How can I effectively manage the nutritional needs of a patient with Crohn's disease?

Effective management of the nutritional needs of a patient with Crohn's disease involves regular assessment and tailored nutritional support to prevent and treat malnutrition, promote growth in children, and support overall health.

Key management steps include:

• Regularly screen for malnutrition and nutritional deficiencies, including monitoring body mass index (BMI), weight, and micronutrient status, as patients with Crohn's disease are at increased risk of malnutrition and deficiencies due to disease activity and malabsorption ¹.
• Consider referral to a dietitian for specialist nutritional assessment and advice, especially in children to promote optimal growth and pubertal development ¹.
• Implement oral nutrition support for patients who can swallow safely but are malnourished or at risk of malnutrition. This includes fortified foods, snacks, oral nutritional supplements, altered meal patterns, and dietary advice to ensure a balanced intake of protein, energy, fibre, electrolytes, vitamins, and minerals ³.
• If oral intake is inadequate or unsafe and the gastrointestinal tract is functional, consider enteral tube feeding with nutritionally complete feeds to meet nutritional requirements ³.
• For patients undergoing surgery or with severe disease, peri-operative oral or enteral nutrition support should be considered to improve nutritional status and outcomes ³.
• Ensure adequate intake of calcium and vitamin D, with supplementation if necessary, to reduce the risk of osteoporosis, which is increased in Crohn's disease due to corticosteroid use and malabsorption ¹.
• Monitor tolerance to nutritional interventions, including gastrointestinal symptoms such as nausea, vomiting, diarrhoea, and constipation, adjusting the nutritional plan accordingly ³.
• Stop nutritional support when the patient is established on adequate oral intake from normal food ³.

Overall, nutritional management should be individualized, multidisciplinary, and integrated with medical treatment to optimize disease control and patient quality of life.