have reported the benefit of 5-ASA in preventing relapse of CD in remission after surgery ( 19). Coward et al. in their Bayesian network meta-analysis found that high-dose mesalamine is an option for inducing remission among mild-to-moderate CD patients preferring to avoid steroids ( 20). Other studies have also reported the treatment effectiveness of aminosalicylates in CD ( 21, 22). A 22-year-old female (70 kg, BMI, 27 kg/m2) presented with symptoms of abdominal pain, diarrhea and vomiting.

The Palaeolithic diet 59 is based on the idea that the human intestinal tract is not sufficiently evolved to digest food from modern agriculture and thus, the exposure to foods not present at the time of human evolution may cause modern diseases, such as IBD. In common with other diets, the Palaeolithic diet excludes many food ingredients and privileges the intake of lean, nondomesticated meats and noncereal plant-based foods (i.e. fruits, roots, legumes, and nuts). So far, no data exist on the role of the Palaeolithic diet in the treatment of IBD, except of rare and isolated rather positive case reports. The Modulen ® formula is casein-based. This protein is significant, since it can protect TGF-β2 from duodenal enzymatic degradation [ 7]. Potential beneficial effects may be due to the whole protein or to its derived peptides ( Figure 1, right panel). In an ileitis model, macroscopic and microscopic lesions, and Goblet cell depletion were protected by β-casofensin [ 46]. The amino acid profile of casein proteins is principally rich in two essential amino acids and one non-essential [ 47]. The first one is leucine (from 69 to 108 mg/g), which promotes cryptidin-1 production by Paneth cells via Slc7a8 transporter [ 48]. The second one is lysine (from 49 to 67 mg/g), which has anti-inflammatory properties as demonstrated by the reduction of weight loss, disease index, and inflammatory cytokines in dextran sulfate sodium (DSS) induced colitis [ 49]. Finally, glutamic acid presents the highest concentration (from 218 to 239 mg/g). This amino acid has been widely studied in the intestine and it is recognized as a principal actor in intestinal integrity ( Figure 1, right panel). Not only glutamic acid can regulate proliferative, apoptotic, and inflammatory cellular pathways, but also tight junction proteins [ 50]. Glutamic acid can act directly on proteins such as ERK1/2, STAT, and HSF, and indirectly by enhancing growth factors’ effects like EGF and TGF-α ( Figure 1, right panel).