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Dr Falk IBD Poster Prize

Dietary triggers of colonic inflammation following treatment with exclusive enteral nutrition in children with Crohn’s disease

Konstantinos Gkikas (1), Michael Logan (1), Ben Nichols (1), Clare Clark (1), Umer Z. Ijaz (1), Lisa Gervais (2), Hazel Duncan (2), Victoria Garrick (2), Lee Curtis (2), Elaine Buchanan (2), Tracey Cardigan (2), Lawrence Armstrong (3), Caroline Delahunty (4), Diana Flynn (2), Andrew R. Barclay (2), Rachel Tayler (2), Richard Hansen (2), Richard K. Russell (2) and Konstantinos Gerasimidis (1).

(1) University of Glasgow; (2) NHS Greater Glasgow & Clyde; (3) NHS Ayrshire and Arran; (4) NHS Lanarkshire

Background: 

Exclusive enteral nutrition (EEN) ameliorates gut inflammation in children with Crohn’s disease (CD). We have previously described the rapid rise in faecal calprotectin levels (FC) when children with CD return to their habitual diet after EEN treatment (1). 

Aim:

We aimed to explore dietary triggers of CD relapse by performing dietary assessment and measuring biomarkers of food consumption in faeces of children with CD during early food reintroduction. 

Subjects and methods:

A composite outcome of clinical remission post EEN (weighted Paediatric Crohn’s Disease Activity Index <12.5) and a significant drop in FC (FC decrease: >500 mg/kg / >35%), was used to define the patient group. All patients completed 3-day estimated weight food diaries and provided a faecal sample. Patients were divided equally for statistical analysis purposes in two groups; above (Group 1) and below (Group 2) the median FC concentration at food reintroduction [900 mg/kg (341, 1,243)]. Nutrient analysis was performed with WinDiets. Short chain fatty acids, the gluten immunogenic peptide (GIP) and starch were measured in stool, as proxy of fibre, gluten and malabsorbed/resistant starch respectively. Food groups were assigned using the National Diet and Nutrition Survey approach and statistics employing taxonomy were utilised in the food group analysis. All data are displayed using medians (Q1, Q3). 

Results:

14 children provided a FC sample within 21 (15, 51) days post EEN. Classification of patients in the two groups resulted in significantly different FC values; Group 1: 1181 mg/kg (1024, 1781) vs Group 2: 411 mg/kg (130, 651) (p<0.001). Age, weight and height were similar between the two groups (p=0.40, p=0.37, p=0.79). Total energy intake did not differ between the groups (p=0.37). Patients in Group 1 consumed more fibre than Group 2 [12.1 g (11.3, 19.9) vs 9.9 g (7.6, 12.1), p=0.04]. Protein and phosphorus intakes, expressed as a percentage of reference nutrient intakes, were also higher in Group 1 than Group 2 [Protein (%): 262 (195, 291) vs 211 (88, 215), p=0.02; phosphorus (%): 241 (171, 290) vs 177 (131, 1901), p=0.04]. Butyrate and valerate levels were higher in Group 1 than Group 2 [Butyrate: 62.5 (41.8, 114) vs 34.1 (29.2, 49.6), p=0.02; valerate: 13.7 (9.3, 17.9) vs 4.5 (2.3, 8.1), p<0.01]. There were no differences in GIP and faecal starch levels between the two groups (p=0.18, p=0.12). Red & processed meat intake was higher in Group 1 than Group 2 [151 g (66.7, 190) vs: 63.3 g (21.7, 67), p=0.02)]. Cereals intake was non-significantly higher in Group 1 [389 (207, 405) vs 231 (141, 279), p=0.08]. Overall diet diversity did not differ between the two groups (p=0.47). 


Summary and Conclusion:

The current analysis suggests that fibre, protein, phosphorus and red & processed meat may be associated with recurrence of colonic inflammation in children with CD during early food reintroduction. These findings should be confirmed in larger studies. 

References 
1. Logan, M. et al. The reduction of faecal calprotectin during exclusive enteral nutrition is lost rapidly after food re-introduction. AP&T 50, 664–674 (2019). 

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