Analysis of 61 exclusive enteral nutrition formulas used in management of active Crohn's disease - new insights into dietary disease triggers

Logan, M. et al. (2020) Analysis of 61 exclusive enteral nutrition formulas used in management of active Crohn's disease - new insights into dietary disease triggers. Alimentary Pharmacology and Therapeutics, 51(10), pp. 935-947. (doi: 10.1111/apt.15695) (PMID:32249975)

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Abstract

Background: Exclusive enteral nutrition (EEN) is an effective treatment for Crohn's disease. Aims: To investigate the hypothesis that ingredients of EEN formulas are unlikely to initiate a disease flare and that their dietary elimination is not essential for disease amelioration. Methods: We performed compositional analysis of EEN formulas with evidence of efficacy in management of active Crohn's disease. Macronutrient content was compared against the dietary reference values (DRV), the UK National Diet and Nutrition Survey (NDNS) and intake of Crohn's disease children. Food additives were cross‐referenced against the FAO/WHO database. Results: Sixty‐one formulas were identified with variable composition (carbohydrates [22.8%‐89.3%], protein [7.8%‐30.1%], fat [0%‐52.5%]). Maltodextrin, milk protein and vegetable/plant oils were the commonest macronutrient sources. Their n‐6:n‐3 fatty acid ratio varied from 0.25 to 46.5. 56 food additives were identified (median per formula: 11). All formulas were lactose‐free, gluten‐free, and 82% lacked fibre. The commonest food additives were emulsifiers, stabilisers, antioxidants, acidity regulators and thickeners. Food additives, implicated in Crohn's disease aetiology, were present in formulas (modified starches [100%], carrageenan [22%], carboxymethyl cellulose [13%] and polysorbate 80 [5%]). Remission rates did not differ between EEN formulas with and without those food additives. Analysis including only formulas from randomised controlled trials (RCTs) retained in the latest Cochrane meta‐analysis produced similar findings. EEN formulas contained less energy from saturated fat than NDNS intake. Conclusion: We have identified food ingredients which are present in EEN formulas that are effective in Crohn's disease and challenge perceptions that these ingredients might be harmful.

Item Type:Articles
Status:Published
Refereed:Yes
Glasgow Author(s) Enlighten ID:Hansen, Dr Richard and Russell, Dr Richard and Logan, Dr Michael and Gaya, Mr Daniel and Gkikas, Konstantinos and Macdonald, Dr Jonathan and Seenan, Dr John and Svolos, Mr Vaios and Nichols, Mr Ben and Milling, Professor Simon and Gerasimidis, Professor Konstantinos and Ijaz, Dr Umer
Authors: Logan, M., Gkikas, K., Svolos, V., Nichols, B., Milling, S., Gaya, D. R., Seenan, J., Macdonald, J., Hansen, R., Ijaz, U. Z., Russell, R. K., and Gerasimidis, K.
College/School:College of Medical Veterinary and Life Sciences > Institute of Infection Immunity and Inflammation
College of Medical Veterinary and Life Sciences > School of Medicine, Dentistry & Nursing
College of Science and Engineering > School of Engineering > Infrastructure and Environment
Journal Name:Alimentary Pharmacology and Therapeutics
Publisher:Wiley
ISSN:0269-2813
ISSN (Online):1365-2036
Published Online:06 April 2020
Copyright Holders:Copyright © 2020 The Authors
First Published:First published in Alimentary Pharmacology and Therapeutics 51(10): 935-947
Publisher Policy:Reproduced under a Creative Commons License

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Project CodeAward NoProject NamePrincipal InvestigatorFunder's NameFunder RefLead Dept
170256Understanding microbial community through in situ environmental 'omic data synthesisUmer Zeeshan IjazNatural Environment Research Council (NERC)NE/L011956/1ENG - Infrastructure & Environment
300280The Role of Dietary D-serine in Health and DiseaseAndrew RoeBiotechnology and Biological Sciences Research Council (BBSRC)BB/R006539/1III - Bacteriology