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. 1994 Jun;35(6):783–787. doi: 10.1136/gut.35.6.783

Comparison of amino acid v peptide based enteral diets in active Crohn's disease: clinical and nutritional outcome.

D Royall 1, K N Jeejeebhoy 1, J P Baker 1, J P Allard 1, F M Habal 1, S C Cunnane 1, G R Greenberg 1
PMCID: PMC1374879  PMID: 8020806

Abstract

Elemental diets are considered an effective primary treatment for active Crohn's disease. This study examined the hypothesis that improvement occurs because of the presence of amino acids or the low fat content, or both. A randomised, controlled trial was undertaken in 40 patients with active Crohn's disease to evaluate clinical and nutritional outcomes after an amino acid based diet containing 3% fat was given by a feeding tube compared with a peptide based diet containing 33% fat. After three weeks' treatment, clinical remission occurred in 84% of patients who were given the amino acid diet and 75% of patients who received the peptide diet (p = 0.38). Plasma linoleic acid concentration was reduced after the amino acid but not the peptide diet. An increase in total body nitrogen was associated with the magnitude of nutritional depletion before treatment and at six months' follow up, only patients who showed gains in total body nitrogen after enteral nutrition had a sustained clinical remission. This study shows that peptide based high fat diets are as effective as amino acid low fat diets for achieving clinical remission in active Crohn's disease. Improved total body protein stores but not essential fatty acid depletion may be an important indicator of a sustained remission.

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Selected References

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  1. Christie P. M., Hill G. L. Effect of intravenous nutrition on nutrition and function in acute attacks of inflammatory bowel disease. Gastroenterology. 1990 Sep;99(3):730–736. doi: 10.1016/0016-5085(90)90962-z. [DOI] [PubMed] [Google Scholar]
  2. Cunnane S. C. The profile of long-chain fatty acids in serum phospholipids: a possible indicator of copper status in humans. Am J Clin Nutr. 1988 Dec;48(6):1475–1478. doi: 10.1093/ajcn/48.6.1475. [DOI] [PubMed] [Google Scholar]
  3. Gassull M. A., Abad A., Cabré E., González-Huix F., Giné J. J., Dolz C. Enteral nutrition in inflammatory bowel disease. Gut. 1986 Nov;27 (Suppl 1):76–80. doi: 10.1136/gut.27.suppl_1.76. [DOI] [PMC free article] [PubMed] [Google Scholar]
  4. Giaffer M. H., North G., Holdsworth C. D. Controlled trial of polymeric versus elemental diet in treatment of active Crohn's disease. Lancet. 1990 Apr 7;335(8693):816–819. doi: 10.1016/0140-6736(90)90936-y. [DOI] [PubMed] [Google Scholar]
  5. Greenberg G. R., Fleming C. R., Jeejeebhoy K. N., Rosenberg I. H., Sales D., Tremaine W. J. Controlled trial of bowel rest and nutritional support in the management of Crohn's disease. Gut. 1988 Oct;29(10):1309–1315. doi: 10.1136/gut.29.10.1309. [DOI] [PMC free article] [PubMed] [Google Scholar]
  6. Halperin M. L., Wolman S. L., Greenberg G. R. Paracellular recirculation of sodium is essential to support nutrient absorption in the gastrointestinal tract: an hypothesis. Clin Invest Med. 1986;9(3):209–211. [PubMed] [Google Scholar]
  7. Jacobson S., Carlmark B. Total body potassium, fat and water during total parenteral nutrition in Crohn's disease. Clin Nutr. 1990 Oct;9(5):272–280. doi: 10.1016/0261-5614(90)90036-r. [DOI] [PubMed] [Google Scholar]
  8. Jensen M. D. Research techniques for body composition assessment. J Am Diet Assoc. 1992 Apr;92(4):454–460. [PubMed] [Google Scholar]
  9. Lefkowith J. B. Essential fatty acid deficiency inhibits the in vivo generation of leukotriene B4 and suppresses levels of resident and elicited leukocytes in acute inflammation. J Immunol. 1988 Jan 1;140(1):228–233. [PubMed] [Google Scholar]
  10. Lochs H., Meryn S., Marosi L., Ferenci P., Hörtnagl H. Has total bowel rest a beneficial effect in the treatment of Crohn's disease? Clin Nutr. 1983 Apr;2(1):61–64. doi: 10.1016/0261-5614(83)90033-x. [DOI] [PubMed] [Google Scholar]
  11. Lochs H., Steinhardt H. J., Klaus-Wentz B., Zeitz M., Vogelsang H., Sommer H., Fleig W. E., Bauer P., Schirrmeister J., Malchow H. Comparison of enteral nutrition and drug treatment in active Crohn's disease. Results of the European Cooperative Crohn's Disease Study. IV. Gastroenterology. 1991 Oct;101(4):881–888. doi: 10.1016/0016-5085(91)90711-s. [DOI] [PubMed] [Google Scholar]
  12. Mernagh J. R., Harrison J. E., McNeill K. G. In vivo determination of nitrogen using Pu-Be sources. Phys Med Biol. 1977 Sep;22(5):831–835. doi: 10.1088/0031-9155/22/5/002. [DOI] [PubMed] [Google Scholar]
  13. O'Moráin C., Segal A. W., Levi A. J. Elemental diet as primary treatment of acute Crohn's disease: a controlled trial. Br Med J (Clin Res Ed) 1984 Jun 23;288(6434):1859–1862. doi: 10.1136/bmj.288.6434.1859. [DOI] [PMC free article] [PubMed] [Google Scholar]
  14. Okada M., Yao T., Yamamoto T., Takenaka K., Imamura K., Maeda K., Fujita K. Controlled trial comparing an elemental diet with prednisolone in the treatment of active Crohn's disease. Hepatogastroenterology. 1990 Feb;37(1):72–80. [PubMed] [Google Scholar]
  15. Ostro M. J., Greenberg G. R., Jeejeebhoy K. N. Total parenteral nutrition and complete bowel rest in the management of Crohn's disease. JPEN J Parenter Enteral Nutr. 1985 May-Jun;9(3):280–287. doi: 10.1177/0148607185009003280. [DOI] [PubMed] [Google Scholar]
  16. Raouf A. H., Hildrey V., Daniel J., Walker R. J., Krasner N., Elias E., Rhodes J. M. Enteral feeding as sole treatment for Crohn's disease: controlled trial of whole protein v amino acid based feed and a case study of dietary challenge. Gut. 1991 Jun;32(6):702–707. doi: 10.1136/gut.32.6.702. [DOI] [PMC free article] [PubMed] [Google Scholar]
  17. Rees R. G., Hare W. R., Grimble G. K., Frost P. G., Silk D. B. Do patients with moderately impaired gastrointestinal function requiring enteral nutrition need a predigested nitrogen source? A prospective crossover controlled clinical trial. Gut. 1992 Jul;33(7):877–881. doi: 10.1136/gut.33.7.877. [DOI] [PMC free article] [PubMed] [Google Scholar]
  18. Rigaud D., Cosnes J., Le Quintrec Y., René E., Gendre J. P., Mignon M. Controlled trial comparing two types of enteral nutrition in treatment of active Crohn's disease: elemental versus polymeric diet. Gut. 1991 Dec;32(12):1492–1497. doi: 10.1136/gut.32.12.1492. [DOI] [PMC free article] [PubMed] [Google Scholar]
  19. Saverymuttu S., Hodgson H. J., Chadwick V. S. Controlled trial comparing prednisolone with an elemental diet plus non-absorbable antibiotics in active Crohn's disease. Gut. 1985 Oct;26(10):994–998. doi: 10.1136/gut.26.10.994. [DOI] [PMC free article] [PubMed] [Google Scholar]
  20. Silk D. B., Fairclough P. D., Clark M. L., Hegarty J. E., Marrs T. C., Addison J. M., Burston D., Clegg K. M., Matthews D. M. Use of a peptide rather than free amino acid nitrogen source in chemically defined "elemental" diets. JPEN J Parenter Enteral Nutr. 1980 Nov-Dec;4(6):548–553. doi: 10.1177/0148607180004006548. [DOI] [PubMed] [Google Scholar]
  21. Teahon K., Bjarnason I., Pearson M., Levi A. J. Ten years' experience with an elemental diet in the management of Crohn's disease. Gut. 1990 Oct;31(10):1133–1137. doi: 10.1136/gut.31.10.1133. [DOI] [PMC free article] [PubMed] [Google Scholar]
  22. Teahon K., Smethurst P., Pearson M., Levi A. J., Bjarnason I. The effect of elemental diet on intestinal permeability and inflammation in Crohn's disease. Gastroenterology. 1991 Jul;101(1):84–89. doi: 10.1016/0016-5085(91)90463-u. [DOI] [PubMed] [Google Scholar]

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