Whole-food diet with partial enteral nutrition benefits children with Crohn's Disease

Whole-food diet coupled with partial enteral nutrition may be effective for children with Crohn's disease, revealed a study published in the journal Gastroenterology.

This new whole-food diet may replace traditional liquid food-based diet in children with Crohn's disease. A team of researchers from led by Arie Levine, MD, Wolfson Medical Center, Holon, Sackler School of Medicine, Faculty of Medicine, Tel Aviv University, performed a 12-week prospective trial of children with mild to moderate CD. The children were randomly assigned to a group that received CDED plus 50% of calories from formula (Modulen, Nestlé) for 6 weeks (stage 1) followed by CDED with 25% PEN from weeks 7 to 12 (stage 2) or a group that received EEN for 6 weeks followed by a free diet with 25% PEN from weeks 7 to 12.

Patients were evaluated at baseline and weeks 3, 6, and 12 and laboratory tests were performed; 16S ribosomal RNA gene (V4V5) sequencing was performed on stool samples. The primary endpoint was dietary tolerance. Secondary endpoints were intention to treat (ITT) remission at week 6 (pediatric CD activity index score below 10) and corticosteroid-free ITT sustained remission at week 12.

Key Findings

• Four patients withdrew from the study because of intolerance by 48 hours, 74 patients were included for remission analysis.


• The combination of CDED and PEN was tolerated in 39 children, whereas EEN was tolerated by 28 children.


• At week 6, 30 of 40 children given CDED plus PEN were in corticosteroid-free remission vs 20 of 34 children given EEN.


• At week 12, 28 of 37 children given CDED plus PEN were in corticosteroid-free remission compared with 14 of 31 children given EEN and then PEN.


• In children given CDED plus PEN, corticosteroid-free remission was associated with sustained reductions in inflammation (based on serum level of C-reactive protein and fecal level of calprotectin) and fecal Proteobacteria.

Based on the results the authors concluded that CDED plus PEN was better tolerated than EEN in children with mild to moderate CD. Both diets were effective in inducing remission by week 6. The combination CDED plus PEN induced sustained remission in a significantly higher proportion of patients than EEN, and produced changes in the fecal microbiome associated with remission. These data support the use of CDED plus PEN to induce remission in children with CD.

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DOI: https://doi.org/10.1053/j.gastro.2019.04.021