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

• Published in: Gut 2002-08, Vol.51 (2), p.164-168
• Main Authors: Gassull, M A, Fernández-Bañares, F, Cabré, E, Papo, M, Giaffer, M H, Sánchez-Lombraña, J L, Richart, C, Malchow, H, González-Huix, F, Esteve, M
• Format: Article
• Language: English
• Subjects: Acute Disease; Adolescent; Adult; Amino acids; Biological and medical sciences; C reactive protein; Care and treatment; CDAI; Crohn Disease - diet therapy; Crohn Disease - drug therapy; Crohn's disease; Crohn's disease activity index; CRP; Cytokines; Diet; Dietary fat; Dietary Fats - administration & dosage; Double-Blind Method; Enteral Nutrition; erythrocyte sedimentation rate; ESR; Europe; fat; Fatty acids; Female; Food, Formulated; Gastroenterology. Liver. Pancreas. Abdomen; Glucocorticoids - therapeutic use; Health aspects; Humans; Inflammation and Inflammatory Bowel Disease; Kinases; LCT; Linoleic Acid - administration & dosage; logistic regression analysis; long chain triglycerides; LRA; Male; MCT; Medical sciences; medium chain triglycerides; Meta-analysis; Middle Aged; monounsaturated fatty acids; MUFA; NRI; Nutrition research; nutritional risk index; Oils & fats; Oleic Acid - administration & dosage; Olive oil; Ostomy; Other diseases. Semiology; PEN; Physiological aspects; polymeric enteral nutrition; polyunsaturated fatty acids; Proteins; PUFA; Regression Analysis; Rodents; Stomach. Duodenum. Small intestine. Colon. Rectum. Anus; Studies; Triglycerides; Van Hees' activity index; Vegetable oils; VHAI
• ISSN: 0017-5749; 1468-3288; 1458-3288
• DOI: 10.1136/gut.51.2.164

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