INFLAMMATION AND INFLAMMATORY BOWEL DISEASE

Fat composition may be a clue to explain the primary therapeutic effect of enteral nutrition in Crohn's disease: results of a double blind randomised multicentre European trial

M A Gassull¹, F Fernández-Bañares¹, E Cabré¹, M Papo², M H Giaffer³, J L Sánchez-Lombraña⁴, C Richart², H Malchow⁵, F González-Huix⁶ and M Esteve¹ European Group on Enteral Nutrition in Crohn's Disease

¹ Department of Gastroenterology, Hospital Universitari Germans Trias i Pujol, Badalona, Spain
² Gastroenterology Unit, Hospital Joan XXIII, Tarragona, Spain
³ Department of Gastroenterology, Royal Hull Hospitals NHS Trust, UK
⁴ Department of Gastroenterology, Complejo Hospitalario de Oviedo, Oviedo, Spain
⁵ Medical Clinic 2, Klinikum Leverkusen, Leverkusen, Germany
⁶ Gastroenterology Unit, Hospital Josep Trueta, Girona, Spain

Correspondence to:
Correspondence to:
Dr M A Gassull, Department of Gastroenterology, Hospital Universitari Germans Trias i Pujol, Carretera del Canyet s/n, 08916 Badalona, Spain;
mgassull{at}ns.hugtip.scs.es

Background: Dietary fat has been suggested to determine the therapeutic effect of enteral diets in Crohn's disease.

Aim: To assess the efficacy of two whole protein based diets with different fat compositions (n6 polyunsaturated fatty acids v monounsaturated fatty acids) in inducing clinical remission in active Crohn's disease compared with steroids.

Methods: Sixty two patients with active Crohn's disease were randomised to receive, for not more than 4 weeks: (a) a polymeric enteral diet containing 35 g of lipids per 1000 kcal, high in oleate (79%) and low in linoleate (6.5%) (PEN1), (b) an identical enteral diet except for the type of fat which was high in linoleate (45%) and low in oleate (28%) (PEN2), or (c) oral prednisone (1 mg/kg/day). Diets were double blindly administered. The steroid group received a conventional ward diet. Treatment failure was considered when remission was not achieved at week 4. Clinical activity and biological and nutritional parameters were monitored. Independent predictors of remission were identified by stepwise logistic regression analysis.

Results: Overall remission rates (by intention to treat) were 20% (4/20) for PEN1, 52% (12/23) for PEN2, and 79% (15/19) for steroids (overall p=0.001; p<0.0005 steroids v PEN1, and p=0.056 PEN2 v PEN1). After excluding those patients who were non-compliant during the first week (per protocol analysis), remission rates were 27%, 63%, and 79%, respectively (p=0.008, steroids and PEN2 v PEN1). After adjusting for confounding variables, PEN1 remained significantly associated with a poor response.

Conclusion: The type of dietary fat may be of importance for the primary therapeutic effect of enteral nutrition in active Crohn's disease.

Keywords: enteral nutrition; Crohn's disease; fat

Abbreviations: CD, Crohn's disease; CRP, C reactive protein; VHAI, Van Hees' activity index; PEN, polymeric enteral nutrition; NRI, nutritional risk index; LRA, logistic regression analysis; MCT, medium chain triglycerides; LCT, long chain triglycerides; EN, enteral nutrition; MUFA, monounsaturated fatty acids; PUFA, polyunsaturated fatty acids; ESR, erythrocyte sedimentation rate; CDAI, Crohn's disease activity index

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