Short-term efficacy of enteral nutrition in the treatment of active Crohn's disease: a randomized, controlled trial comparing nutrient formulas.
BACKGROUND
The optimal dietary fat content to induce clinical remission in active Crohn's disease has been the subject of controversy. We therefore performed a prospective, randomized, controlled study to compare the effects of nutrient formulas differing in the amount of medium-chain triglycerides (MCT).


METHODS
Thirty-six patients with active Crohn's disease whose Crohn's disease activity index (CDAI) was > or =150 were included in the study. A formula with 3.4 g of fat per 2000-kcal dose was used as the nutrient formula with a low-fat content (ED group), and a formula with 55.6 g of fat per 2000-kcal dose was used as the nutrient formula with a high amount of MCT (TL group).


RESULTS
The rate of short-term remission induction at 6 weeks was 67% in the ED group and 72% in the TL group (p = NS). Therapy markedly reduced the high CDAI and van Hees activity index in both groups, with no significant difference in the pattern of the time-course changes. C-reactive protein levels, erythrocyte sedimentation rate, and low serum albumin and plasma prealbumin levels normalized over the course of therapy, with no significant difference between the 2 groups. The assessment of fatty acid fractions revealed that the triene/tetraene ratio began to increase at 2 weeks in the ED group. The serum levels of linoleic acid, an omega-6 fatty acid, almost always varied within the normal range during the treatment period in the TL group, but in the ED group, levels began to decrease significantly at 2 weeks. The levels of linolenic acid, an omega-3 fatty acid, decreased in both groups.


CONCLUSIONS
Both nutrient formulas induced clinical remission in about two-thirds of patients. The results of the present study suggest that it is not necessary to restrict the amount of MCT when given in liquid form to patients with active Crohn's disease.
Sakurai
Toshihiro
T
Department of Gastroenterology, Fukuoka University Chikushi Hospital, Chikushino, Japan. sakurait@cis.fukuoka-u.ac.jp
Matsui
Toshiyuki
T
Yao
Tsuneyoshi
T
Takagi
Yasuhiro
Y
Hirai
Fumihito
F
Aoyagi
Kunihiko
K
Okada
Mitsuo
M
D000328:Adult; D001799:Blood Sedimentation; D002097:C-Reactive Protein / Q000032:analysis; D003424:Crohn Disease / Q000628:therapy*; D004041:Dietary Fats / Q000008:administration & dosage; D002149:Energy Intake; D004750:Enteral Nutrition; D015525:Fatty Acids, Omega-3 / Q000097:blood; D043371:Fatty Acids, Omega-6; D005231:Fatty Acids, Unsaturated / Q000097:blood; D005260:Female; D005526:Food, Formulated; D006801:Humans; D019787:Linoleic Acid / Q000097:blood; D008297:Male; D011228:Prealbumin / Q000032:analysis; D011446:Prospective Studies; D012074:Remission Induction; D012709:Serum Albumin / Q000032:analysis; D014280:Triglycerides / Q000008:administration & dosage; D017962:alpha-Linolenic Acid / Q000097:blood
D004041:Dietary Fats; D015525:Fatty Acids, Omega-3; D043371:Fatty Acids, Omega-6; D005231:Fatty Acids, Unsaturated; D011228:Prealbumin; D012709:Serum Albumin; D014280:Triglycerides; D017962:alpha-Linolenic Acid; D002097:C-Reactive Protein; D019787:Linoleic Acid