Table 1.
Characteristics of included studies
| References | Origin | Study groups, dose, number of patients | Age at diagnosis (y) | Patients | Treatment time (wk) | Clinical remission | Quality score |
|---|---|---|---|---|---|---|---|
| Randomized controlled trail | |||||||
| Terrin et al. [38] | Italy | EEN: extensively hydrolyzed formula 50–60 kcal/kg/d (n = 10). CS: prednisolone 1.6 mg/kg/d and mesalazine (n = 10) |
12.4 (7–17) | Children with active CD | 8 | PCDAI < 10 | 5 |
| Thomas et al. [39] | England | EEN: elemental formula (n = 12) CS: prednisolone 2 mg/kg/d (maximum 60 mg/d) and sulphasalazine 25 mg/kg/d (n = 12) |
12.9 (5.7–17.2) | Children with active CD | 4 | Activity was graded According to the Lloyd–Still activity index |
3 |
| Ruuska et al. [40] | Finland | EEN: whole-protein based on weight (n = 10) CS: prednisolone 1.5 mg/kg/d up to a maximum of 60 mg (n = 9) |
8.5–18.6 | Children with new onset or relapsing CD | 8 | PCDAI < 10 | 3 |
| Borrelli et al. [41] | Italy | EEN: polymeric formula 120% to 130% of the recommended daily requirement (n = 19) CS: methylprednisolone 1.6 mg/kg/d (up to maximum 60 mg) for 4 wk, then tapered by 5–10 mg/kg, each week over 6 wk (n = 18) |
4–17 | Diagnosis of CD within 12 wk | 10 | PCDAI < 10 | 3 |
| Retrospective analysis of records | |||||||
| Canani et al. [42] | Italy | EEN: polymeric formula (n = 12); semi-elemental diet (n = 13); elemental diet (n = 12). 50–70 kcal/kg CS: methylprednisolone (1–2 mg/kg/d, maximal dose 40 mg/d) for 4 wk with subsequent gradual tapering over at least 4 wk (n = 10) |
Polymeric: 11.5 (9–17) Semi-elemental: 11.8 (8–15) Elemental: 12.1 (7–16) CS: 12.4 (8–17) |
Children with newly diagnosed CD | 8 | PCDAI < 10 | 8 |
| Papadopoulou et al. [43] | Greece | EEN: elemental diet. The daily intake of the elemental diet ranged between 60 and 135 mL/kg/d, calculated to provide 140% of the recommended daily allowance of energy (n = 30) CS: prednisolone, 2 mg/kg/d up to a maximal dose of 60 mg/d, the dose was halved every 2–4 wk until a dose of 5–10 mg was achieved (n = 28) |
EEN: 12.6 ± 3.1 CS: 12 ± 3.1 |
Children with diagnosed CD | 8 | Both the absence of clinical symptoms referable to Crohn’s disease (i.e., diarrhea, abdominal pain, fever) and achievement of a disease activity score > 80 | 8 |
| Lambert et al. [44] | Australia | EEN: polymeric formula (n = 31). After completion of EEN, normal diet was reintroduced gradually and children were encouraged to continue supplementary volumes of enteral formula (500–1000 mL daily) CS: corticosteroids (n = 26). |
EEN: 9.9 ± 4 CS: 9.97 ± 4.7 |
Children with newly diagnosed CD | 6–8 | PCDAI < 15 | 9 |
| Soo et al. [45] | Canada | EEN: polymeric formula (n = 33) or semi-elemental formula (n = 3) for 6 wk and then partially over the next 2 wk depending on patient compliance CS: prednisone, 1 mg/kg/d to a maximum dose of 50 mg/d (n = 69) |
EEN: 12.9 (7.4–16.2) CS: 11.2 (2.4–16.8) |
Children with newly diagnosed CD | 6–8 | PCDAI < 10 | 9 |
| Levine et al. [46] | Israel | EEN: polymeric formula (n = 43) CS: prednisone, 1–2 mg/kg up to 60 mg equivalent of prednisone (n = 114) |
EEN: 12.3 ± 3.9 CS: 13.3 ± 3.1 |
Children with newly diagnosed CD | 6–8 | PCDAI < 10 | 8 |
| Wang et al. [47] | China | EEN: polymer formula, according to the normal age of the required amount of 120–130% (n = 25) CS: oral methylprednisolone at an initial dose of 1.6 mg/kg/d (maximal dose ≤ 60 mg/d). After 4 wk of treatment, the dose was reduced (n = 23) |
EEN: 9.3 ± 2.6 CS: 10.2 ± 3.1 |
Children with diagnosed CD | 12 | CDAI < 150 points or lower than the baseline value of at least 100 points and CRP normal | 9 |
| Hojsak et al. [48] | Croatia | EEN: polymeric formula, taken exclusively for 6–8 wk either through nasogastric tube or orally (n = 57) CS: corticosteroids (n = 17). |
13.4 (1–17.9) | Children with newly diagnosed CD | 6–8 | PCDAI < 10 | 8 |
| Grover et al. [49] | Australia | EEN: polymeric formula, Nutrison (1 kcal/mL, Nutricia, UK, 4 g protein, 3.9 g fat/100 mL) through nasogastric tube (NGT) or resource protein (1.25 kcal/mL, Nestle, 9.4 g protein, 3.5 g fat/100 mL) orally based on children preference and dietetic consultation (n = 43) CS: corticosteroids: 10 mg/d prednisolone (n = 46) |
EEN: 13 (11.35–14) CS: 11.5 (9.5–13) |
Children with newly diagnosed CD | 6 | PCDAI < 10 | 9 |
| Luo et al. [50] | China | EEN: polymeric formula, the average caloric intake in EEN group was 117.9 ± 4.2 kcal (n = 10) CS: the average dosage for prednisone was 1.1 ± 0.4 mg/kg (n = 15). The average dosage for hydrocortisone was 8.7 ± 2.3 mg/kg (n = 3) |
EEN: 11.1 (5–15) CS: 11.6 (1–16) |
Children with active CD (PCDAI > 10) | 8 | PCDAI < 10 | 8 |
| Hradsky et al. [51] | Czech Republic | EEN: polymeric formula (n = 29) CS: prednisone 1–2 mg/kg/d (up to 40 mg/d, exceptionally 60 mg/d) approximately 2 mont (n = 36) |
EEN: 13.91 (12.3–15.02) CS: 14.85 (11.25–15.57) |
Children with newly diagnosed CD | 6–10 | NG | 7 |
| Goncalves et al. [52] (abstract) | Portuguese | EEN: polymeric formula for 8 wk (1500–2000 mL/d) (n = 11) CS: the steroid dose was 1 mg/kg/d (n = 19) |
There was no difference in age | Children with newly diagnosed CD | 8 | NG | 7 |
| Gavin et al. [53] (abstract) | UK | EEN: exclusive enteral nutrition (n = 43) CS: steroids (n = 19) |
13 (2–16) | Children with newly diagnosed CD | NG | Clinical remission was determined using a physician global assessment and blood biochemistry | 6 |
| Scarpato et al. [54] (abstract) | Italy | EEN: receiving exclusive enteral nutrition for 8 wk, followed by a gradual introduction of foods during the subsequent 4 wk (n = 33). CS: treated with oral corticosteroids with tapering off by week 11 (n = 11). |
EEN: 10.4 ± 3.5 CS: 11.7 ± 4.6 |
Children with newly diagnosed CD | 8 | NG | 7 |
| Prospective analysis of records | |||||||
| Kierkus et al. [55] | Poland | EEN: each infused 1400–2200 mL. This provided approximately 50 kcal/kg/d (n = 20). CS: corticosteroids (n = 24) |
EEN: 13.4 ± 5.18 CS: 13.8 ± 4.34 |
Children with moderate to severe CD (PCDAI > 30) | 6 | PCDAI < 10 | 9 |
EEN exclusive enteral nutrition group, CS corticosteroid group, PCDAI Pediatric Crohn’s Disease Activity Index, CD Crohn’s disease, n number, NG not given