Weeks Of Exclusive Enteral Nutrition Research Articles

Osteoprotegerin in pediatric Crohnʼs disease and the effects of exclusive enteral nutrition

Osteoprotegerin (OPG) may have proinflammatory roles in addition to its contribution to the maintenance of bone mass. Exclusive enteral nutrition (EEN) is an established therapy for the induction of remission in Crohn's disease (CD). The aims of this study were to ascertain serum, fecal, and mucosal expression of OPG in children with CD and to investigate the effects of EEN on OPG expression. OPG was measured by enzyme-linked immunosorbent assay in serum, mucosal, and fecal samples collected from children with CD and controls. Fecal and Serum OPG was measured prior to and following 6-8 weeks of EEN therapy. Children with CD (n=82) and controls (n=45) were included. Mucosal and fecal OPG levels were elevated in CD compared to controls (P=0.018 and P<0.0001, respectively). Serum OPG was elevated in children with severe CD (P=0.005). Serum and fecal OPG levels dropped significantly following EEN therapy (P=0.0001 and P=0.002, respectively). Increased serum and fecal OPG are seen in active CD and likely originate from the inflamed gut. Fecal and serum OPG decrease following EEN therapy. Further investigation of OPG and related proteins in the setting of IBD is now required.

Effect of exclusive enteral nutrition on bone turnover in children with Crohn’s disease

Poor bone acquisition and increased fracture risk are significant complications associated with Crohn's disease (CD). The aim of this study was to determine the effects of 8 weeks of exclusive enteral nutrition (EEN) therapy upon markers of bone turnover in children with newly diagnosed CD. Twenty-three children with newly diagnosed CD and 20 controls (without CD) were enrolled. Children with CD were treated with 8 weeks of EEN. Inflammatory markers [C-reactive protein (CRP), erythrocyte sedimentation rate (ESR), albumin, platelets], nutritional markers (height, weight), and bone markers [C-terminal telopeptides of Type-1 collagen (CTX) and bone specific alkaline phosphatase (BAP)] were measured prior to and following therapy. At diagnosis, children with CD had elevated serum CTX (2.967 +/- 0.881 ng/ml) compared to controls (2.059 +/- 0.568 ng/ml; P = 0.0003). Following the period of EEN, CTX levels fell significantly (2.260 +/- 0.547 ng/ml; P = 0.002), while serum BAP levels (51.24 +/- 31.31 microg/L at diagnosis; control serum BAP = 66.80 +/- 23.23 microg/L; P = 0.07) increased significantly (64.82 +/- 30.51 microg/L; P = 0.02), with both normalizing to control levels. As well as reducing inflammation, decreasing disease activity, and improving nutrition in children with newly diagnosed CD, EEN therapy also normalized serum markers of bone turnover, suggesting an improvement in bone health. Further investigations of short- and long-term effects of EEN on bone density and overall bone health are now required.