Food-based diet may be comparable to exclusive enteral nutrition in kids with Crohn's

Last Updated: 2018-12-25

By David Douglas

NEW YORK (Reuters Health) - A pilot study suggests that an individualized, food-based diet (CD-TREAT) may be as effective as exclusive enteral nutrition (EEN) in treating children with Crohn's disease (CD), according to European researchers.

Dr. Konstantinos Gerasimidis told Reuters Health by email that the "CD-TREAT diet has the potential to be used interchangeably or in conjunction with established therapies, is side-effects free and raises the prospect of long-term maintenance of disease remission with diet only."

In a paper online December 7 in Gastroenterology, Dr. Gerasimidis of the Glasgow Royal Infirmary, in the U.K., and colleagues note that particularly in Europe, EEN is the only established dietary treatment in pediatric CD. This, they say, "induces clinical remission in approximately 80% of patients and promotes gut healing."

The mechanism of action of EEN is not clear but its therapeutic properties may involve modulation of the gut microbiome. The effects appear to be reversed when patients resume their habitual diet and gut inflammation increases.

The team developed the Crohn's Disease Treatment-with-EATing diet (CD-TREAT), which is based on the composition of an EEN feed (Modulen IBD, Nestle) and mimics its effect on the gut microbiome. However, this diet employs ordinary food. For example, food high in starch and low in fiber substitutes for maltodextrin, an artificial glucose polymer commonly used in EEN.

CD-TREAT and EEN were randomly compared in 25 healthy adult volunteers. Both diets produced similar effects on the microbiome, and CD-TREAT was considered more acceptable.

Using a rat model, the researchers also found CD-TREAT and EEN produced similar changes in bacterial load.

The team then studied five children diagnosed with relapsing CD who were treated exclusively with the CD-TREAT diet for eight weeks. One discontinued after nine days due to symptom exacerbation, but the four remaining children had a clinical response and three entered remission with significant concurrent reductions in fecal calprotectin.

The researchers conclude that large, well-controlled clinical trials and other studies are now required. Should the outcome be successful, they say, "CD-TREAT has the potential to be used interchangeably with EEN, particularly in adults where EEN uptake is low."

Dr. Arun Swaminath, director of the Inflammatory Bowel Disease Program of Lenox Hill Hospital, in New York City, told Reuters Health by email, "This is a very powerful, but preliminary, study."

"Many have taken note of the benefit of liquid polymeric diets . . . in getting kids with Crohn's into remission," added Dr. Swaminath, who was not involved in the research. But, he said, "One of the main limitations to adoption of such a diet is the single flavor (sweet) and fatigue that develops with trying to maintain this diet long term."

The improvement seen in the five children with CD, Dr. Swaminath said, "is a very important step in identifying things to include (or exclude) from solid food so that patients with Crohn's can have a diet option that may mitigate their disease activity."

Dr. Eytan Wine, associate professor in the division of pediatric gastroenterology and nutrition at the University of Alberta, in Edmonton, Canada, agrees.

"The findings of the study are of great interest, since they demonstrate much similarity between these diets in their effects on gut microbes and metabolism and (although only 5 children with Crohn's disease were included) CD-TREAT does seem to have a positive impact on patients," Dr. Wine, who also was not involved in the study, told Reuters Health by email.

He concluded, "While larger studies would be needed to confirm the clinical impact of this work, any progress in understanding how food can impact Crohn's disease is exciting and may get us closer to finding effective, safe, and well-tolerated treatments for these complex conditions."

SOURCE: https://bit.ly/2V8isIs

Gastroenterology 2018.