Malnutrition in Crohn's disease: substrate deficiency or misuse?

Growth failure is frequently associated with Crohn's disease. However, it does not seem to be fully accounted for by overt endocrinological abnormalities or nutrient deficiencies. It may be related to an abnormal utilization of available substrates, particularly proteins, due to an imbalance in protein metabolism kinetics. Its primary mechanism may be an increase in protein breakdown rates over synthesis, specifically related to the associated inflammatory syndrome, and progressively leading to a protein debt. Reduction in food intake would only exaggerate this trend by further reducing the synthesis to breakdown ratio, whereas nutrient supplementation merely compensates for the deficit by promoting protein synthesis.