Table 6.

Nutrition in maintenance of disease remission. ED = elemental diet, MEN = maintenance enteral nutrition, EEN = exclusive enteral nutrition, SCD = specific carbohydrate diet, CRP = C-reactive protein, BMI = body mass index, 5-ASA = 5-aminosalycilates, ARC = risk change.

Nutrition in Maintenance of Disease Remission in Pediatric IBD
Author/Year	Study Type	Population	Method	Main Findings
PEN
Belli et al. 1988 [54]	Clinical trial	Children and adolescents with CD (n = 8) aged 9.8–14.2 years	- 8 children treated with chronic Intermittent ED for 1 month out of 4, over the course of 1 year - 4 children treated with conventional medical treatment	- CD activity index and prednisone intake decreased significantly in patients receiving ED therapy when compared with controls on conventional medical therapy (p < 0.05).
Duncan et al. 2014 [55]	Clinical trial	Children and adolescents newly diagnosed CD (n = 59) aged 2.5–16.33 years	Patients newly diagnosed CD who commenced EEN for 8 weeks, than followed up: - 11/59 poor response to EEN, switched to steroids. 48/59 completed 8 weeks with EEN and achieved remission - 15/48 continued MEN, post EEN completion. Duration of MEN ranged 4–14 months (mean 10.8 months)	- Remission rates at 1 year in patients continuing MEN were 60% (9/15), compared to 15% (2/13) in patients taking no treatment (p = 0.001) and 65% (13/20) in patients taking azathioprine (p = 0.14).
Wilschanski et al. 1996 [61]	Retrospective cohort study	Children and adolescents (n = 65) aged 7–17 years	After induction of remission of CD with EEN: - Group 1: patients (n = 28) continued nocturnal nasogastric supplementary feeding combined with a normal diet - Group 2: patients (n = 19) stopped nocturnal supplements after the remission	- Higher relapse rate in group 2 vs. group 2 at 6 and 12 months (At 6 months relapse rate of group 2: 78% (15/19) vs. 17.8% (5/28) of group 1, p < 0.02; at 12 months relapse rate of group 2 78.9% (15/19) vs. group 1 42.8% (12/28), p < 0.02). - Mean changes in height velocity was greater for group 1 (2.87 cm/year) compared to group 2 (0.4 cm/year), p =0.057.
Obih et al. 2015 [63]	Retrospective cohort study	Children affected by IBD (n = 26), CD (n = 20) or UC (n = 6) aged 1.5–19 years	- Group of patients (n = 26) who followed a SCD for more than 2 weeks (mean duration 9.6 ± 10.1 months). 15/26 patients were on concurrent medication with SCD; 11/26 were not on IBD-related drugs - Children with IBD (n = 10), CD (n = 7), UC (n = 3) who did not follow SCD but only standard medical therapy	- In SCD group PCDAI improved from 32.8 ± 13.2 at baseline to 20.8 ± 16.6 by week 4 ± 2 w and 8.8 ± 8.5 by month 6. - The mean Pediatric Ulcerative Colitis Index (PUCAI) decreased from baseline 28.3 ± 10.3 to 20.0 + 17.3 at week 4 ± 2 w and to 18.3 ± 31.7 at month 6. - Significant improvement of Crohn’s disease activity index, CRP, and calprotectin in SCD group respect to control group (p = 0.03, 0.03, and 0.03, respectively) - lower BMI, height and weight in SCD group than in control (p = 0.01, 0.03, and 0.009, respectively)
Curcumin
Hanai H et al. 2006 [69]	Randomized double-blind, placebo-controlled trial	Adolescents and adults with quiescent UC aged 13–65 years (n = 89)	- 43 patients received curcumin 2 g/day plus sulfasalazine or mesalazine; - 39 patients received placebo plus sulfasalazine or mesalazine	- Relapse rate at 6 months of therapy was lower for curcumin group compared to placebo group: - 2/43 (4.65%) in curcumin group vs. 8/39 (20.51%) in placebo group, p = 0.049. ARC = −0.16 (exact 95% CI −0.30 to −0.02). - Curcumin improved both clinical activity index (CAI, p = 0.038) and endoscopic index (EI, p = 0.0001). - High tolerability and no serious side effect associated to curcumin
Suskind et al. 2013 [71]	Clinical trial	Children and adolescents (n = 11) aged 11–18 years affective by CD (n = 6) or UC (n = 5).	All patients, in addition to their standard IBD therapy, received increasing doses of curcumin, up to 2 g twice daily for 3 weeks	- High tolerability of curcumin without side effects except for increase in gassiness which was consistently reported in two patients. Three patients had lowering of PUCAI/PCDAI scores. - No patients had IBD relapse or worsening of symptoms.
n-3 PUFAs
Romano et al. 2005 [82]	Double-blind, randomized, placebo-controlled study	Children and adolescents affected by CD (n = 38) in remission, aged 5–16 years and treated for 12 months.	- Group 1 (n = 18): patients treated with 5-ASA (50 mg/kg/day) and omega-3 fatty acids for 12 months. - Group 2 (n = 20): patients treated with 5-ASA (50 mg/kg/day) plus placebo (olive oil in capsules) for 12 months.	Number of patients who relapsed at 12 months was significantly lower in Omega-3 fatty acid group than in patients receiving placebo (relapse rate group 1 11/18 (61%), group 2 19/20 (95%); p < 0.001). ARC −0.34 (exact 95% CI −0.58 to −0.09).