Maintenance Enteral Nutrition in Paediatric Crohn's Disease: A Systematic Review and Meta-Analysis

Area of Science:

• Pediatric Gastroenterology
• Clinical Nutrition
• Inflammatory Bowel Disease Research

Background:

• Crohn's disease (CD) management in children often involves exclusive enteral nutrition (EEN) or corticosteroids for induction therapy.
• Maintenance enteral nutrition (MEN) is a subsequent strategy involving partial nutritional intake via formula alongside regular food to sustain remission.

Purpose of the Study:

• To evaluate the clinical effectiveness of MEN in maintaining remission in pediatric CD patients.
• To assess MEN's impact on inflammatory markers and anthropometric outcomes, including growth.

Main Methods:

• Systematic review of five databases up to April 30, 2025.
• Included studies involved children (≤18 years) with CD initiating MEN post-EEN or corticosteroid induction.
• Random-effects meta-analyses were employed for data synthesis, with risk of bias assessed using ROBINS-I and RoB 2 tools.

Main Results:

• Five studies with 271 participants showed MEN significantly reduced relapse risk (pooled OR, 0.455; p=0.038).
• Improvements were noted in Pediatric Crohn's Disease Activity Index scores and fecal calprotectin, though significance varied.
• Modest gains in BMI and height z-scores were observed, particularly in prepubertal children.

Conclusions:

• MEN is associated with a reduced risk of relapse in pediatric CD patients.
• The strategy also appears to improve nutritional status and growth parameters.
• Further high-quality trials with standardized protocols are necessary to confirm optimal MEN utilization.