Dietary Strategies for Maintenance of Clinical Remission in Inflammatory Bowel Diseases: Are We There Yet?

Gkikas, Konstantinos; Gerasimidis, Konstantinos; Milling, Simon; Ijaz, Umer Zeeshan; Hansen, Richard; Russell, Richard K.

doi:10.3390/nu12072018

Cited by 29 publications

(20 citation statements)

References 104 publications

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“…In a recent meta-analysis based on studies in children and adults with CD, Gkikas et al concluded that the consumption of more than 35% of caloric needs that come from EN is necessary to achieve clinical benefits in maintaining remission [ 96 ]. The ESPHGAN guideline recommends a daily caloric intake of at least 50% to reach therapeutic efficacy for effective prolongation of remission in low-risk CD [ 9 ].…”

Section: Different Types Of Nutritional Therapy and Their Efficacymentioning

confidence: 99%

Nutritional Therapy Strategies in Pediatric Crohn’s Disease

et al. 2021

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The increase in incidences of pediatric Crohn’s Disease (CD) worldwide has been strongly linked with dietary shifts towards a Westernized diet, ultimately leading to altered gut microbiota and disturbance in intestinal immunity and the metabolome. Multiple clinical studies in children with CD have demonstrated the high efficacy of nutritional therapy with exclusive enteral nutrition (EEN) to induce remission with an excellent safety profile. However, EEN is poorly tolerated, limiting its compliance and clinical application. This has spiked an interest in the development of alternative and better-tolerated nutritional therapy strategies. Several nutritional therapies have now been designed not only to treat the nutritional deficiencies seen in children with active CD but also to correct dysbiosis and reduce intestinal inflammation. In this review, we report the most recent insights regarding nutritional strategies in children with active CD: EEN, partial enteral nutrition (PEN), Crohn’s disease exclusion diet (CDED), and CD treatment-with-eating diet (CD-TREAT). We describe their setup, efficacy, safety, and (dis)advantages as well as some of their potential mechanisms of action and perspectives. A better understanding of different nutritional therapeutic options and their mechanisms will yield better and safer management strategies for children with CD and may address the barriers and limitations of current strategies in children.

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Section: Different Types Of Nutritional Therapy and Their Efficacymentioning

confidence: 99%

Nutritional Therapy Strategies in Pediatric Crohn’s Disease

et al. 2021

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“…Although some of them have shown interestingly results, their efficacy has been frequently evaluated in studies with several limitations. Many of these studies were mostly focused on the assessment of improvement in symptoms without standardized clinical outcomes, and with poor attention to inflammation and mucosal healing achievement [ 80 ]. Moreover, most data have been extrapolated from studies on adults, with sometimes conflicting results between those showing a real improvement of symptoms [ 81 , 82 ] and those showing no significative changing or even worsening of symptoms [ 83 , 84 ].…”

Section: Nutritional Strategies In Induction Of Remission In Pediamentioning

confidence: 99%

“…For these reasons, trials investigating nutritional strategies for maintenance of remission have been carried out in the last years. To date, EEN is not recommended for maintenance of remission in pediatric patients, since efficacy has not been thoroughly evaluated in children and long-term adherence may be challenging after a first cycle of induction [ 36 , 55 , 80 ]. Although other nutritional interventions are usually intended for short-period use, it is not infrequent for many patients to continue using them for longer period of time.…”

Section: Nutritional Strategies In Maintenance Of Remission In Pedmentioning

confidence: 99%

Diet and Nutrition in Pediatric Inflammatory Bowel Diseases

2021

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Both genetic and environmental factors are involved in the onset of inflammatory bowel disease (IBD). In particular, diet composition is suspected to significantly contribute to IBD risk. In recent years, major interest has raised about the role of nutrition in disease pathogenesis and course, and many studies have shown a clear link between diet composition and intestinal permeability impairment. Moreover, many IBD-related factors, such as poor dietary intake, nutrients loss and drugs interact with nutritional status, thus paving the way for the development of many therapeutic strategies in which nutrition represents the cornerstone, either as first-line therapy or as reversing nutritional deficiencies and malnutrition in IBD patients. Exclusive enteral nutrition (EEN) is the most rigorously supported dietary intervention for the treatment of Crohn’s Disease (CD), but is burdened by a low tolerability, especially in pediatric patients. Promising alternative regimens are represented by Crohn’s Disease Exclusion Diet (CDED), and other elimination diets, whose use is gradually spreading. The aim of the current paper is to provide a comprehensive and updated overview on the latest evidence about the role of nutrition and diet in pediatric IBD, focusing on the different nutritional interventions available for the management of the disease.

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“…Another approach that was recently evaluated through a randomized controlled trial is the CD treatment-with-eating diet (CD-TREAT), a personalized and tolerable diet with comparable composition to EEN, based on the exclusion of certain dietary components (gluten, lactose and alcohol) and the inclusion of others (macronutrients, vitamins, minerals and fibers) using ordinary food [141]. The study was conducted on healthy volunteers, pediatric IBD patients and animal murine models, in order to evaluate the effects of the diet on gut microbiome composition, inflammation and clinical response.…”

Section: Dietary Therapiesmentioning

confidence: 99%

Diet and Nutrients in Gastrointestinal Chronic Diseases

et al. 2020

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Diet and nutrition are known to play key roles in many chronic gastrointestinal diseases, regarding both pathogenesis and therapeutic possibilities. A strong correlation between symptomatology, disease activity and eating habits has been observed in many common diseases, both organic and functional, such as inflammatory bowel disease and irritable bowel syndrome. New different dietary approaches have been evaluated in order improve patients’ symptoms, modulating the type of sugars ingested, the daily amount of fats or the kind of metabolites produced in gut. Even if many clinical studies have been conducted to fully understand the impact of nutrition on the progression of disease, more studies are needed to test the most promising approaches for different diseases, in order to define useful guidelines for patients.

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Dietary Strategies for Maintenance of Clinical Remission in Inflammatory Bowel Diseases: Are We There Yet?

Cited by 29 publications

References 104 publications

Nutritional Therapy Strategies in Pediatric Crohn’s Disease

Nutritional Therapy Strategies in Pediatric Crohn’s Disease

Diet and Nutrition in Pediatric Inflammatory Bowel Diseases

Diet and Nutrients in Gastrointestinal Chronic Diseases

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