Is the frequency of dietitian support associated with greater clinical improvements in adults with Crohn's disease undertaking exclusive enteral nutrition?

Abstract

Background: Exclusive enteral nutrition (EEN) is considered to be an effective, low-risk therapy in the treatment of Crohn's disease (CD). Frequent dietetic support may assist adults to succeed. The present observational study aimed to compare whether the frequency of dietetic support during EEN therapy was associated with differences in clinical and nutritional outcomes across two gastroenterology inflammatory bowel disease services. Site A provided ≥3 visits plus more if clinically indicated and Site B provided weekly support. Methods: Eligible patients were adults with active CD recommended to be treated with oral EEN for ≥6 weeks between February 2018 and December 2019. Demographic, anthropometric, clinical, medications, pathology and EEN treatment descriptors were sourced from the medical chart. Descriptive statistics, as well as chi-squared and t tests, were used to compare data between sites. Results: Eighty-four CD patients were eligible (44 ± 14 years, 54% female, baseline Crohn's disease activity index [CDAI] 259.5 ± 113.1, n = 51 Site A) and completed EEN for median (range) 6.1 (1–12) weeks. Most patients (82%, n = 69/84) completed ≥6 weeks of EEN treatment. CDAI score and calprotectin improved across the total sample from pre- to post-EEN by −109.8 ± 92.1 (p < 0.001) and −65 µg g–1 (−65,230 to 4370) (p = 0.002), respectively. Dietitian occasions of service were more frequent at Site B (7 [4–12] occasions vs. 3 [1–8], p < 0.001). However, changes in clinical and biomarker data were similar between sites (p < 0.05). Conclusions: EEN with regular dietetic input resulted in clinical and biochemical improvements for patients with active CD. Tailoring dietetic support based on the client's needs and preference may achieve clinical improvements similar to providing weekly dietetic support to adults on EEN.