Abstract
BackgroundThe anti-inflammatory effect of exclusive enteral nutrition on the gut of children with Crohn’s disease is rapidly lost after food reintroduction. This study assessed disease dietary triggers following successful treatment with exclusive enteral nutrition.MethodsNutrient intake, dietary patterns and dietary biomarkers in faeces (gluten immunogenic peptides, undigestible starch, short chain fatty acids) were assessed in 14 children with Crohn’s disease during early food reintroduction, following exclusive enteral nutrition. Groups above (Group A) and below (Group B) the median levels of faecal calprotectin after food reintroduction were assigned for comparative analysis.ResultsIntakes of fibre, gluten-containing cereals and red and processed meat were significantly higher in Group A than Group B; (median [Q1, Q3], g/day; Fibre: 12.1 [11.2, 19.9] vs. 9.9 [7.6, 12.1], p = 0.03; Red and processed meat: 151 [66.7, 190] vs. 63.3 [21.7, 67], p = 0.02; gluten-containing cereals: 289 [207, 402] vs. 203 [61, 232], p = 0.035). A diet consisting of cereals and meat products was predictive (92% accuracy) of higher faecal calprotectin levels after food reintroduction. In faeces, butyrate levels, expressed as absolute concentration and relative abundance, were higher in Group A than Group B by 28.4 µmol/g (p = 0.015) and 6.4% (p = 0.008), respectively. Levels of gluten immunogenic peptide and starch in faeces did not differ between the two groups.ConclusionsThis pilot study identified potential dietary triggers of gut inflammation in children with Crohn’s disease after food reintroduction following treatment with exclusive enteral nutrition.Trial registration: Clinical trials.gov registration number: NCT02341248; Clinical trials.gov URL: https://clinicaltrials.gov/ct2/show/NCT02341248 (retrospectively registered).
Highlights
The increasing incidence of Crohn’s disease (CD) in societies in economic transition, suggests that environmental factors, including a Western diet are major contributors to the disease pathogenesis [1]
We have recently observed a rapid increase in faecal calprotectin (FC) within the first 17 days of food reintroduction, following treatment with enteral nutrition (EEN); an effect which preceded any noticeable changes in clinical disease activity [8]
There were no significant differences in immunomodulator use, energy intake from maintenance treatment (MEN), and the time elapsed between the end of EEN and sample collection after food reintroduction
Summary
The increasing incidence of Crohn’s disease (CD) in societies in economic transition, suggests that environmental factors, including a Western diet are major contributors to the disease pathogenesis [1]. Exclusive enteral nutrition (EEN) is the only established dietary treatment for active CD in children [5, 6]. We have recently observed a rapid increase in FC within the first 17 days of food reintroduction, following treatment with EEN; an effect which preceded any noticeable changes in clinical disease activity [8]. This intriguing observation suggests that reintroduction of certain dietary components, after return to habitual diet, provokes recurrence of intestinal inflammation. The anti-inflammatory effect of exclusive enteral nutrition on the gut of children with Crohn’s disease is rapidly lost after food reintroduction. This study assessed disease dietary triggers following successful treatment with exclusive enteral nutrition
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