Nutrition therapy of Crohn's disease is considered the first-line of
treatment for Crohn's disease in children, especially in Europe. This article
discusses the role, mechanism, and the available updated evidence supporting
use of this treatment to induce and maintain remission of Crohn's disease. It
also highlights the importance of the team approach in achieving success using
this treatment. Future research-related topics are briefly summarized.
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References
1.
El-Matary W, Spray C, Sandhu BK. Irritable bowel syndrome: the
commonest cause of recurrent abdominal pain in children. Eur J
Pediatr. 2004;63:584
-588.
2.
Savage M, Beattie R, Camacho-Hubner C, Walker-Smith J, Sanderson I.
Growth in Crohn's disease. Acta Pediatr Suppl.1999
;88:89
-92.
3.
Walker-Smith JA. Management of growth failure in Crohn's disease.
Arch Dis Child.1996
;75:351
-354.
4.
Bernstein C, Seeger L, Sayre J, Anton P, Artinian L, Shanahan F.
Decreased bone density in inflammatory bowel disease is related to
corticosteroid use and not disease diagnosis. J Bone Miner
Res. 1995;10:250
-256.
Han PD, Burke A, Baldassano RN, Rombeau JL, Lichtenstein GR.
Nutrition and inflammatory bowel disease. Gastroenterol Clin North
Am. 1999;28:423
-443.
7.
Gosh J, O'Morain CA. Nutrition and adult inflammatory bowel
disease. Aliment Pharmacol Ther.2003
;17:307
-320.
8.
Gokhale R, Favus MJ, Karrison T, Sutton MM, Rich B, Kirschner BS.
Bone mineral density assessment in children with inflammatory bowel disease.
Gastroenterology.1998
;114:902
-911.
9.
Seidman E, LeLeiko N, Ament M, et al. Nutritional issues in
pediatric inflammatory bowel disease. J Pediatr Gastroenterol
Nutr. 1991;12:424
-438.
10.
Crokins MR, Gohil AD, Fitzgerald JF. The insulin-like growth factor
I axis in children with inflammatory bowel disease. J Pediatr
Gastroenterol Nutr. 2003;36:228
-234.
11.
Gronbaek H, Thogersen T, Frystyk J, Vilstrup H, Flyvbjerg A,
Dahlerup JF. Low free and total insulin-like growth factor I (IGF-I) and
IGF-binding protein 3 levels in chronic inflammatory bowel disease: partial
normalisation during prednisolone treatment. Am J
Gastroenterol. 2002;97:673
-678.
12.
Ballinger AB, Azooz O, El-Haj T, Poole S, Farthing MJ. Growth
failure occurs through a decrease in insulin-like growth factor I which is
independent of undernutrition in a rat model of colitis.
Gut. 2000;46:1
-6.
13.
De Benedetti F, Alonzi T, Moretta A, et al. Interleukin-6 causes
growth impairment in transgenic mice through a decrease in insulin-like growth
factor I. J Clin Invest.1997
;99:643
-650.
14.
Habtezoin A, Silverberg MS, Parkes R, Mikolainis S, Steinhart AH.
Risk factors for low bone density in Crohn's disease. Inflamm Bowel
Dis. 2002;8:87
-92.
15.
Lashner BA, Prvencher KS, Seidner DL, Knesebeck A, Brzezinski A.
The effect of folic acid supplementation on the risk for cancer or dyspepsia
in ulcerative colitis. Gastroenterology.1997
:112:29
-32.
16.
Chowers Y, Sela BA, Holland R, Fidder H, Simoni FB, Barmeir S.
Increased levels of homocysteine in patients with Crohn's disease are related
to folate levels. Am J Gastroenterol.2000
;95:3498
-3502.
17.
McClain C, Soutor C, Zieve L. Zinc deficiency: a complication of
Crohn's disease. Gastroenterology.1980
;78:272
-279.
18.
Voitke AJ, Echave V, Brwon RA, Gurd FN. Use of elemental diet
during the adaptive stage of short gut syndrome.
Gastroenterology.1973
:65:419
-426.
19.
Nealon TF Jr, Grossi CE, Steier M. Use of elemental diets to
correct catabolic states prior to surgery. Ann Surg.1974
;180:9
-13.
20.
Goode A, Hawkines T, Feggetter JG, Johnston ID. Use of an elemental
diet for long-term nutritional support in Crohn's disease.
Lancet. 1976;1:122
-124.
21.
Voitke AJ, Echave V, Feller JH, Brwon RA, Gurd FN. Experience with
elemental diet in the treatment of inflammatory bowel disease. Is this primary
therapy? Arch Surg.1973
;107:329
-333.
22.
El-Matary W, Sharples P, Sandhu BK. Use of elemental feed as in
mesenteric ischemia. J Pediatr Gastroenterol. Nutr2003
;37:85
-86.
23.
Leach ST, Mitchell HM, Eng WR, Zhang L, Day AS. Exclusive enteral
nutrition alters the intestinal microbiota of children with Crohn's disease.
Gastroenterology.2005
;128:A511
.
24.
Ruemmele F, Roy C, Levy E, Siedman E. Nutrition as primary therapy
in pediatric Crohn's disease: fact or fantasy? J
Pediatr. 2000;136:285
-291.
25.
Siedman E. Nutritional management of inflammatory bowel disease.
Gastroenterol Clin North Am.1989
;18:129
-155.
26.
Sanderson IR, Croft NM. The anti-inflammatory effects of enteral
nutrition. JPEN J Parenter Enteral Nutr.2005
;29(suppl 4):S134
-S138.
27.
Greenberg GR, Fleming CR, Jeejeebhoy KN, Rosenberg IH, Sales D,
Tremaine WJ. Controlled trial of bowel rest and nutritional support in the
management of Crohn's disease. Gut.1988
;9:1309
-1315.
28.
Johnson T, Macdonald S, Hills SM, Thomas A, Murphy MS. Treatment of
active Crohn's disease in children using a partial enteral nutrition with
liquid formula: a randomised controlled trial. Gut.2006
;55:365
-361.
29.
Fell J, Hollis A, Paintin M, Arnaud-Battandier F, MacDonald TT,
Walker-Smith J. Normalisation of mucosal cytokine mRNA in association with
clinical improvement in children with Crohn's disease treated with polymeric
diet. J Pediatr Gastroenterol Nutr.1998
;26:A34
.
30.
Yamamoto T, Nagahigashi M, Umegae S. Impact of elemental diet on
mucosal inflammation in patients with active Crohn's disease: cytokine
production and endoscopic and histological findings. Inflamm Bowel
Dis. 2005;11:580
-588.
31.
Mills SC, Windsor AC, Knight SC. The potential interactions between
polyunsaturated fatty acids and colonic inflammatory processes.
Clin Exp Immunol.2005
;142:216
-228.
32.
Zachos M, Tondeur M, Griffiths AM. Enteral nutrition therapy for
inducing remission of Crohn's disease. Cochrane Database Syst
Rev. 2007;(1):CD000542
.
33.
Gassull MA. The role of nutrition in the treatment of inflammatory
bowel disease. Aliment Pharmacol Ther.2004
;20(suppl 4):79
-83.
34.
Belli DC, Seidman E, Bouthillier L, et al. Chronic intermittent
elemental diet improves growth in children with Crohn's disease.
Gastroenterology.1988
;94:603
-610.
35.
Siedman E. Gastrointestinal benefits of enteral feeds. In: Baker S,
Baker R, Davis A, eds. Paediatric Enteral Nutrition.
New York, NY: Chapman & Hall; 1994:46
-66.
36.
Sideman E, Leek N, Aments M. Symposium report: nutritional issues
in paediatric inflammatory bowel disease. J Pediatr Gastroenterol
Nutr. 1991;12:424
-438.
37.
Day AS, Whitten KE, Sidler M, Lemberg DA. Systemic review:
nutritional therapy in paediatric Crohn's disease. Aliment
Pharmacol Ther. 2008;28:293
-307.
38.
Griffiths A, Ohlsson A, Sherman P, Sutherland L. Meta-analysis of
enteral nutrition as a primary treatment of active Crohn's disease.
Gastroenterology.1995
;108:1056
-1067.
39.
Fernandez-Banares F, Cabre E, Esteve-Comas M, Gassull MA. How
effective is enteral nutrition in inducing clinical remission in active
Crohn's disease? A meta-analysis of the randomized clinical trials.
JPEN J Parenter Enteral Nutr.1995
;19:356
-364.
40.
Messori A, Trallori G, D'Alabasio G, Milla M, Vannozzi G, Pacini F.
Defined-formula diets versus steroids in the treatment of active Crohn's
disease: a meta-analysis. Scand J Gastroenterol.1996
;31:257
-272.
41.
Ghosh S, Cowen S, Hannan WJ, Ferguson A. Low bone mineral density
in Crohn's disease, but not in ulcerative colitis, at diagnosis.
Gastroenterology.1994
;107:1031
-1039.
Morin CL, Roulet M, Roy CC, Weber A. Continuous elemental enteral
alimentation in children with Crohn's disease and growth failure.
Gastroenterology.1980
;79:1205
-1210.
44.
Heuschkel R, Menache C, Megerian J, Baird A. Enteral nutrition and
corticosteroids in the treatment of acute Crohn's disease in children.
J Pediatr Gastroenterol Nutr.2000
;31:8
-15.
45.
Sanderson I, Udeen S, Davies P, Savage M, Walker-Smith J. Remission
induced by an elemental diet in small bowel Crohn's disease. Arch
Dis Child. 1987;62:123
-127.
46.
Zachos M, Tondeur M, Griffiths AM. Enteral nutrition therapy for
inducing remission of Crohn's disease. Cochrane Database Syst
Rev. 2001;(3):CD000542
.
47.
Rigaud D, Cosnes J, Le Quintrec Y, René E, Gendre JP, Mignon
M. Controlled trial comparing two types of enteral nutrition in treatment of
active Crohn's disease. Gut.1991
;32:1492
-1497.
48.
Yamamoto T, Nakahigashi M, Saniabadi AR, et al. Impacts of
long-term enteral nutrition on clinical and endoscopic disease activities and
mucosal cytokines during remission in patients with Crohn's disease: a
prospective study. Inflamm Bowel Dis.2007
;13:1493
-1501.
49.
Afzal N, Davies S, Paintin M, et al. Colonic Crohn's disease in
children does not respond well to treatment with enteral nutrition if ileum is
not involved. Dig Dis Sci.2005
;50:1471
-1475.
50.
Borrelli O, Cordischi L, Cirulli M, et al. Polymeric diet alone
versus corticosteroids in the treatment of active pediatric Crohn's disease: a
randomized controlled open-label trial. Clin Gastroenterol
Hepatol. 2006;4:744
-753.
51.
Fell J, Hollis A, Paintin M, et al. Mucosal healing and fall in
mucosal pro-inflammatory cytokine mRNA induced by specific polymeric diet in
paediatric Crohn's disease. Aliment Pharmacol Ther.2000
;14:281
-289.
52.
Afzal NA, Van Der Zaag-Loonen HJ, Arnaud-Battandier F, et al.
Improvement in quality of life in children with acute Crohn's disease does not
parallel mucosal healing after treatment with exclusive enteral nutrition.
Aliment Pharmacol Ther.2004
;20:167
-172.
53.
Yamamoto T, Nakahigashi M, Umegae S, Kitawaga K, Matsumoto K.
Impact of long-term enteral nutrition on clinical and endoscopic recurrence
after resection for Crohn's disease: a prospective, nonrandomized, parallel,
controlled study. Aliment Pharmacol Ther.2007
;25:67
-72.
54.
Seidman E, Jones A, Issenman R, Griffiths AM. Cyclical exclusive
enteral nutrition versus alternative day prednisone in maintaining remission
in pediatric Crohn's disease. J Pediatr Gastroenterol
Nutr. 1996;23:A334
.
55.
Wilschanski M, Sherman P, Pencharz P, Davis L, Corey M, Griffiths
A. Supplementary enteral nutrition maintains remission in paediatric Crohn's
disease. Gut.1996
;38:543
-548.
56.
Verma S, Kirkwood B, Brown S, Giaffer HM. Oral nutritional
supplementation is effective in the maintenance of remission in Crohn's
disease. Dig Liver Dis.2000
;32:769
-774.
57.
Takagi S, Utsunomiya K, Kuriyama S. Effectiveness of an `half
elemental diet' as maintenance therapy for Crohn's disease: a
randomized-controlled trial. Aliment Pharmacol Ther.2006
;24:1333
-1340.
58.
Akobeng AK, Thomas A. Enteral nutrition as maintenance therapy for
Crohn's disease. Cochrane Database Syst Rev.2007
;(3):CD005984
.
59.
Verma S, Holsworth CD, Giaffer MH. Does adjunctive nutritional
support diminish steroid dependency in Crohn's disease? Scan J
Gastroenterol. 2001;36:383
-388.
60.
Turner D, Zlotkin SH, Shah PS, Griffiths AM. Omega 3 fatty acids
(fish oil) for maintenance of remission in Crohn's disease.
Cochrane Database Syst Rev.2007
;(2):CD006320
.
61.
Feagan BG, Sandborn WJ, Mittmann U, et al. Omega-3 free fatty acids
for the maintenance of remission in Crohn's disease: the EPIC randomized
controlled trials. JAMA.2008
;299:1690
-1697.
62.
Akobeng AK, Miller V, Stanton J, Elbadri AM, Thomas AG.
Double-blind randomized controlled trial of glutamine-enriched polymeric diet
in the treatment of active Crohn's disease. J Pediatr Gastroenterol
Nutr. 2000;30:78
-84.
63.
Akobeng AK, Clayton PE, Miller V, Hall CM, Thomas AG. Low serum
concentrations of insulin-like growth factor-I in children with active Crohn's
disease: effect of enteral nutrition support and glutamine supplementation.
Scan J Gastroenterol.2002
;37:1422
-1427.
64.
Akobeng AK, Richmond K, Miller V, Thomas AG. Effect of exclusive
enteral nutritional treatment on plasma antioxidant concentrations in
childhood Crohn's disease. Clin Nutr.2007
;26:51
-56.
65.
Ruuska T, Savilati E, Maki M, Visakorpi J. Exclusive whole protein
enteral diet versus prednisolone in the treatment of acute Crohn's disease in
children. J Pediatr Gastroenterol Nutr.1994
;19:175
-180.
66.
Papadopoulou A, Rawashdeh M, Brown G, McNeish A, Booth I. Remission
following an elemental diet or prednisolone in Crohn's disease.
Acta Paediatr.1995
;84:79
-83.
67.
Beattie RM, Schiffrin EJ, Donnet-Hughs A. Polymeric nutrition as
the primary therapy in children with small bowel Crohn's disease.
Aliment Pharmacol Ther.1994
;8:609
-615.
68.
Raouf AH, Hildery V, Daniel J. Enteral feeding as sole treatment
for Crohn's disease: controlled trial of whole protein versus amino-acid based
feed and a case study of dietary challenge. Gut.1991
;32:702
-707.
69.
Park RHR, Galloway A, Danesh BJZ. A double-blind controlled trial
comparing elemental and polymeric diets as primary therapy in active Crohn's
disease. Eur J Gastroenterol Hepatol.1991
;32:1492
-1497.
70.
Verma S, Brown S, Kirkwood B, Giaffer MH. Polymeric versus
elemental diet as primary treatment in active Crohn's disease: a randomized,
double-blind trial. Am J Gastroenterol.2000
;95:735
-739.
71.
Ludvigsson JF, Krantz M, Bodin L, Stenhammar L, Lindquist B.
Elemental versus polymeric enteral nutrition in paediatric Crohn's disease: a
multicentre randomized controlled trial. Acta
Paediatr. 2004;93:327
-335.