Adults with mild-to-moderate Crohn’s disease could benefit from the CD exclusion diet (CDED) with or without partial enteral nutrition, a pilot study suggests.
The Nestle Health Science-funded study of 91 biologic-naive patients with active Crohn’s disease saw 63% of those on the high-protein, low-animal fat, low-haem, low-gluten and low-additive diet with fibre exposure achieve remission within six weeks of treatment initiation, regardless of partial enteral nutrition use (68% with supplement versus 57% without, P = 0.4618).
Of those who achieved remission at Week 6, 50% had sustained remission at Week 24 while 35% of all treated patients had endoscopic remission at the same time point.
A few patients experienced disease exacerbation (three on CDED plus partial enteral nutrition and two on CDED alone) during the trial, though no serious or treatment-related adverse events were reported, gastroenterologist and head of the Rabin Medical Center’s Division of Gastroenterology Dr Henit Yanai and her team wrote in the Lancet Gastroenterology and Hepatology.
This is the first time CDED has shown efficacy in adults with mild-to-moderate Crohn’s disease who weren’t on concurrent immunomodulators or steroids, though it has previously proven effective in children with partial enteral nutrition, they wrote.
Dietary therapy could be an “ideal” alternative to immunosuppressants in patients with milder or uncomplicated disease, saving them from unnecessary side-effects and high costs, the authors suggested.
It could also act as a “as a bridge to medical therapy if there is a delay in instituting medical therapy, and might address the involvement of diet as a trigger of inflammation”.
Gastroenterologist and University of Toronto Clinical Nutrition fellow, Dr Alexa Sasson welcomed the results in an accompanying editorial, saying CDED “is promising and paves the way for inclusion of dietary monotherapy in the treatment of Crohn’s disease”.
Along with being safer (when nutritionally adequate) and more cost-effective than medical treatments, dietary therapy “is not subject to disruption by burdensome authorisation policies and pharmacy-associated delays” and “can be incorporated into daily life”, she wrote.
Further research into the efficacy of each included and excluded food (chicken breast, eggs, partial enteral nutrition and some fruits and vegetables, with no wheat or food additives) and the importance of strict adherence is needed, however.
Therefore, the diet may best serve patients “with mild-to-moderate disease activity with low risk of disease progression who are highly motivated, have appropriate resources, and close clinical follow-up”, Dr Sasson suggested.
“Adjunctive dietary measures might be considered in all interested patients as a method of improving gastrointestinal-related symptoms and quality of life, with the potential to achieve a higher and more sustained level of remission,” she added.
Variable efficacy of diet in previous IBD trials, likely driven by pre-intervention long-term dietary patterns, interindividual differences in gut microbial composition, and dynamic response to diet, could allow for more personalised treatment approaches for “enhanced clinical intervention”.
“Future studies incorporating larger, randomised trials with long-term follow-up are essential to guide treatment decisions and further identify which patients might derive benefit from this dietary approach,” she concluded.