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

Abstract

AbstractBackgroundIn 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.MethodsA 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.ResultsTen 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).ConclusionA 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.