Polyphenols in the treatment of inflammatory bowel disease and acute pancreatitis
Authors: H. Shapiro, P. Singer, Z. Halpern, R. Bruck
Journal: Gut (2006)

olyphenols are phytochemicals that are abundant in food and beverages derived from plants.Although no deficiency state has been described for them, increased intake of polyphenols appears to protect against disease in virtue of their anti-inflammatory and vasculoprotective properties.This article focuses on four polyphenols with established anti-inflammatory properties: resveratrol, epigallocatechin gallate, curcumin and quercetin.In rodents, ingestion or systemic administration of these agents inhibits nuclear factor k B-dependent gene expression and induces phase II antioxidant and detoxifying proteins.Conditions prevented and/or ameliorated by these polyphenols include inflammatory colitis and acute pancreatitis.Polyphenols also attenuate ischaemia-reperfusion injury and endotoxemic sepsis, which has a role in the development of multiple organ dysfunction in severe acute pancreatitis.Enteral nutrition has an important role in the management of inflammatory bowel disease (IBD)-mainly of Crohn's disease, and of acute pancreatitis.Parenteral nutrition is reserved for refractory cases and disease-associated complications.Artificial nutrition attempts to safely administer the essential and otherwise beneficial constituents of food to patients with an impaired ability to ingest or digest food; yet, polyphenols are not included in the formulas.We suggest that the addition of polyphenols to artificial nutritional formulas would improve the outcome of patients with IBD and acute pancreatitis in need of enteral or parenteral nutrition. POLYPHENOLS, A GROUP OF SECONDARY PLANT METABOLITES, ARE NON-ESSENTIAL NUTRIENTS THAT PROBABLY CONTRIBUTE TO HUMAN HEALTH cPlants, like other unicellular and multicellular organisms, contain ubiquitous organic molecules (eg, amino acids, carbohydrates and fatty acids) termed primary metabolites that are essential to cell structure and basic metabolism.These compounds also serve as substrates for the synthesis of an array of chemicals called secondary plant metabolites, which are accumulated at lower concentrations and are more variably distributed among different species.Once thought to be waste products, these agents are now considered to have a role in ecological interactions with friendly and hostile microorganisms and macroorganisms, and protection from environmental stressors.After their ingestion, certain secondary metabolites from edible plants interact beneficially with the regulatory domains of functional proteins that are shared by plants and herbivores, due to evolutionary conservation.Vitamins, for instance, act as enzyme coactivators and their insufficient intake results in some disease. 1-3][6][7][8][9][10][11][12][13][14][15] PPLs' status as a non-essential, but an established health-promoting dietary constituent is similar to that of the marine-life-derived, long chain v-3 polyunsaturated fatty acids (LC PUFAs), eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA).These can be synthesised to some extent from the shorter-chain, plant-derived, essential v-3 PUFA, a-linolenic acid.Thus, EPA and DHA are not considered essential nutrients for adults. 9Yet, since the initial interest in their vasculoprotective properties during the 1970s, a formidable body of knowledge from mechanistic, epidemiological and large clinical studies has evolved, defining a role for the LC v-3 PUFAs in the secondary prevention of cardiovascular disease. 16 17Several studies have also shown the importance of supplementing artificial nutrition formulas with these fatty acids, by showing that they reduce morbidity, and possibly mortality, in several clinical scenarios. 18 19Thus, modern nutritional science has expanded its focus from overt nutrient-deficiency states to the relationship of diet and nutritional status to the industrialised world's common diseases, including the benefits derived from consuming certain non-essential bioactive components of food. 9 20Although interest in