Pediatric Crohn’s: partial enteral nutrition plus exclusion diet bests EEN

  • Gastroenterology

  • International Clinical Digest
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Takeaway

  • For children with Crohn’s disease (CD), whole-food-based exclusion diet and partial enteral nutrition (PEN) outperformed exclusive enteral nutrition (EEN) in tolerability, sustained remission.
  • Authors: data favor excluding certain foods to maintain remission. 

Why this matters

  • EEN can induce remission but is hard to tolerate.
  • CD exclusion diet (CDED) removes inflammatory foods, includes mandatory foods.

Key results

  • 4 children in group 2 withdrew due to intolerance.
  • Group 1 vs group 2: 
    • Tolerance: 97.5% (39/40) vs 73.7% (28/38); P=.002;
      • OR, 13.92 (95% CI, 1.68-115.14).
    • Similar week-6 response, remission rates.
    • Week-12 remission: 75.6% (28/37) vs 45.1% (14/31); P=.01;
      • OR, 3.77 (95% CI, 1.34-10.59).
  • Group 1 had lower C-reactive protein, fecal calprotectin, fecal Proteobacteria.

Study design

  • Prospective randomized controlled 12-week trial (n=78).
  • Children with mild-to-moderate active CD randomly assigned to:
    • Group 1: CDED+50% of calories from formula for 6 weeks (PEN), then CDED+25% of calories from formula, vs
    • Group 2: EEN for 6 weeks, then free diet+25% PEN.
  • Primary outcome: dietary tolerance. 
  • Secondary outcome: response and steroid-free remission at weeks 6 and 12.
  • Funding: Israeli and Canadian nonindustry sources; Nestlé Health Science.

Limitations

  • Small; wide CIs.
  • Mucosal healing not assessed.

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