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Nutrients
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Nutritional Management for Crohn's Disease
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Nutritional Management for Crohn's Disease

A special issue of Nutrients (ISSN 2072-6643). This special issue belongs to the section "Clinical Nutrition".

Deadline for manuscript submissions: closed (5 May 2024) | Viewed by 19190

Special Issue Editors

Dr. Iva Hojsak

E-Mail Website
Guest Editor
1. Referral Centre for Pediatric Gastroenterology and Nutrition, Children’s Hospital Zagreb, 10000 Zagreb, Croatia
2. School of Medicine, University of Zagreb, 10000 Zagreb, Croatia
3. School of Medicine, University J.J. Strossmayer Osijek, 31000 Osijek, Croatia
Interests: nutrition; IBD; parenteral and enteral nutrition; probiotics
Dr. Sara Sila

E-Mail Website
Co-Guest Editor
Referral Centre for Pediatric Gastroenterology and Nutrition, Children’s Hospital Zagreb, 10000 Zagreb, Croatia
Interests: nutrition; IBD; parenteral and enteral nutrition

Special Issue Information

Dear Colleagues,

It is known that the complex interaction of dietary components with the host’s immune system plays a key role in the development of chronic inflammation and, consequently, CD. The scientific community has focused on diet in two aspects when linking it to CD: 1) to identify dietary habits that are associated with a higher risk of acquiring CD in susceptible individuals (pre-illness diet), and 2) to identify dietary habits and components of the diet that can affect the course of the disease and potential dietary treatment of CD.

Significant progress in the nutritional management of CD has been made in previous decades, especially since the discovery of exclusive enteral nutrition (EEN), which is used as a first-line treatment in paediatric CD patients. Rather novel nutritional interventions that not only sustain or restore the adequate nutritional status of the patient, but also support prolonged remission of the disease, have been thoroughly investigated in previous years. A couple of dietary interventions have been proposed; these are most commonly based on a reduction in the exposure to dietary components that could adversely affect the microbiome and intestinal barrier. However, more research is needed to fully elucidate the role of diet in the remission of the disease.

This Special issue will publish manuscripts that focus on the nutritional therapy of Crohn’s disease, as well as on the consequences of inadequate nutritional management on the nutritional status in children with Crohn’s disease.

Dr. Iva Hojsak
Dr. Sara Sila
Guest Editors

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Keywords

  • Crohn’s disease
  • diet
  • exclusion diets
  • exclusive enteral nutrition
  • nutrition management
  • malabsorption

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Published Papers (7 papers)

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Editorial

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3 pages, 170 KiB  
Editorial
Nutritional Management for Crohn’s Disease
by Sara Sila and Iva Hojsak
Nutrients 2024, 16(16), 2597; https://doi.org/10.3390/nu16162597 - 7 Aug 2024
Viewed by 1117
Abstract
Diet has been implicated in the pathogenesis of inflammatory bowel disease (IBD) and, more specifically, Crohn’s disease (CD), for a long time [...] Full article
(This article belongs to the Special Issue Nutritional Management for Crohn's Disease)

Research

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20 pages, 1246 KiB  
Article
Pre-Diagnosis Diet Predicts Response to Exclusive Enteral Nutrition and Correlates with Microbiome in Pediatric Crohn Disease
by Stephanie Dijk, Megan Jarman, Zhengxiao Zhang, Morgan Lawley, Muzammil Ahmad, Ricardo Suarez, Laura Rossi, Min Chen, Jessica Wu, Matthew W. Carroll, Anthony Otley, Mary Sherlock, David R. Mack, Kevan Jacobson, Jennifer C. deBruyn, Wael El-Matary, Colette Deslandres, Mohsin Rashid, Peter C. Church, Thomas D. Walters, Hien Q. Huynh, Michael G. Surette, Anne M. Griffiths and Eytan Wineadd Show full author list remove Hide full author list
Nutrients 2024, 16(7), 1033; https://doi.org/10.3390/nu16071033 - 2 Apr 2024
Cited by 1 | Viewed by 2542
Abstract
Exclusive enteral nutrition (EEN) is effective in inducing remission in pediatric Crohn disease (CD). EEN alters the intestinal microbiome, but precise mechanisms are unknown. We hypothesized that pre-diagnosis diet establishes a baseline gut microbiome, which then mediates response to EEN. We analyzed prospectively [...] Read more.
Exclusive enteral nutrition (EEN) is effective in inducing remission in pediatric Crohn disease (CD). EEN alters the intestinal microbiome, but precise mechanisms are unknown. We hypothesized that pre-diagnosis diet establishes a baseline gut microbiome, which then mediates response to EEN. We analyzed prospectively recorded food frequency questionnaires (FFQs) for pre-diagnosis dietary patterns. Fecal microbiota were sequenced (16SrRNA) at baseline and through an 18-month follow-up period. Dietary patterns, Mediterranean diet adherence, and stool microbiota were associated with EEN treatment outcomes, disease flare, need for anti-tumor necrosis factor (TNF)-α therapy, and long-term clinical outcomes. Ninety-eight patients were included. Baseline disease severity and microbiota were associated with diet. Four dietary patterns were identified by FFQs; a “mature diet” high in fruits, vegetables, and fish was linked to increased baseline microbial diversity, which was associated with fewer disease flares (p < 0.05) and a trend towards a delayed need for anti-TNF therapy (p = 0.086). Baseline stool microbial taxa were increased (Blautia and Faecalibacterium) or decreased (Ruminococcus gnavus group) with the mature diet compared to other diets. Surprisingly, a “pre-packaged” dietary pattern (rich in processed foods) was associated with delayed flares in males (p < 0.05). Long-term pre-diagnosis diet was associated with outcomes of EEN therapy in pediatric CD; diet–microbiota and microbiota–outcome associations may mediate this relationship. Full article
(This article belongs to the Special Issue Nutritional Management for Crohn's Disease)
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14 pages, 4019 KiB  
Article
Exclusive Enteral Nutrition Orchestrates Immunological Balances as Early as Week 4 in Adult Patients of Crohn’s Disease: A Pilot, Open-Lable Study
by Na Diao, Xinyu Liu, Minzhi Lin, Qingfan Yang, Bingyang Li, Jian Tang, Ni Ding, Xiang Gao and Kang Chao
Nutrients 2023, 15(24), 5091; https://doi.org/10.3390/nu15245091 - 13 Dec 2023
Cited by 1 | Viewed by 1517
Abstract
Background and aims: The efficacy and underlying mechanisms of exclusive enteral nutrition (EEN) in adult patients with Crohn’s disease (CD) remain controversial. This study aimed to evaluate the role of EEN in adult patients with CD and to explore the mechanisms from the [...] Read more.
Background and aims: The efficacy and underlying mechanisms of exclusive enteral nutrition (EEN) in adult patients with Crohn’s disease (CD) remain controversial. This study aimed to evaluate the role of EEN in adult patients with CD and to explore the mechanisms from the perspective of immunoregulation. Methods: This is a prospective, open-label pilot study. Active patients with CD were enrolled and prescribed an amino-acid-rich elemental diet for 12 weeks. Dynamic changes in immune cells, including neutrophils, monocytes, T cells and B cells, were detected by flow cytometry. Plasma cytokines were evaluated by ELISA. Results: Twenty adult patients with CD were enrolled. Among them, 1 discontinued treatment due to poor compliance, and 19 patients were included for final analysis. Clinical remission was achieved in 47.37% (9/19), 63.16% (12/19), and 73.68% (14/19) patients at weeks 4, 8, and 12, respectively. Endoscopic remission and transmural healing were achieved in 52.63% (10/19) and 15.79% (3/19) patients at week 12. Notably, there was no significant difference in clinical remission between week 4 and week 8 (p = 0.33) or week 12 (p = 0.09). Furthermore, we observed a rapid reconstitution of immunologic homeostasis as early as week 4. At week 4, both the frequency and activation of neutrophils and monocytes were decreased after EEN therapy. Significant decreases in Th17 cells and naïve B cells, increases in memory B cells, and regulatory B cells were also detected. These changes remained stable at weeks 8 and 12. Conclusions: EEN with an amino-acid-rich elemental diet orchestrated immunological balances and induces clinical remission in adult CD patients as early as week 4, suggesting a 4-week EEN therapy may be feasible and practicable in clinical practice. Full article
(This article belongs to the Special Issue Nutritional Management for Crohn's Disease)
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15 pages, 1087 KiB  
Article
Treatment of Active Crohn’s Disease in Children Using Partial Enteral Nutrition Combined with a Modified Crohn’s Disease Exclusion Diet: A Pilot Prospective Cohort Trial on Clinical and Endoscopic Outcomes
by Darja Urlep, Rok Orel, Patricija Kunstek and Evgen Benedik
Nutrients 2023, 15(21), 4676; https://doi.org/10.3390/nu15214676 - 4 Nov 2023
Cited by 4 | Viewed by 2547
Abstract
Background: Partial enteral nutrition (PEN) coupled with the Crohn’s disease (CD) exclusion diet (CDED) was shown to be effective in inducing clinical remission in paediatric CD. There are currently no robust data on the endoscopic outcomes of PEN. The aim of this study [...] Read more.
Background: Partial enteral nutrition (PEN) coupled with the Crohn’s disease (CD) exclusion diet (CDED) was shown to be effective in inducing clinical remission in paediatric CD. There are currently no robust data on the endoscopic outcomes of PEN. The aim of this study was to evaluate the clinical and endoscopic rates of remission after PEN combined with a modified CDED (mCDED) adjusted to the local cuisine in comparison with exclusive enteral nutrition (EEN) for the induction of remission. Methods: Between June 2017 and February 2021, a prospective cohort study on children with active CD, treated with PEN + mCDED or EEN, was performed at a single tertiary centre. Results: During the study period, 54 patients were screened and 15 were excluded according to the exclusion criteria, with six patients excluded in the first two days due to intolerance of the enteral formula. Fourteen patients were included in the PEN and 19 in the EEN group. They were assessed at Weeks 0, 1, 3 and 6, using clinical and laboratory parameters. Endoscopy was performed at Weeks 0 and 6. Clinical remission rates per protocol analysis were 84.6% in the PEN group and 81.3% in the EEN group (p = 0.99). At Week 6, an endoscopic response (a decline in the Simple Endoscopic Score for CD (SES-CD) > 50%) was observed in 84.6% of patients on PEN and in 68.8% on EEN treatment (p = 0.41). Endoscopic remission (SES-CD ≤ 2) was achieved in 53.8% of patients in the PEN group and in 50.0% in the EEN group (p = 0.99), while the mucosal healing rates (SES-CD = 0) were 38.5% with PEN and 43.8% with EEN (p = 0.99). A significant decline in the clinical and endoscopic activity scores was observed in both groups. Conclusion: Our study suggests that PEN + mCDED could be effective in inducing endoscopic remission and mucosal healing in active paediatric CD patients. Here, we present an analysis of the data from our cohort of patients and our real-world experience with PEN + mCDED. Full article
(This article belongs to the Special Issue Nutritional Management for Crohn's Disease)
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Review

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17 pages, 1254 KiB  
Review
Carrageenan in the Diet: Friend or Foe for Inflammatory Bowel Disease?
by Nina Kimilu, Katarzyna Gładyś-Cieszyńska, Magdalena Pieszko, Dorota Mańkowska-Wierzbicka and Marcin Folwarski
Nutrients 2024, 16(11), 1780; https://doi.org/10.3390/nu16111780 - 6 Jun 2024
Viewed by 3538
Abstract
While the exact pathogenesis of IBD remains unclear, genetic, environmental and nutritional factors as well as the composition of the gut microbiome play crucial roles. Food additives, which are increasingly consumed in the Western diet, are being investigated for their potential effects on [...] Read more.
While the exact pathogenesis of IBD remains unclear, genetic, environmental and nutritional factors as well as the composition of the gut microbiome play crucial roles. Food additives, which are increasingly consumed in the Western diet, are being investigated for their potential effects on IBD. These additives can affect gut health by altering the composition of the microbiota, immune responses, and intestinal permeability, contributing to autoimmune diseases and inflammation. Despite the growing number of studies on food additives and IBD, the specific effects of carrageenan have not yet been sufficiently researched. This review addresses this gap by critically analyzing recent studies on the effects of carrageenan on the gut microbiota, intestinal permeability, and inflammatory processes. We searched the MEDLINE and SCOPUS databases using the following terms: carrageenan, carrageenan and inflammatory bowel disease, carrageenan and cancer, food additives and microbiome, food additives and intestinal permeability, and food additives and autoimmune diseases. In animal studies, degraded carrageenan has been shown to trigger intestinal ulceration and inflammation, highlighting its potential risk for exacerbating IBD. It can affect the gut microbiota, reduce bacterial diversity, and increase intestinal permeability, contributing to “leaky gut” syndrome. Some studies suggest that carrageenan may inhibit the growth of cancer cells by influencing the progression of the cell cycle, but the anti-cancer effect is still unclear. Carrageenan may also increase glucose intolerance and insulin resistance. Further research is needed to determine whether carrageenan should be excluded from the diet of individuals with IBD. Full article
(This article belongs to the Special Issue Nutritional Management for Crohn's Disease)
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15 pages, 996 KiB  
Review
High-Fiber Diet and Crohn’s Disease: Systematic Review and Meta-Analysis
by Victor Serrano Fernandez, Marta Seldas Palomino, José Alberto Laredo-Aguilera, Diana Patricia Pozuelo-Carrascosa and Juan Manuel Carmona-Torres
Nutrients 2023, 15(14), 3114; https://doi.org/10.3390/nu15143114 - 12 Jul 2023
Cited by 8 | Viewed by 6012
Abstract
Crohn’s disease (CD) is a subtype of inflammatory bowel disease (IBD). CD is a health problem in Western countries such as the US and European nations and is an idiopathic disease; however, certain cases of CD have been associated with intestinal dysbiosis. A [...] Read more.
Crohn’s disease (CD) is a subtype of inflammatory bowel disease (IBD). CD is a health problem in Western countries such as the US and European nations and is an idiopathic disease; however, certain cases of CD have been associated with intestinal dysbiosis. A systematic review with a meta-analysis was carried out to determine the efficacy of a diet rich in fiber with or without cointervention to improve remission rates for CD. The literature in the PubMed, Scopus, Web of Science, and ClinicalTrials databases was reviewed. The quality of the studies was evaluated using the Johanna Briggs Institute (JBI) scale. This review was conducted in accordance with the structure outlined in the PRISMA statement. In addition, a meta-analysis was performed with a 95% confidence interval (CI) and a random effects model. Eleven studies were included, totaling 2389 patients with CD. Applying a diet rich in fiber with or without the administration of routine therapies improved CD remission rates. Data regarding CD activity, remission time, and adverse effects derived from fiber consumption were analyzed. Consumption of fiber in the diet could improve remission rates for CD patients who receive or do not receive other treatment to maintain remission. Full article
(This article belongs to the Special Issue Nutritional Management for Crohn's Disease)
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Other

9 pages, 268 KiB  
Brief Report
Magnetic Resonance Imaging Can Be Used to Assess Sarcopenia in Children with Newly Diagnosed Crohn’s Disease
by Paola Blagec, Sila Sara, Ana Tripalo Batoš, Ivana Trivić Mažuranić, Ana Močić Pavić, Zrinjka Mišak and Iva Hojsak
Nutrients 2023, 15(17), 3838; https://doi.org/10.3390/nu15173838 - 2 Sep 2023
Viewed by 1276
Abstract
Background: This study aimed to determine the proportion of patients with sarcopenia diagnosed by MRI and compare these results to bioelectrical impedance analysis (BIA). Methods: Children with newly diagnosed Crohn’s disease (CD) who had MRI enterography (MRE) and BIA and had at least [...] Read more.
Background: This study aimed to determine the proportion of patients with sarcopenia diagnosed by MRI and compare these results to bioelectrical impedance analysis (BIA). Methods: Children with newly diagnosed Crohn’s disease (CD) who had MRI enterography (MRE) and BIA and had at least 12 months of follow-up were included. Total psoas muscle area (TPMA) and total paravertebral muscle (TPVM) were measured and compared to subjects’ lean mass and the lean mass body index (LMBI) was assessed by BIA. Results: 30 newly diagnosed children with CD were included (mean age 14.2 years, 53% male). Sarcopenia was found in 13 (43%) children; mean TPMA was 15.2 (1.1 SD) cm2 and TPVM 30.95 (1.7 SD) cm2. A highly positive correlation was shown for lean mass assessed by BIA and TPMA (0.706, p < 0.001) and TPVM (0.75, p < 0.001). Sarcopenia was more prevalent in boys (77% vs. 24%, p = 0.004), patients with the perianal disease (69% vs. 29%, p = 0.03), and children with sarcopenia were likely to receive anti-TNF (77% vs. 41%, p = 0.05). During the follow-up period, 16 (53%) children experienced a relapse. TPMA (HR 0.99, p = 0.018) and TPVM (HR 0.99, p = 0.031) values were statistically significant risk factors for relapse. Conclusion: A high proportion of patients with CD have sarcopenia at the time of the diagnosis. There is a good correlation between muscle mass assessed by MRI and BIA. Because MRI is performed in a great proportion of newly diagnosed CD patients it can also be used to assess the presence of sarcopenia. Full article
(This article belongs to the Special Issue Nutritional Management for Crohn's Disease)
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