Lack of efficacy of a reduced microparticle diet in a multi-centred trial of patients with active Crohn's disease.
OBJECTIVE
Dietary microparticles, which are bacteria-sized and non-biological, found in the modern Western diet, have been implicated in both the aetiology and pathogenesis of Crohn's disease. Following on from the findings of a previous pilot study, we aimed to confirm whether a reduction in the amount of dietary microparticles facilitates induction of remission in patients with active Crohn's disease, in a single-blind, randomized, multi-centre, placebo controlled trial.


METHODS
Eighty-three patients with active Crohn's disease were randomly allocated in a 2 x 2 factorial design to a diet low or normal in microparticles and/or calcium for 16 weeks. All patients received a reducing dose of prednisolone for 6 weeks. Outcome measures were Crohn's disease activity index, Van Hees index, quality of life and a series of objective measures of inflammation including erythrocyte sedimentation rate, C-reactive protein, intestinal permeability and faecal calprotectin. After 16 weeks patients returned to their normal diet and were followed up for a further 36 weeks.


RESULTS
Dietary manipulation provided no added effect to corticosteroid treatment on any of the outcome measures during the dietary trial (16 weeks) or follow-up (to 1 year); e.g., for logistic regression of Crohn's disease activity index based rates of remission (P=0.1) and clinical response (P=0.8), in normal versus low microparticle groups.


CONCLUSIONS
Our adequately powered and carefully controlled dietary trial found no evidence that reducing microparticle intake aids remission in active Crohn's disease.
Lomer
Miranda C E
MC
Gastrointestinal Laboratory, The Rayne Institute, St Thomas' Hospital, London, UK. miranda.lomer@kcl.ac.uk
Grainger
Stephen L
SL
Ede
Roland
R
Catterall
Adrian P
AP
Greenfield
Simon M
SM
Cowan
Russell E
RE
Vicary
F Robin
FR
Jenkins
Anthony P
AP
Fidler
Helen
H
Harvey
Rory S
RS
Ellis
Richard
R
McNair
Alistair
A
Ainley
Colin C
CC
Thompson
Richard P H
RP
Powell
Jonathan J
JJ
D000293:Adolescent; D000328:Adult; D000368:Aged; D002136:Calcium, Dietary / Q000008:administration & dosage; D003092:Colitis / Q000178:diet therapy; D003424:Crohn Disease / Q000178:diet therapy*; D004032:Diet; D004781:Environmental Exposure / Q000009:adverse effects; D005260:Female; D005503:Food Additives / Q000008:administration & dosage; D006801:Humans; D007079:Ileitis / Q000178:diet therapy; D008297:Male; D008875:Middle Aged; D016037:Single-Blind Method; D016896:Treatment Outcome
D002136:Calcium, Dietary; D005503:Food Additives