Enteral nutrition in Crohn's disease: fat in the formula

Enteral nutrition is effective in inducing remission in active Crohn's disease. Speculation on the underlying mechanism of action has moved away from the presentation of nitrogen and towards the fat content of the various enteral feeds. Evidence is accumulating that additional long-chain triglyceride in such feeds impairs the response rate in active Crohn's disease, whereas no deleterious effects of additional medium-chain triglyceride have been identified. It has been proposed that long-chain triglycerides composed from n-6 fatty acids may be the most harmful, since such fatty acids are substrates for inflammatory eicosanoid production. However, recent studies comparing different enteral feeds are not consistent in identifying which additional fatty acids impair response rates to the greatest extent. Despite meta-analyses concluding that polymeric diets (typically containing large amounts of fat) are as effective as elemental diets, it would seem sensible to use enteral feeds with minimal fat content when treating active Crohn's disease.