Crohn’s Disease Exclusion Diet Efficacious for Pediatric Patients

Tena Niseteo, PhD

Specific diets can be effective in treating patients with Crohn’s disease, particularly for pediatric patients.

However, these diets can be restrictive and cumbersome and require a family commitment for several months.

A newer diet called Crohn’s disease Exclusion Diet (CDED) could be an option that expands the food options for many children.

A team, led by Tena Niseteo, PhD, Referral Centre for Pediatric Gastroenterology and Nutrition, Children's Hospital Zagreb, examined the efficacy of CDED compared with exclusive enteral nutrition (EEN) for remission induction of patients with Crohn’s disease.

The Diets

EEN, which consists of a liquid polymeric enteral formula as the sole source of nutrition for 6-8 weeks, is considered a first-line treatment for pediatric patients with Crohn’s disease.

The formula is mainly delivered orally, but there are instances where the solution needs to be delivered with a nasogastric (NG) tube.

While much newer, CDED is an option that reduces the need for feeding tubes.

CDED was created to reduce exposure to dietary components known to adversely affect the microbiome and intestinal barrier. The diet combines a specific whole-food diet with partial EN.

The 3 phases of diet include a remission induction period for 6 weeks (phase 1), where 50% of energy is derived from strictly determined food types and quantities and the remaining 50% from enteral formula.

In phase 2, the patient is allowed a wider spectrum of allowed foods for 6 weeks. The final phase is considered the maintenance phase and lasts about 9 months.

While promising, the data on efficacy of this new data is scarce, limited to a single randomized controlled trials and various case reports.

The Analysis

In the retrospective analysis, the investigators examined 61 pediatric patients diagnosed with Crohn’s disease. Each patient was treated with CDED plus partial EN or with EEN. The median age was 14.4 years old.

A total of 80% of the patient population assigned to the CDED arm underwent 1-2 weeks of EEN prior to beginning the predetermined study diet.

The investigators also extracted data from the medical charts of the entire patient population before the introduction of diet therapy, as well as at the conclusion of phase 1 of the study.

Results

Overall, 68.9% (n = 42) of patients achieved remission, including 65.9% (n = 27) of the EEN group and 75% (n = 20) of the CDED and PEN arm. Also, of the 14 patients in the EEN group that did not achieve remission, 12 prematurely stopped the treatment.

The investigators did not find a significant difference in the failure of nutrition therapies between the competing arms (P = .469), but patients in the CDED arm had significantly higher weight gain (P = .002) and increases in body mass index (BMI) z-scores (P = .001).

There was also no difference in disease activity, disease location, duration of symptoms, and presence of upper gastrointestinal or perianal disease, laboratory parameters, failure of nutrition therapy, and the need for corticosteroids between the 2 groups.

“Treatment with CDED + PEN (with prior 1–2 weeks of EEN) has comparable efficacy to EEN therapy alone in inducing remission in children with CD, and it leads to better weight gain,” the authors wrote.

The investigators expect future studies to expand on this research in an effort to confirm the findings.

The study, “Modified Crohn's disease exclusion diet is equally effective as exclusive enteral nutrition: Real-world data,” was published online in Nutrition in Clinical Practice.