Table 7.
Health benefits of nutritional therapy in pediatric IBD. ED = elemental diet, REE = resting energy expenditure, IGF-1 = insulin like growth factor 1, IGFBP-3 = insulin like growth factor binding protein, EEN = exclusive enteral nutrition, corticosteroids = CS.
| Health Benefits of Nutritional Therapy in Pediatric IBD | ||||
|---|---|---|---|---|
| Author/Year | Study Type | Population | Method | Main Findings |
| Azcue et al. 1997 [83] | Clinical trial | Children and adolescents affected by CD (n = 24); malnourished adolescents with anorexia nervosa (n = 19); healthy control subjects (n = 22) | - Group of patients (n = 12) treated with nocturnal enteral nutrition via nasogastric tube for 5–6 weeks, then 1 night a week for 2 months - Group of patients (n = 12) treated with prednisolone - control group (n = 22), healthy subjects - group of malnourished adolescents with anorexia nervosa (n = 19) |
- All body compartments and REE increased significantly in enteral nutrition group compared to patients treated with corticosteroids. In enteral nutrition group REE (kcal/day) from 1153 ± 283 at baseline to 1415 ± 535 at 1 month post-treatment; in prednisolone group REE at baseline 1380 ± 308 to 1432 ± 265 at one month post-treatment. For lean body mass (LBM % weight) in enteral nutrition group 86.6 ± 8.9 at baseline to 88.8 + 9.9 at one month post-treatment, in prednisolone group 87.5 ± 9.4 at baseline to 79.1 ± 9.4 at one month post-treatment. - Significant height increase in enteral nutrition group compared with prednisolone group (p < 0.01). |
| Beattie et al. 1998 [86] | Clinical trial | Children and adolescents affected by CD (n = 23) | - Study A: 14 patients treated with EEN for 8 weeks, then gradual reduction of nutritional support over 2 months - Study B: 9 patients treated with intestinal resection |
Study A - Significant weight gain for all patients treated with EEN after 8 and 16 weeks, compared to pre-treatment values (weight SDS at baseline= -0.9 (−1.3 to −0.5), weight SDS at week 8 = −0.5 (−0.9 to 0), at 16 weeks weight SDS = −0.6 (−1.1 to 0) (p < 0.05) - Significant increase of median IGF-1 and IGFBP-3 at 2, 8, and 16 weeks in EEN group compared to pre-treatment values (p < 0.01) Study B - No significant changes in auxological data, IGF-1 and IGFBP-3 in patients who had surgical resection compared to pre-treatment values |
| 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 |
- 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. |
| 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 enteral ED for 1 month out of 4, over the course of 1 year - 4 children treated with conventional medical treatment |
- Significant height and weight gains in the ED group vs. controls. Weight gain for ED group 6.9 ± 1.5 kg; 209.8% ± 41.9%; weight gain for control group −0.9 + 1.6 kg; −9.8% ± 52.6% (p < 0.01). Height changes in ED group 7.0 + 0.8 cm; 126.0% ± 11.8% of ideal predicted. Height change in control group 1.7 + 0.8 cm; 28.7% ± 13.1% (p < 0.01). |
| Berni Canani et al. 2006 [44] | Retrospective study | Children and adolescents affected by active CD (n = 47) | Children received nutritional therapy (NT) for 8 weeks as - Polymeric formula (n = 12) - Semi-elemental diet (n = 13) - Elemental diet (n = 12) Ten subjects received oral CS for 8 weeks. |
- Significant improvement of serum albumin and iron levels in NT compared to CS group. In NT group elemental: albumin at baseline 13.14 ± 0.47 to 3.98 ± 0.36 at 8 weeks, p < 0.001; NT group semi-elemental: albumin at baseline 3.13 + 0.40 to 3.88 + 0.26 at 8 weeks, p < 0.001; NT group polymeric: albumin at baseline 3.09 + 0.39 to 3.86 + 0.38 at 8 weeks, p < 0.001)). In CS group: albumin at baseline 3.37 ± 0.24 to 3.40 ± 0.22 after 8 weeks, p = 0.28). In NT group elemental: iron at baseline 31.25 ± 20.4 to 72.17 ± 20.4 at 8 weeks, p = 0.001; NT group semi-elemental: iron at baseline 29.46 + 23.7 to 66.69 + 19.8 at 8 weeks, p = 0.002; NT group polymeric: iron at baseline 32.58 + 24.0 to 69.25 + 29.6 at 8 weeks, p = 0.004)). In CS group: iron at baseline 20.80 ± 15.5 to 35.80 ± 16.0 after 8 weeks, p = 0.01). Linear growth recovery was superior in nutritional group compared to CS group (p < 0.05). |
| Motil et al. 1982 [87] | Clinical trial | Adolescents affected by CD | - 6 patients affected by CD received nutritional supplements for 7 months - 5 healthy control subjects |
Increase of linear and ponderal growth velocities in patients treated with nutritional support (Height gain cm/month pre-supplements 0.10 ± 0.08, post-supplements 0.50 + 0.16; weight gain kg/month pre-supplements 0.21 ± 0.09, post-supplements 1.22 ± 0.25). Achievement of weight and height gain similar to control group levels after the 7 months treatment with nutritional supplements (height gain cm/month 0.38 ± 0.12, weight gain kg/month 0.40 + 0.17). |
| O’Morain et al. 1983 [88] | Clinical trial | Children and adolescents affected by CD (n = 15) aged 6–20 years | 14 patients received ED as the main energy source for 4 weeks; 1 received corticosteroids. | Improvement of nutritional status, weight, and height gain in children receiving ED. |
| Whitten et al. 2010 [94] | Clinical trial | Children newly diagnosed CD (n = 23) compared to a healthy control group (n = 20) | Children newly diagnosed with CD received 8 weeks EEN for induction of remission | Normalization of serum markers of bone turnover after EEN therapy. CTX levels at diagnosis 2.967 ± 0.881 ng/mL and after EEN 2.260 ± 0.547 ng/mL, p = 0.002. BAP levels at diagnosis 51.24 ± 31.31 microg/L and after EEN 64.82 ± 30.51 microg/L, p = 0.02. |
| Polk et al. 1992 [89] | Clinical trial | Adolescents affected by CD (n = 6) | All patients received enteral nutrition via nasogastric tube during night 1 out of 4 months for 1 year. Then the patients received a 2-week exclusion diet and a 2-week low-residue diet for 2 months, before re-starting a normal diet. | Significant increase of weight, height, IGF-1, and albumin; decrease of steroid use and disease activity compared to pretreatment values |