Development and validation of the Glasgow Exclusive Enteral Nutrition Index of Compliance

Jatkowska, A. et al. (2023) Development and validation of the Glasgow Exclusive Enteral Nutrition Index of Compliance. Journal of Crohn's and Colitis, 17(9), pp. 1426-1435. (doi: 10.1093/ecco-jcc/jjad063) (PMID:37004165) (PMCID:PMC10588781)

Abstract

Background and aims: Treatment adherence is key to the efficacy of exclusive enteral nutrition (100% EN) in active Crohn’s disease (CD), but there are no biomarkers to objectively estimate this. We explored faecal parameters as biomarkers of compliance with 100% EN, and subsequently developed and validated the Glasgow Exclusive Enteral Nutrition Index of Compliance (GENIE). Methods: Healthy adults replaced all (100% EN) or part (85% EN, 50% EN, 25% EN) of their diet with a formula for 7 days. Faecal pH, water content, short chain fatty acids and branched chain fatty acids (BCFAs) were measured before (D0) and after (D7) each intervention. Optimal biomarkers and threshold values were derived using receiver operating characteristic curve analyses and machine learning to develop the GENIE. The GENIE was then validated in 30 CD children, during and after 100% EN. Results Sixty-one adults were recruited. D7 faecal pH and the ratios of BCFAs to either acetate or butyrate performed the best to differentiate between patients on 100% EN from <100% EN. Two models were generated; one including faecal metabolites (Laboratory GENIE, L-GENIE; sensitivity, specificity, and positive predictive value (PPV) of 88%, 94%, and 92%) and a second one (Clinical Genie, C-GENIE) which considers only faecal pH (sensitivity, specificity and PPV of 84%, 86% and 81%). Validation of GENIE in CD children found that C-GENIE outperformed L-GENIE, producing a sensitivity, specificity and PPV of 85%, 88% and 88%, respectively. Conclusions GENIE can help predict adherence to 100% EN and may complement current conventional dietary assessment.

• Item Type: Articles
• Additional Information: This work was supported by Nestle Health Science.
• Status: Published
• Refereed: Yes
• Glasgow Author(s) Enlighten ID: Hansen, Dr Richard and Russell, Dr Richard and Gaya, Mr Daniel and White, Ms Bernadette and Macdonald, Dr Jonathan and Seenan, Dr John and Svolos, Dr Vaios and Jatkowska, Aleksandra and Gkikas, Dr Konstantinos and Brownson, Dr Emily and Nichols, Mr Ben and Milling, Professor Simon and Gerasimidis, Professor Konstantinos
• Authors: Jatkowska, A., White, B., Nichols, B., Svolos, V., Gkikas, K., Hansen, R., Russell, R. K., Gaya, D., Brownson, E., Seenan, J. P., Milling, S., MacDonald, J., and Gerasimidis, K.
• College/School: College of Medical Veterinary and Life Sciences > School of Infection & Immunity; College of Medical Veterinary and Life Sciences > School of Medicine, Dentistry & Nursing
• Research Centre: College of Medical Veterinary and Life Sciences > School of Infection & Immunity > Centre for Immunobiology
• Journal Name: Journal of Crohn's and Colitis
• Publisher: Oxford University Press
• ISSN: 1873-9946
• ISSN (Online): 1876-4479
• Published Online: 02 April 2023
• Copyright Holders: Copyright © 2023 The Authors
• First Published: First published in Journal of Crohn's and Colitis 17(9):1426–1435
• Publisher Policy: Reproduced under a Creative Commons License