Treatment of Active Crohn's Disease With an Ordinary Food-based Diet That Replicates Exclusive Enteral Nutrition
Copyright © 2019 AGA Institute. Published by Elsevier Inc. All rights reserved..
BACKGROUND & AIMS: Exclusive enteral nutrition (EEN) is the only established dietary treatment for Crohn's disease (CD), but its acceptability is limited. There is a need for novel dietary treatments for CD.
METHODS: We evaluated the effects of an individualized food-based diet (CD-TREAT), with similar composition to EEN, on the gut microbiome, inflammation, and clinical response in a rat model, healthy adults, and children with relapsing CD. Twenty-five healthy adults randomly received EEN or CD-TREAT for 7 days, followed by a 14-day washout period, followed by the alternate diet. Fecal microbiome and metabolome were assessed before and after each diet. HLA-B7 and HLA-B27 transgenic rats with gut inflammation received EEN, CD-TREAT, or standard chow for 4 weeks. Fecal, luminal, and tissue microbiome, fecal metabolites, and gut inflammation were assessed. Five children with active CD activity received CD-TREAT and their clinical activity and calprotectin were evaluated after 8 weeks of treatment.
RESULTS: For healthy adults, CD-TREAT was easier to comply with and more acceptable than EEN. CD-TREAT induced similar effects to EEN (EEN vs CD-TREAT) on fecal microbiome composition, metabolome, mean total sulfide (increase 133.0 ± 80.5 vs 54.3 ± 47.0 nmol/g), pH (increase 1.3 ± 0.5 vs 0.9 ± 0.6), and the short-chain fatty acids (μmol/g) acetate (decrease 27.4 ± 22.6 vs 21.6 ± 20.4), propionate (decrease 5.7 ± 7.8 vs 5.2 ± 7.9), and butyrate (decrease 7.0 ± 7.4 vs 10.2 ± 8.5). In the rat model, CD-TREAT and EEN produced similar changes in bacterial load (decrease 0.3 ± 0.3 log10 16S rRNA gene copies per gram), short-chain fatty acids, microbiome, and ileitis severity (mean histopathology score decreases of 1.25 for EEN [P = .015] and 1.0 for CD-TREAT [P = .044] vs chow). In children receiving CD-TREAT, 4 (80%) had a clinical response and 3 (60%) entered remission, with significant concurrent decreases in fecal calprotectin (mean decrease 918 ± 555 mg/kg; P = .002).
CONCLUSION: CD-TREAT replicates EEN changes in the microbiome, decreases gut inflammation, is well tolerated, and is potentially effective in patients with active CD. ClinicalTrials.gov, numbers NCT02426567 and NCT03171246.
| Errataetall: |
CommentIn: Gastroenterology. 2019 Oct;157(4):1160-1161. - PMID 31228437 |
|---|---|
| Medienart: |
E-Artikel |
| Erscheinungsjahr: |
2019 |
|---|---|
| Erschienen: |
2019 |
| Enthalten in: |
Zur Gesamtaufnahme - volume:156 |
|---|---|
| Enthalten in: |
Gastroenterology - 156(2019), 5 vom: 01. Apr., Seite 1354-1367.e6 |
| Sprache: |
Englisch |
|---|
| Beteiligte Personen: |
Svolos, Vaios [VerfasserIn] |
|---|
| Links: |
|---|
| Themen: |
Carbohydrate |
|---|
| Anmerkungen: |
Date Completed 03.05.2019 Date Revised 29.01.2022 published: Print-Electronic ClinicalTrials.gov: NCT02426567, NCT03171246 CommentIn: Gastroenterology. 2019 Oct;157(4):1160-1161. - PMID 31228437 Citation Status MEDLINE |
|---|
| doi: |
10.1053/j.gastro.2018.12.002 |
|---|
| funding: |
|
|---|---|
| Förderinstitution / Projekttitel: |
|
| PPN (Katalog-ID): |
NLM291807054 |
|---|
| LEADER | 01000naa a22002652 4500 | ||
|---|---|---|---|
| 001 | NLM291807054 | ||
| 003 | DE-627 | ||
| 005 | 20231225071702.0 | ||
| 007 | cr uuu---uuuuu | ||
| 008 | 231225s2019 xx |||||o 00| ||eng c | ||
| 024 | 7 | |a 10.1053/j.gastro.2018.12.002 |2 doi | |
| 028 | 5 | 2 | |a pubmed24n0972.xml |
| 035 | |a (DE-627)NLM291807054 | ||
| 035 | |a (NLM)30550821 | ||
| 035 | |a (PII)S0016-5085(18)35398-8 | ||
| 040 | |a DE-627 |b ger |c DE-627 |e rakwb | ||
| 041 | |a eng | ||
| 100 | 1 | |a Svolos, Vaios |e verfasserin |4 aut | |
| 245 | 1 | 0 | |a Treatment of Active Crohn's Disease With an Ordinary Food-based Diet That Replicates Exclusive Enteral Nutrition |
| 264 | 1 | |c 2019 | |
| 336 | |a Text |b txt |2 rdacontent | ||
| 337 | |a ƒaComputermedien |b c |2 rdamedia | ||
| 338 | |a ƒa Online-Ressource |b cr |2 rdacarrier | ||
| 500 | |a Date Completed 03.05.2019 | ||
| 500 | |a Date Revised 29.01.2022 | ||
| 500 | |a published: Print-Electronic | ||
| 500 | |a ClinicalTrials.gov: NCT02426567, NCT03171246 | ||
| 500 | |a CommentIn: Gastroenterology. 2019 Oct;157(4):1160-1161. - PMID 31228437 | ||
| 500 | |a Citation Status MEDLINE | ||
| 520 | |a Copyright © 2019 AGA Institute. Published by Elsevier Inc. All rights reserved. | ||
| 520 | |a BACKGROUND & AIMS: Exclusive enteral nutrition (EEN) is the only established dietary treatment for Crohn's disease (CD), but its acceptability is limited. There is a need for novel dietary treatments for CD | ||
| 520 | |a METHODS: We evaluated the effects of an individualized food-based diet (CD-TREAT), with similar composition to EEN, on the gut microbiome, inflammation, and clinical response in a rat model, healthy adults, and children with relapsing CD. Twenty-five healthy adults randomly received EEN or CD-TREAT for 7 days, followed by a 14-day washout period, followed by the alternate diet. Fecal microbiome and metabolome were assessed before and after each diet. HLA-B7 and HLA-B27 transgenic rats with gut inflammation received EEN, CD-TREAT, or standard chow for 4 weeks. Fecal, luminal, and tissue microbiome, fecal metabolites, and gut inflammation were assessed. Five children with active CD activity received CD-TREAT and their clinical activity and calprotectin were evaluated after 8 weeks of treatment | ||
| 520 | |a RESULTS: For healthy adults, CD-TREAT was easier to comply with and more acceptable than EEN. CD-TREAT induced similar effects to EEN (EEN vs CD-TREAT) on fecal microbiome composition, metabolome, mean total sulfide (increase 133.0 ± 80.5 vs 54.3 ± 47.0 nmol/g), pH (increase 1.3 ± 0.5 vs 0.9 ± 0.6), and the short-chain fatty acids (μmol/g) acetate (decrease 27.4 ± 22.6 vs 21.6 ± 20.4), propionate (decrease 5.7 ± 7.8 vs 5.2 ± 7.9), and butyrate (decrease 7.0 ± 7.4 vs 10.2 ± 8.5). In the rat model, CD-TREAT and EEN produced similar changes in bacterial load (decrease 0.3 ± 0.3 log10 16S rRNA gene copies per gram), short-chain fatty acids, microbiome, and ileitis severity (mean histopathology score decreases of 1.25 for EEN [P = .015] and 1.0 for CD-TREAT [P = .044] vs chow). In children receiving CD-TREAT, 4 (80%) had a clinical response and 3 (60%) entered remission, with significant concurrent decreases in fecal calprotectin (mean decrease 918 ± 555 mg/kg; P = .002) | ||
| 520 | |a CONCLUSION: CD-TREAT replicates EEN changes in the microbiome, decreases gut inflammation, is well tolerated, and is potentially effective in patients with active CD. ClinicalTrials.gov, numbers NCT02426567 and NCT03171246 | ||
| 650 | 4 | |a Journal Article | |
| 650 | 4 | |a Randomized Controlled Trial | |
| 650 | 4 | |a Research Support, Non-U.S. Gov't | |
| 650 | 4 | |a Carbohydrate | |
| 650 | 4 | |a Inflammatory Bowel Disease | |
| 650 | 4 | |a Microbiota | |
| 650 | 4 | |a Pediatric Trial | |
| 650 | 7 | |a HLA-B27 Antigen |2 NLM | |
| 650 | 7 | |a HLA-B7 Antigen |2 NLM | |
| 700 | 1 | |a Hansen, Richard |e verfasserin |4 aut | |
| 700 | 1 | |a Nichols, Ben |e verfasserin |4 aut | |
| 700 | 1 | |a Quince, Christopher |e verfasserin |4 aut | |
| 700 | 1 | |a Ijaz, Umer Z |e verfasserin |4 aut | |
| 700 | 1 | |a Papadopoulou, Rodanthi T |e verfasserin |4 aut | |
| 700 | 1 | |a Edwards, Christine A |e verfasserin |4 aut | |
| 700 | 1 | |a Watson, David |e verfasserin |4 aut | |
| 700 | 1 | |a Alghamdi, Adel |e verfasserin |4 aut | |
| 700 | 1 | |a Brejnrod, Asker |e verfasserin |4 aut | |
| 700 | 1 | |a Ansalone, Cecilia |e verfasserin |4 aut | |
| 700 | 1 | |a Duncan, Hazel |e verfasserin |4 aut | |
| 700 | 1 | |a Gervais, Lisa |e verfasserin |4 aut | |
| 700 | 1 | |a Tayler, Rachel |e verfasserin |4 aut | |
| 700 | 1 | |a Salmond, Jonathan |e verfasserin |4 aut | |
| 700 | 1 | |a Bolognini, Daniele |e verfasserin |4 aut | |
| 700 | 1 | |a Klopfleisch, Robert |e verfasserin |4 aut | |
| 700 | 1 | |a Gaya, Daniel R |e verfasserin |4 aut | |
| 700 | 1 | |a Milling, Simon |e verfasserin |4 aut | |
| 700 | 1 | |a Russell, Richard K |e verfasserin |4 aut | |
| 700 | 1 | |a Gerasimidis, Konstantinos |e verfasserin |4 aut | |
| 773 | 0 | 8 | |i Enthalten in |t Gastroenterology |d 1945 |g 156(2019), 5 vom: 01. Apr., Seite 1354-1367.e6 |w (DE-627)NLM00001706X |x 1528-0012 |7 nnns |
| 773 | 1 | 8 | |g volume:156 |g year:2019 |g number:5 |g day:01 |g month:04 |g pages:1354-1367.e6 |
| 856 | 4 | 0 | |u http://dx.doi.org/10.1053/j.gastro.2018.12.002 |3 Volltext |
| 912 | |a GBV_USEFLAG_A | ||
| 912 | |a GBV_NLM | ||
| 951 | |a AR | ||
| 952 | |d 156 |j 2019 |e 5 |b 01 |c 04 |h 1354-1367.e6 | ||