Reverse-engineered exclusive enteral nutrition in pediatric Crohn's disease: A pilot trial

Background

In pediatric Crohn's disease (CD), commercial formulas used as exclusive enteral nutrition (EEN) are effective at inducing remission. This study aims to assess the impact of a whole-food blended smoothie as EEN on CD activity and the intestinal microbiome.

Methods

A 4-week prospective trial assessed the impact of EEN with a whole-food smoothie on newly diagnosed mild-to-moderate active pediatric CD. The smoothie with a multivitamin were developed to meet age-appropriate nutritional requirements. Assessment over 4 weeks included Pediatric Crohn's Disease Activity Index (PCDAI), serum laboratories, fecal calprotectin (FCP), and stool collection for metagenomic shotgun sequencing and microbiota composition analysis. Clinical remission was defined as PCDAI ≤ 10 at week 4.

Results

Ten participants were enrolled with median age 14.5 years, and 8 completed the trial. Baseline mean PCDAI was 26.3 ± 9.1 and mean FCP 1149 ± 718 µg/g. At week 4, 80% of participants achieved clinical remission. FCP decreased by over half in 60% of participants, with FCP below 250 µg/g in 60% and below 100 µg/g in 40%. Microbiome analysis showed a significant increase in species richness over 4 weeks (p = 0.01). Compared to baseline, the relative abundance at week 2 and at week 4 was significantly increased for Bifidobacterium and Streptococcus and decreased for Blautia (p < 0.05 for all).

Conclusion

A whole-food blended smoothie was effective for inducing clinical remission and decreasing FCP in pediatric CD similar to commercial EEN formulas. Further research may give insight into data-driven whole-food dietary approaches for CD management. ClinicalTrials.gov NCT03508193.

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Highlights

What is Known

• Exclusive enteral nutrition (EEN) is effective therapy for pediatric Crohn's disease.
• EEN thus far has only been evaluated with commercial formulas.
• Large interest exists in using restriction diets to treat Crohn's disease.

What is New

• A whole-food blended smoothie was able to induce clinical and biochemical remission of active Crohn's disease.
• A whole-food blended smoothie was associated with a significant increase in gut microbiome species richness.

Brief Summary

Exclusive Enteral Nutrition (EEN) for Crohn's disease commonly employs commercial formula, but this study utilizes a specific home-blended whole-food recipe for EEN in a clinical trial over 4 weeks studying impact on inflammation and the gut microbiome.

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