Dietary therapies beneficial in paediatric Crohn’s disease

In children with active Crohn’s disease (CD), dietary therapies such as CD exclusion diet (CDED) and exclusive enteral nutrition (EEN) appear to produce a rapid clinical response, with most of the patients achieving remission by week 3, a study has found.

Seventy-three paediatric patients with mild-to-moderate CD (mean age, 14.2 years) were randomized to receive either EEN (n=34) or the CDED with 50 percent (partial) enteral nutrition (n=39). Evaluations were conducted at baseline and at weeks 3 and 6 of the dietary intervention. Remission was defined as CD activity index scores <10, while response was defined as a score reduction of 12.5 points or clinical remission. Inflammation was assessed by measuring C-reactive protein (CRP).

At week 3 of the intervention, the majority of patients in the CDED and EEN groups achieved clinical response (82 percent vs 85 percent) and remission (61.5 percent vs 64.7 percent), without significant between-group differences (p=0.71 and p=0.78, respectively).

Median serum levels of CRP decreased from 28.1 mg/L at baseline to 5 mg/L at week 3 and remained at 5 mg/L at week 6 in the CDED group, and from 24 mg/L to 5 mg/L at week 3 and 4.1 mg/L at week 6 in the EEN group.

Of the 49 patients in the entire cohort who remained in remission at week 6, 46 (94 percent) had shown response and 40 (81 percent) had achieved remission by week 3.

Multivariable regression analysis revealed that week-3 remission was associated with an increased likelihood of remaining in remission at week 6 (odds ratio [OR], 6.37, 95 percent confidence interval [CI], 1.6–25.0; p=0.008). On the other hand, poor compliance with the dietary intervention reduced the odds of remission at week 6 (OR, 0.75, 95 percent CI, 0.012–0.46; p=0.006).

According to the researchers, identifying patients with and without a rapid response to dietary therapies might help pinpoint those who, with compliance, are likely to achieve clinical remission by week 6.