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Nutritional support in paediatric Crohn's disease: outcome at 12 months
J Gavin1, J J Ashton2,3, N Heather1
1Department of Dietetics, University Hospital Southampton Foundation NHS Trust, Southampton, UK.
Insights
Maintenance enteral nutrition (MEN) improved BMI Z-score in pediatric Crohn's disease (CD) patients but did not affect height Z-score or prolong remission. Further research is needed to confirm MEN's utility.
Area of Science:
- Pediatric Gastroenterology
- Inflammatory Bowel Disease Research
- Nutritional Support in Chronic Illness
Background:
- Pediatric Crohn's disease (CD) often leads to impaired growth and poor nutritional status.
- Maintenance enteral nutrition (MEN) is explored as a strategy to enhance growth and sustain remission in pediatric CD.
- Understanding the impact of MEN on growth and relapse rates is crucial for optimizing treatment protocols.
Purpose of the Study:
- To evaluate the effect of maintenance enteral nutrition (MEN) on growth parameters (BMI Z-score and height Z-score) in pediatric Crohn's disease (CD) patients.
- To assess whether MEN influences remission duration and relapse rates compared to a normal diet (ND) in pediatric CD patients.
- To analyze anthropometric changes and treatment outcomes over a 12-month period following diagnosis.
Main Methods:
- A cohort of newly diagnosed pediatric Crohn's disease (CD) patients was identified and followed for 12 months.
- Data collected included anthropometry, treatment modalities (exclusive enteral nutrition (EEN), MEN, steroids, ND), and clinical outcomes.
- Statistical analysis focused on changes in BMI Z-score and height Z-score, and relapse rates between different nutritional interventions.
Main Results:
- Patients receiving exclusive enteral nutrition (EEN) induction showed significant improvement in BMI Z-score (-1.41 to -0.21).
- The maintenance enteral nutrition (MEN) group experienced a significant increase in BMI Z-score (-0.62 to -0.44), while the normal diet (ND) group did not.
- Neither MEN nor ND groups showed significant improvement in height Z-score over 12 months, and relapse rates were comparable between groups at 6 and 12 months.
Conclusions:
- Maintenance enteral nutrition (MEN) improved BMI Z-score in pediatric Crohn's disease (CD) patients but did not impact height Z-score over 12 months.
- The use of MEN was not associated with a prolonged time to relapse compared to a normal diet (ND).
- Prospective studies are warranted to further investigate the specific utility and long-term benefits of MEN in managing pediatric CD.
Aim:
Paediatric Crohn's disease (CD) is associated with growth delay and poor nutritional status. Maintenance enteral nutrition (MEN) supplementation is a potential adjunct to improve growth/prolong remission.
Methods:
Newly diagnosed CD patients were identified. Anthropometry, treatments and outcomes were collected for 12 months following diagnosis. Data are presented as medians.
Results:
A total of 102 patients were identified (age = 13 years, 76% male), 58 (57%) completed exclusive enteral nutrition (EEN) as induction therapy, and 77 (75%) entered clinical remission. Following induction, 58 (57%) of all patients continued MEN and 44 (43%) consumed normal diet (ND). BMI Z-score increased (diagnosis-12 months) for EEN (-1.41 to -0.21 (p = <0.0001)) and steroid groups (-0.97 to -0.11 (p = 0.001)). BMI Z-score increased (post induction - 12 months) for MEN (-0.62 to -0.44 (p = 0.04)) but not ND (-0.33 to -0.4 (p = 0.79)). Height Z-score did not increase for any treatment group over 12 months. MEN and ND group relapse rates were similar at six months, MEN = 21/58 (36%); ND = 21/44 (48%) (p = 0.24) and 12 months, MEN = 24/58 (41%); ND = 13/44 (30%) (p = 0.22). Fewer patients treated with EEN then MEN relapsed less than six months, 14 of 43 (33%), compared to patients treated with steroids then ND 16/29 (55%) (p = 0.09).
Conclusion:
BMI Z-score increased but height Z-score remained unchanged over 12 months for the MEN group. Use of MEN was not associated with prolonged time to relapse. Prospective studies are required to examine the utility of MEN.
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