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An update of the role of nutritional therapy in the management of Crohn’s disease

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Abstract

Crohn’s disease is an increasingly global health concern. Currently without a cure, it significantly alters the quality of life of Crohn’s disease sufferers and places a heavy financial burden on the community. Recent reports show that the rising prevalence of Crohn’s disease is no longer confined to Western countries, with considerable increases seen particularly in Asia. Nutritional problems are often associated with Crohn’s disease, most notably in the paediatric population, with underweight and stunting commonly seen at presentation. In addition, linear growth retardation and pubertal delay can also manifest in these younger patients. Therefore, exclusive enteral nutrition has been used as a therapeutic option to treat Crohn’s disease, in part to address the nutritional complications of the disease. Exclusive enteral nutrition can improve nutrition as well as induce remission at a rate equivalent to corticosteroids. It is safe particularly with long-term use and can induce mucosal healing, considered the gold standard for therapy, at a rate superior to corticosteroids. Exclusive enteral nutrition has thus become the preferred therapeutic option in many centres for the treatment of paediatric Crohn’s disease. This review discusses the role of exclusive enteral nutrition as a therapeutic option for the treatment of Crohn’s disease, as well as the latest findings into its mechanisms of action.

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References

  1. Pariente B, Peyrin-Biroulet L, Cohen L, Zagdanski AM, Colombel JF. Gastroenterology review and perspective: the role of cross-sectional imaging in evaluating bowel damage in Crohn disease. Am J Roentgenol. 2011;197:42–9.

    Article  Google Scholar 

  2. Parray F, Wani M, Bijli A, Thakur N, Irshad I. Crohn’s disease: a surgeon’s perspective. Saudi J Gastroenterol. 2011;17:6.

    Article  PubMed  Google Scholar 

  3. Molodecky NA, Soon IS, Rabi DM, Ghali WA, Ferris M, Chernoff G, et al. Increasing incidence and prevalence of the inflammatory bowel diseases with time, based on systematic review. Gastroenterology. 2012;142:46–54.

    Article  PubMed  Google Scholar 

  4. Economou M, Pappas G. New global map of Crohn’s disease: genetic, environmental, and socioeconomic correlations. Inflamm Bowel Dis. 2008;14:709–20.

    Article  PubMed  Google Scholar 

  5. Wilson J, Hair C, Knight R, Catto Smith A, Bell S, Kamm M, et al. High incidence of inflammatory bowel disease in Australia: a prospective population based Australian incidence study. Inflamm Bowel Dis. 2010;16:1550–6.

    Article  PubMed  Google Scholar 

  6. Gearry RB, Richardson A, Frampton C, Collett JA, Burt MJ, Chapman BA, et al. High incidence of Crohn’s disease in Canterbury, New Zealand: results of an epidemiologic study. Inflamm Bowel Dis. 2006;12:936–43.

    Article  PubMed  Google Scholar 

  7. Lakatos PL. Recent trends in the epidemiology of inflammatory bowel diseases: up or down? World J Gastroenterol. 2006;12:6102.

    PubMed  Google Scholar 

  8. Goh K, XIAO SD. Inflammatory bowel disease: a survey of the epidemiology in Asia. J Dig Dis. 2009;10:1–6.

    Article  PubMed  Google Scholar 

  9. Asakura K, Nishiwaki Y, Inoue N, Hibi T, Watanabe M, Takebayashi T. Prevalence of ulcerative colitis and Crohn’s disease in Japan. J Gastroenterol. 2009;44:659–65.

    Article  PubMed  Google Scholar 

  10. Sartor B. Bacteria in Crohn’s disease: mechanisms of inflammation and therapeutic implications. J Clin Gastroenterol. 2007;41:S37.

    Article  Google Scholar 

  11. Lichtenstein GR. Emerging prognostic markers to determine Crohn’s disease natural history and improve management strategies: a review of recent literature. Gastroenterol Hepatol (N Y). 2010;6:99.

    Google Scholar 

  12. Rampton DS. Management of Crohn’s disease. BMJ. 1999;319:1480.

    Article  PubMed  CAS  Google Scholar 

  13. Scribano M, Prantera C. Medical treatment of active Crohn’s disease. Aliment Pharmacol Ther. 2002;16:35–9.

    Article  PubMed  Google Scholar 

  14. Ordás I, Feagan BG, Sandborn WJ. Early use of immunosuppressives or TNF antagonists for the treatment of Crohn’s disease: time for a change. Gut. 2011;60:1754–63.

    Article  PubMed  Google Scholar 

  15. Rutgeerts P, Lofberg R, Malchow H, Lamers C, Olaison G, Jewell D, et al. A comparison of budesonide with prednisolone for active Crohn’s disease. N Engl J Med. 1994;331:842–5.

    Article  PubMed  CAS  Google Scholar 

  16. Lichtenstein GR, Abreu MT, Cohen R, Tremaine W. American Gastroenterological Association Institute technical review on corticosteroids, immunomodulators, and infliximab in inflammatory bowel disease. Gastroenterology. 2006;130:940.

    Article  PubMed  CAS  Google Scholar 

  17. Smith PA. Nutritional therapy for active Crohn’s disease. World J Gastroenterol. 2008;14:4420.

    Article  PubMed  Google Scholar 

  18. Allez M, Vermeire S, Mozziconacci N, Michetti P, Laharie D, Louis E, et al. The efficacy and safety of a third anti-TNF monoclonal antibody in Crohn’s disease after failure of two other anti-TNF antibodies. Aliment Pharmacol Ther. 2010;31:92–101.

    Article  PubMed  CAS  Google Scholar 

  19. Danese S, Colombel JF, Reinisch W, Rutgeerts P. Review article: infliximab for Crohn’s disease treatment—shifting therapeutic strategies after 10 years of clinical experience. Aliment Pharmacol Ther. 2011.

  20. Lichtenstein GR, Hanauer SB, Sandborn WJ. Management of Crohn’s disease in adults. Am J Gastroenterol. 2009;104:465–83.

    Article  PubMed  Google Scholar 

  21. Arnott IDR, McDonald D, Williams A, Ghosh S. Clinical use of infliximab in Crohn’s disease: the Edinburgh experience. Aliment Pharmacol Ther. 2001;15:1639–46.

    Article  PubMed  CAS  Google Scholar 

  22. Ten Hove T, Van Montfrans C, Peppelenbosch M, Van Deventer S. Infliximab treatment induces apoptosis of lamina propria T lymphocytes in Crohn’s disease. Gut. 2002;50:206.

    Article  PubMed  Google Scholar 

  23. Rutgeerts P, Assche G, Vermeire S. Review article: infliximab therapy for inflammatory bowel disease—seven years on. Aliment Pharmacol Ther. 2006;23:451–63.

    Article  PubMed  CAS  Google Scholar 

  24. Nielsen OH, Seidelin JB, Munck LK, Rogler G. Use of biological molecules in the treatment of inflammatory bowel disease. J Intern Med. 2011.

  25. Moustou AE, Matekovits A, Dessinioti C, Antoniou C, Sfikakis PP, Stratigos AJ. Cutaneous side effects of anti-tumor necrosis factor biologic therapy: a clinical review. J Am Acad Dermatol. 2009;61:486–504.

    Article  PubMed  CAS  Google Scholar 

  26. De Bie CI, Hummel T, Kindermann A, Kokke F, Damen GM, Kneepkens C, et al. The duration of effect of infliximab maintenance treatment in paediatric Crohn’s disease is limited. Aliment Pharmacol Ther. 2011.

  27. Rubio A, Pigneur B, Garnier‐Lengliné H, Talbotec C, Schmitz J, Canioni D, et al. The efficacy of exclusive nutritional therapy in paediatric Crohn’s disease, comparing fractionated oral vs. continuous enteral feeding. Aliment Pharmacol Ther. 2011.

  28. Hiwatashi N. Enteral nutrition for Crohn’s disease in Japan. Dis Colon Rectum. 1997;40:48–53.

    Article  Google Scholar 

  29. El-Matary W. Enteral nutrition as a primary therapy of Crohn’s disease: the pediatric perspective. Nutr Clin Pract. 2009;24:91.

    Article  PubMed  Google Scholar 

  30. Day A, Whitten K, Sidler M, Lemberg D. Systematic review: nutritional therapy in paediatric Crohn’s disease. Aliment Pharmacol Ther. 2008;27:293–307.

    Article  PubMed  CAS  Google Scholar 

  31. Voitk AJ, Echave V, Feller JH, Brown RA, Gurd FN. Experience with elemental diet in the treatment of inflammatory bowel disease: is this primary therapy? Arch Surg. 1973;107:329.

    Article  PubMed  CAS  Google Scholar 

  32. Grogan JL, Casson DH, Terry A, Burdge GC, El-Matary W, Dalzell AM. Enteral feeding therapy for newly diagnosed pediatric crohn’s disease: A double-blind randomized controlled trial with two years follow-up. Inflamm Bowel Dis. 2012.

  33. Rajendran N, Kumar D. Role of diet in the management of inflammatory bowel disease. World J Gastroenterol. 2010;16:1442.

    Article  PubMed  CAS  Google Scholar 

  34. Verma S, Brown S, Kirkwood B, Giaffer M. Polymeric versus elemental diet as primary treatment in active Crohn’s disease: a randomized, double-blind trial. Am J Gastroenterol. 2000;95:735–9.

    Article  PubMed  CAS  Google Scholar 

  35. Sakurai T, Matsui T, Yao T, Takagi Y, Hirai F, Aoyagi K, et al. Short-term efficacy of enteral nutrition in the treatment of active Crohn’s disease: a randomized, controlled trial comparing nutrient formulas. J Parenter Enteral Nutr. 2002;26:98–103.

    Article  CAS  Google Scholar 

  36. Heuschkel R. Enteral nutrition in crohn disease: more than just calories. J Pediatr Gastroenterol Nutr. 2004;38:239.

    Article  PubMed  Google Scholar 

  37. Hartman C, Eliakim R, Shamir R. Nutritional status and nutritional therapy in inflammatory bowel diseases. World J Gastroenterol. 2009;15:2570.

    Article  PubMed  CAS  Google Scholar 

  38. Zachos M, Tondeur M, Griffiths A. Enteral nutritional therapy for induction of remission in Crohn’s disease. Cochrane Database Syst Rev. 2007;24:CD000542.

    Google Scholar 

  39. Beattie RM. Enteral nutrition as primary therapy in childhood Crohn’s disease: control of intestinal inflammation and anabolic response. J Parenter Enteral Nutr. 2005;29:S151–9.

    Article  Google Scholar 

  40. Ruemmele FM, Roy CC, Levy E, Seidman EG. Nutrition as primary therapy in pediatric Crohn’s disease: fact or fantasy? J Pediatr. 2000;136:285.

    Article  PubMed  CAS  Google Scholar 

  41. Escher JC, Taminiau JAJM, Nieuwenhuis EES, Büller HA, Grand RJ. Treatment of inflammatory bowel disease in childhood: best available evidence. Inflamm Bowel Dis. 2003;9:34–58.

    Article  PubMed  Google Scholar 

  42. Heuschkel R. Enteral nutrition should be used to induce remission in childhood Crohn’s disease. Dig Dis. 2009;27:297–305.

    Article  PubMed  Google Scholar 

  43. Levine A, Milo T, Buller H, Markowitz J. Consensus and controversy in the management of pediatric Crohn disease: an international survey. J Pediatr Gastroenterol Nutr. 2003;36:464.

    Article  PubMed  Google Scholar 

  44. Lochs H, Dejong C, Hammarqvist F, Hebuterne X, Leon-Sanz M, Schutz T, et al. ESPEN guidelines on enteral nutrition: gastroenterology. Clini Nutr. 2006;25:260–74.

    Article  CAS  Google Scholar 

  45. Matsui T, Sakurai T, Yao T. Nutritional therapy for Crohn’s disease in Japan. J Gastroenterol. 2005;40:25–31.

    Article  PubMed  Google Scholar 

  46. Day AS, Whitten KE, Lemberg DA, Clarkson C, Vitug-Sales M, Jackson R, et al. Exclusive enteral feeding as primary therapy for Crohn’s disease in Australian children and adolescents: a feasible and effective approach. J Gastroenterol Hepatol. 2006;21:1609–14.

    Article  PubMed  Google Scholar 

  47. Berni B, Canani R, Terrin G, Borrelli O, Romano M, Manguso F, Coruzzo A, et al. Short- and long-term therapeutic efficacy of nutritional therapy and corticosteroids in paediatric Crohn’s disease. Dig liver Dis. 2006;38:381–7.

    Article  CAS  Google Scholar 

  48. Heuschkel RB, Menache CC, Megerian JT, Baird AE. Enteral nutrition and corticosteroids in the treatment of acute Crohn’s disease in children. J Pediatr Gastroenterol Nutr. 2000;31:8.

    Article  PubMed  CAS  Google Scholar 

  49. Dziechciarz P, Horvath A, Shamir R, Szajewska H. Meta-analysis: enteral nutrition in active Crohn’s disease in children. Aliment Pharmacol Ther. 2007;26:795–806.

    Article  PubMed  CAS  Google Scholar 

  50. Buchanan E, Gaunt W, Cardigan T, Garrick V, McGrogan P, Russell R. The use of exclusive enteral nutrition for induction of remission in children with Crohn’s disease demonstrates that disease phenotype does not influence clinical remission. Aliment Pharmacol Ther. 2009;30:501–7.

    Article  PubMed  CAS  Google Scholar 

  51. 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;62:123–7.

    Article  PubMed  CAS  Google Scholar 

  52. Seidman E, Lohoues M, Turgeon J, Bouthillier L, Morin C. Elemental diet versus prednisone as initial therapy in Crohn’s disease: early and long term results. Gastroenterology. 1991;100:A250.

    Google Scholar 

  53. Seidman E, Griffiths A, Jones A, Issenman R. Semi-elemental (SE) diet versus prednisone in pediatric Crohn’s disease. Gastroenterology. 1993;104:A778.

    Google Scholar 

  54. Thomas A, Taylor F, Miller V. Dietary intake and nutritional treatment in childhood Crohn’s disease. J Pediatr Gastroenterol Nutr. 1993;17:75.

    Article  PubMed  CAS  Google Scholar 

  55. Ruuska T, Savilahti E, Mäki M, Örmälä T, 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.

    Article  PubMed  CAS  Google Scholar 

  56. Yamamoto T, Nakahigashi M, Umegae S, Kitagawa T, Matsumoto K. 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;11:580–8.

    Article  PubMed  Google Scholar 

  57. Borrelli O, Cordischi L, Cirulli M, Paganelli M, Labalestra V, Uccini S, 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;4:744–53.

    Article  PubMed  Google Scholar 

  58. Knight C, El-Matary W, Spray C, Sandhu BK. Long-term outcome of nutritional therapy in paediatric Crohn’s disease. Clin Nutr. 2005;24:775–9.

    Article  PubMed  CAS  Google Scholar 

  59. Takagi S, Utsunomiya K, Kuriyama S, Yokoyama H, Takahashi S, Iwabuchi M, et al. Effectiveness of an ‘half elemental diet’ as maintenance therapy for Crohn’s disease: a randomized-controlled trial. Aliment Pharmacol Ther. 2006;24:1333–40.

    Article  PubMed  CAS  Google Scholar 

  60. Esaki M, Matsumoto T, Nakamura S, Yada S, Fujisawa K, Jo Y, et al. Factors affecting recurrence in patients with Crohn’s disease under nutritional therapy. Dis Colon Rectum. 2006;49:68–74.

    Article  Google Scholar 

  61. Yamamoto T, Nakahigashi M, Umegae S, Matsumoto K. Enteral nutrition for the maintenance of remission in Crohn’s disease: a systematic review. Eur J Gastroenterol Hepatol. 2010;22:1.

    Article  PubMed  CAS  Google Scholar 

  62. Ikeuchi H, Yamamura T, Nakano H, Kosaka T, Shimoyama T, Fukuda Y. Efficacy of nutritional therapy for perforating and non-perforating Crohn’s disease. Hepatogastroenterology. 2004;51:1050–2.

    PubMed  Google Scholar 

  63. Esaki M, Matsumoto T, Hizawa K, Nakamura S, Jo Y, Mibu R, et al. Preventive effect of nutritional therapy against postoperative recurrence of Crohn disease, with reference to findings determined by intra-operative enteroscopy. Scand J Gastroenterol. 2005;40:1431–7.

    Article  PubMed  Google Scholar 

  64. Yamamoto T, Nakahigashi M, Saniabadi AR, Iwata T, Maruyama Y, Umegae S, 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;13:1493–501.

    Article  PubMed  Google Scholar 

  65. Yamamoto T, Nakahigashi M, Umegae S, Kitagawa T, Matsumoto K. Impact of long-term enteral nutrition on clinical and endoscopic recurrence after resection for Crohn’s disease: a prospective, non-randomized, parallel, controlled study. Aliment Pharmacol Ther. 2007;25:67–72.

    Article  PubMed  CAS  Google Scholar 

  66. Lucendo AJ, De Rezende LC. Importance of nutrition in inflammatory bowel disease. World J Gastroenterol. 2009;15:2081.

    Article  PubMed  CAS  Google Scholar 

  67. Goulet O. Nutrition in paediatric Crohn’s disease. S Afr J Clin Nutr. 2010;23.

  68. Beattie R, Schiffrin E, Donnet-Hughes A, Huggett A, Domizio P, MacDonald T, et al. Polgmeric nutrition as the primary therapy in children with small bowel Crohn’s disease. Aliment Pharmacol Ther. 1994;8:609–15.

    Article  PubMed  CAS  Google Scholar 

  69. Breese E, Michie C, Nicholls S, Williams C. The effect of treatment on lymphokine-secreting cells in the intestinal mucosa of children with Crohn’s disease. Aliment Pharmacol Ther. 1995;9:547–52.

    Article  PubMed  CAS  Google Scholar 

  70. Fell J, Paintin M, Arnaud-Battandier F, Beattie R, Hollis A, Kitching P, et al. Mucosal healing and a fall in mucosal pro-inflammatory cytokine mRNA induced by a specific oral polymeric diet in paediatric Crohn’s disease. Aliment Pharmacol Ther. 2000;14:281–90.

    Article  PubMed  CAS  Google Scholar 

  71. Bannerjee K, Camacho-Hübner C, Babinska K, Dryhurst KM, Edwards R, Savage MO, et al. Anti-inflammatory and growth-stimulating effects precede nutritional restitution during enteral feeding in Crohn disease. J Pediatr Gastroenterol Nutr. 2004;38:270.

    Article  PubMed  CAS  Google Scholar 

  72. Meister D, Bode J, Shand A, Ghosh S. Anti-inflammatory effects of enteral diet components on Crohn’s disease-affected tissues in vitro. Dig Liver Dis. 2002;34:430–8.

    Article  PubMed  CAS  Google Scholar 

  73. de Jong NSH, Leach ST, Day AS. Polymeric formula has direct anti-inflammatory effects on enterocytes in an in vitro model of intestinal inflammation. Dig Dis Sci. 2007;52:2029–36.

    Article  PubMed  CAS  Google Scholar 

  74. Flaring U, Rooyackers O, Wernerman J, Hammarqvist F. Glutamine attenuates post-traumatic glutathione depletion in human muscle. Clin Sci. 2003;104:275–82.

    Article  PubMed  CAS  Google Scholar 

  75. Morrison AL, Dinges M, Singleton KD, Odoms K, Wong HR, Wischmeyer PE. Glutamine’s protection against cellular injury is dependent on heat shock factor-1. Am J Physiol Cell Physiol. 2006;290:C1625.

    Article  PubMed  CAS  Google Scholar 

  76. Garrel D, Patenaude J, Nedelec B, Samson L, Dorais J, Champoux J, et al. Decreased mortality and infectious morbidity in adult burn patients given enteral glutamine supplements: a prospective, controlled, randomized clinical trial. Crit Care Med. 2003;31:2444.

    Article  PubMed  CAS  Google Scholar 

  77. Boelens PG, Houdijk APJ, Fonk J, Nijveldt RJ, Ferwerda CC, Von Blomberg-Van der Flier BME, et al. Glutamine-enriched enteral nutrition increases HLA-DR expression on monocytes of trauma patients. J Nutr. 2002;132:2580–6.

    PubMed  CAS  Google Scholar 

  78. Wischmeyer PE, Lynch J, Liedel J, Wolfson R, Riehm J, Gottlieb L, et al. Glutamine administration reduces Gram-negative bacteremia in severely burned patients: a prospective, randomized, double-blind trial versus isonitrogenous control. Crit Care Med. 2001;29:2075.

    Article  PubMed  CAS  Google Scholar 

  79. Goeters C, Wenn A, Mertes N, Wempe C, Van Aken H, Stehle P, et al. Parenteral l-alanyl-l-glutamine improves 6-month outcome in critically ill patients. Crit Care Med. 2002;30:2032.

    Article  PubMed  CAS  Google Scholar 

  80. Singleton KD, Wischmeyer PE. Glutamine’s protection against sepsis and lung injury is dependent on heat shock protein 70 expression. Am J Physiol Regul Integr Comp Physiol. 2007;292:R1839.

    Article  PubMed  CAS  Google Scholar 

  81. Fillmann H, Kretzmann NA, San-Miguel B, Llesuy S, Marroni N, González-Gallego J, et al. Glutamine inhibits over-expression of pro-inflammatory genes and down-regulates the nuclear factor kappaB pathway in an experimental model of colitis in the rat. Toxicology. 2007;236:217–26.

    Article  PubMed  CAS  Google Scholar 

  82. Li N, Liboni K, Fang MZ, Samuelson D, Lewis P, Patel R, et al. Glutamine decreases lipopolysaccharide-induced intestinal inflammation in infant rats. Am J Physiol Gastrointest Liver Physiol. 2004;286:G914–21.

    Article  PubMed  CAS  Google Scholar 

  83. Lecleire S, Hassan A, Marion-Letellier R, Antonietti M, Savoye G, Bôle-Feysot C, et al. Combined glutamine and arginine decrease proinflammatory cytokine production by biopsies from Crohn’s patients in association with changes in nuclear factor-kappaB and p38 mitogen-activated protein kinase pathways. J Nutr. 2008;138:2481.

    Article  PubMed  CAS  Google Scholar 

  84. Bamba T, Shimoyama T, Sasaki M, Tsujikawa T, Fukuda Y, Koganei K, et al. Dietary fat attenuates the benefits of an elemental diet in active Crohn’s disease: a randomized, controlled trial. Eur J Gastroenterol Hepatol. 2003;15:151.

    Article  PubMed  CAS  Google Scholar 

  85. Gassull M, Fernandez-Banares F, Cabre E, Papo M, Giaffer M, Sanchez-Lombrana J, et al. 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. Gut. 2002;51:164–8.

    Article  PubMed  CAS  Google Scholar 

  86. Gorard DA. Enteral nutrition in Crohn’s disease: fat in the formula. Eur J Gastroenterol Hepatol. 2003;15:115.

    Article  PubMed  CAS  Google Scholar 

  87. Mañé J, Pedrosa E, Lorén V, Ojanguren I, Fluvià L, Cabré E, et al. Partial replacement of dietary (n-6) fatty acids with medium-chain triglycerides decreases the incidence of spontaneous colitis in interleukin-10-deficient mice. J Nutr. 2009;139:603–10.

    Article  PubMed  CAS  Google Scholar 

  88. Shoda R, Matsueda K, Yamato S, Umeda N. Epidemiologic analysis of Crohn disease in Japan: increased dietary intake of n-6 polyunsaturated fatty acids and animal protein relates to the increased incidence of Crohn disease in Japan. Am J Clin Nutr. 1996;63:741–5.

    PubMed  CAS  Google Scholar 

  89. Hartman C, Berkowitz D, Weiss B, Shaoul R, Levine A, Adiv OE, et al. Nutritional supplementation with polymeric diet enriched with transforming growth factor-beta 2 for children with Crohn’s disease. Isr Med Assoc J. 2008;10:503–7.

    PubMed  Google Scholar 

  90. D’Haens G. Mucosal healing in pediatric Crohn’s disease. The goal of medical treatment. Inflamm Bowel Dis. 2004;10:479–80.

    Article  PubMed  Google Scholar 

  91. Tibble JA, Sigthorsson G, Bridger S, Fagerhol MK, Bjaranson I. Surrogate markers of intestinal inflammation are predictive of relapse in patients with inflammatory bowel disease. Gastroenterology. 2000;119:15–22.

    Article  PubMed  CAS  Google Scholar 

  92. Afzal N, Van Der Zaag-Loonen H, Arnaud-Battandier F, Davies S, Murch S, Derkx B, et al. Improvement in quality of life of children with acute Crohn’s disease does not parallel mucosal healing after treatment with exclusive enteral nutrition. Aliment Pharmacol Ther. 2004;20:167–72.

    Article  PubMed  CAS  Google Scholar 

  93. Lionetti P, Callegari ML, Ferrari S, Cavicchi MC, Pozzi E, de Martino M, et al. Enteral nutrition and microflora in pediatric Crohn’s disease. J Parenter Enteral Nutr. 2005;29:S173.

    Article  Google Scholar 

  94. Leach S, Mitchell H, Eng W, Zhang L, Day A. Sustained modulation of intestinal bacteria by exclusive enteral nutrition used to treat children with Crohn’s disease. Aliment Pharmacol Ther. 2008;28:724–33.

    Article  PubMed  CAS  Google Scholar 

  95. Greenberg G, Fleming C, Jeejeebhoy K, Rosenberg I, Sales D, Tremaine W. Controlled trial of bowel rest and nutritional support in the management of Crohn’s disease. Gut. 1988;29:1309.

    Article  PubMed  CAS  Google Scholar 

  96. Newby E, Sawczenko A, Thomas A, Wilson D. Interventions for growth failure in childhood Crohn’s disease. Cochrane Database Syst Rev. 2005;3:CD003873.

    Google Scholar 

  97. Sawczenko A, Sandhu B. Presenting features of inflammatory bowel disease in Great Britain and Ireland. Arch Dis Child. 2003;88:995–1000.

    Article  PubMed  CAS  Google Scholar 

  98. Yamamoto T, Nakahigashi M, Saniabadi A. Review article: diet and inflammatory bowel disease–epidemiology and treatment. Aliment Pharmacol Ther. 2009;30:99–112.

    Article  PubMed  CAS  Google Scholar 

  99. Wiskin AE, Wootton SA, Beattie RM. Nutrition issues in pediatric Crohn’s disease. Nutr Clin Pract. 2007;22:214–22.

    Article  PubMed  Google Scholar 

  100. Moorthy D, Cappellano KL, Rosenberg IH. Nutrition and Crohn’s disease: an update of print and web-based guidance. Nutr Rev. 2008;66:387–97.

    Article  PubMed  Google Scholar 

  101. Goh J, O’Morain C. Nutrition and adult inflammatory bowel disease. Aliment Pharmacol Ther. 2003;17:307–20.

    Article  PubMed  CAS  Google Scholar 

  102. Shamir R. Nutritional aspects in inflammatory bowel disease. J Pediatr Gastroenterol Nutr. 2009;48:S86.

    Article  PubMed  Google Scholar 

  103. Hébuterne X, Filippi J, Al-Jaouni R, Schneider S. Nutritional consequences and nutrition therapy in Crohn’s disease. Gastroenterol Clin Biol. 2009;33:S235–44.

    Article  PubMed  Google Scholar 

  104. Gerasimidis K, McGrogan P, Edwards C. The aetiology and impact of malnutrition in paediatric inflammatory bowel disease. J Hum Nutr Diet. 2011;24:313–26.

    Article  PubMed  CAS  Google Scholar 

  105. Savage M, Beattie R, Camacho-Hübner C, Walker-Smith J, Sanderson I. Growth in Crohn’s disease. Acta Paediatr. 1999;88:89–92.

    Article  CAS  Google Scholar 

  106. De Benedetti F, Alonzi T, Moretta A, Lazzaro D, Costa P, Poli V, et al. Interleukin 6 causes growth impairment in transgenic mice through a decrease in insulin-like growth factor-I. A model for stunted growth in children with chronic inflammation. J Clin Invest. 1997;99:643.

    Article  PubMed  Google Scholar 

  107. Ballinger A, Azooz O, El-Haj T, Poole S, Farthing M. Growth failure occurs through a decrease in insulin-like growth factor 1 which is independent of undernutrition in a rat model of colitis. Gut. 2000;46:695.

    Article  Google Scholar 

  108. MacRae V, Farquharson C, Ahmed S. The restricted potential for recovery of growth plate chondrogenesis and longitudinal bone growth following exposure to pro-inflammatory cytokines. J Endocrinol. 2006;189:319.

    Article  PubMed  CAS  Google Scholar 

  109. Wong S, Smyth A, McNeill E, Galloway P, Hassan K, McGrogan P, et al. The growth hormone insulin-like growth factor 1 axis in children and adolescents with inflammatory bowel disease and growth retardation. Clin Endocrinol (Oxf). 2010;73:220–8.

    CAS  Google Scholar 

  110. Street ME, de’Angelis GL, Camacho-Hübner C, Giovannelli G, Ziveri MA, Bacchini PL, et al. Relationships between serum IGF-1, IGFBP-2, interleukin-1beta and interleukin-6 in inflammatory bowel disease. Horm Res Paediatr. 2004;61:159–64.

    CAS  Google Scholar 

  111. Shamir R, Phillip M, Levine A. Growth retardation in pediatric Crohn’s disease: pathogenesis and interventions. Inflamm Bowel Dis. 2007;13:620–8.

    Article  PubMed  Google Scholar 

  112. Seidman E. Nutritional therapy for Crohn’s disease: lessons from the Ste.-Justine hospital experience. Inflamm Bowel Dis. 1997;3:49–53.

    Article  Google Scholar 

  113. Otley AR, Russell RK, Day AS. Nutritional therapy for the treatment of pediatric Crohn’s disease. Expert Rev Clin Immunol. 2010;6:667–76.

    Article  PubMed  Google Scholar 

  114. Wiskin AE, Wootton SA, Hunt TM, Cornelius VR, Afzal NA, Jackson AA, et al. Body composition in childhood inflammatory bowel disease. Clin Nutr. 2011;30:112–5.

    Article  PubMed  Google Scholar 

  115. Lee KM. Nutrition in inflammatory bowel disease. Korean J Gastroenterol. 2008;52:1–8.

    PubMed  Google Scholar 

  116. Seidman E. Nutritional management of inflammatory bowel disease. Gastroenterol Clin North Am. 1989;18:129.

    PubMed  CAS  Google Scholar 

  117. O’Morain C, Segal A, Levi A. Elemental diets in treatment of acute Crohn’s disease. Br Med J. 1980;281:1173–5.

    Article  PubMed  Google Scholar 

  118. Capristo E, Mingrone G, Addolorato G, Greco AV, Gasbarrini G. Effect of a vegetable-protein-rich polymeric diet treatment on body composition and energy metabolism in inactive Crohn’s disease. Eur J Gastroenterol Hepatol. 2000;12:5.

    Article  PubMed  CAS  Google Scholar 

  119. Royall D, Greenberg GR, Allard JP, Baker JP, Jeejeebhoy KN. Total enteral nutrition support improves body composition of patients with active Crohn’s disease. J Parenter Enteral Nutr. 1995;19:95–9.

    Article  CAS  Google Scholar 

  120. Alastair F, Emma G, Emma P. Nutrition in inflammatory bowel disease. J Parenter Enteral Nutr. 2011;35:571–80.

    Article  CAS  Google Scholar 

  121. Whitten KE, Rogers P, Ooi CKY, Day AS. International survey of enteral nutrition protocols used in children with Crohn’s disease. J Dig Dis. 2012;13:107–12.

    Article  PubMed  Google Scholar 

  122. Gråfors JM, Casswall TH. Exclusive enteral nutrition in the treatment of children with Crohn’s disease in Sweden: a questionnaire survey. Acta Paediatr. 2011;100:1018–22.

    Article  PubMed  Google Scholar 

  123. Stewart M, Day AS, Otley A. Physician attitudes and practices of enteral nutrition as primary treatment of paediatric Crohn disease in North America. J Pediatr Gastroenterol Nutr. 2011;52:38.

    Article  PubMed  CAS  Google Scholar 

  124. Scholz D. The role of nutrition in the etiology of inflammatory bowel disease. Curr Probl Pediatr Adolesc Health Care. 2011;41:248–53.

    Article  PubMed  Google Scholar 

  125. Fell J. Update of the management of inflammatory bowel disease. Arch Dis Child. 2012;97:78–83.

    Article  PubMed  CAS  Google Scholar 

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Acknowledgments

MHA is funded by the Libyan government and would like to acknowledge Libya for that support.

Conflict of interest

The authors declare that they have no conflict of interest.

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Authors and Affiliations

  1. School of Women’s and Children’s Health, University of New South Wales, Sydney, NSW, Australia

    Moftah H. Alhagamhmad, Andrew S. Day, Daniel A. Lemberg & Steven T. Leach

  2. Paediatric Gastroenterology, Christchurch Hospital, Christchurch, New Zealand

    Andrew S. Day

  3. Department of Gastroenterology, Sydney Children’s Hospital, Randwick, Sydney, NSW, Australia

    Daniel A. Lemberg

  4. Westfield Research Laboratories, Level 2, Sydney Children’s Hospital, Randwick High Street, Sydney, NSW, 2031, Australia

    Steven T. Leach

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  1. Moftah H. Alhagamhmad
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  2. Andrew S. Day
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  3. Daniel A. Lemberg
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  4. Steven T. Leach
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Correspondence to Steven T. Leach.

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Alhagamhmad, M.H., Day, A.S., Lemberg, D.A. et al. An update of the role of nutritional therapy in the management of Crohn’s disease. J Gastroenterol 47, 872–882 (2012). https://doi.org/10.1007/s00535-012-0617-9

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  • DOI: https://doi.org/10.1007/s00535-012-0617-9

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