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Formula modifications to the Crohn's disease exclusion diet do not impact therapy success in paediatric Crohn's
Emma Landorf1, Paul Hammond2, Rammy Abu-Assi2
1Department of Nutrition, Women's and Children's Hospital, Adelaide, South Australia, Australia.
Insights
The Crohn's disease exclusion diet (CDED) plus partial enteral nutrition (PEN) effectively induced clinical remission in 70.8% of Australian children with active Crohn's disease. Different PEN formulas did not impact treatment success, showing the diet's consistent efficacy.
Area of Science:
- Pediatric Gastroenterology
- Clinical Nutrition
- Inflammatory Bowel Disease Research
Background:
- The Crohn's disease exclusion diet (CDED) combined with partial enteral nutrition (PEN) is an increasingly recognized dietary intervention for pediatric Crohn's disease (CD).
- This approach aims to induce clinical remission in children experiencing active CD flares.
Purpose of the Study:
- To evaluate the effectiveness of the CDED + PEN regimen in inducing clinical remission in Australian children with active CD.
- To assess the impact of different PEN formulas and patient-specific dietary needs on treatment outcomes.
Main Methods:
- A retrospective analysis of 24 children (newly diagnosed or on therapy) with active CD (Pediatric Crohn's Disease Activity Index [PCDAI] ≥10) and biochemical markers of inflammation.
- Data collected at baseline, week 6, and week 12, with primary endpoint defined as clinical remission (PCDAI < 10) at week 6.
- Included assessment of C-reactive protein (CRP), erythrocyte sedimentation rate (ESR), and fecal calprotectin (FC) levels.
Main Results:
- Clinical remission was achieved in 17 out of 24 (70.8%) children by week 6.
- Significant reductions in mean PCDAI, CRP, ESR, and FC were observed after 6 weeks (p < 0.05).
- No significant difference in treatment efficacy was found based on the type of PEN formula used (cow's milk, rice, or soy-based).
Conclusions:
- Formula modifications within the CDED + PEN approach do not appear to influence its efficacy in inducing remission.
- The CDED + PEN is an effective strategy for achieving clinical remission in Australian children with active luminal CD.
- Dietary interventions play a crucial role in managing pediatric Crohn's disease.
Objectives:
The Crohn's disease exclusion diet (CDED) + partial enteral nutrition (PEN) is an emerging diet used to induce clinical remission in children with active Crohn's disease (CD). This study aims to determine the effectiveness of using the CDED+PEN to induce clinical remission in an Australian group of children with active CD using different PEN formulas and incorporating patient dietary requirements.
Methods:
We retrospectively collected data from children (both newly diagnosed and with existing CD while on therapy) with active CD (Paediatric Crohn's Disease Activity Index [PCDAI] ≥10) and biochemical evidence of active disease (elevated C-reactive protein [CRP], erythrocyte sedimentation rate [ESR] or faecal calprotectin [FC]) who completed at least phase 1 (6 weeks) of the CDED+PEN to induce clinical remission. Data were collected at baseline, Week 6 and Week 12. The primary endpoint was clinical remission at Week 6 defined as PCDAI < 10.
Results:
Twenty-four children were included in phase 1 analysis (mean age 13.8 ± 3.2 years). Clinical remission at Week 6 was achieved in 17/24 (70.8%) patients. Mean PCDAI, CRP, ESR and FC decreased significantly after 6 weeks (p < 0.05). Formula type (cow's milk based, rice based, soy based) did not affect treatment efficacy. A greater than 50% decrease in FC was achieved in 14/21 (66.7%) patients who completed phase 1 and 12/14 (85.7%) patients who completed phase 2 of the CDED+PEN.
Conclusions:
Formula modifications to the CDED+PEN do not impact the expected treatment efficacy in Australian children with active luminal CD.
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