Effect of exclusive enteral nutrition on bone turnover in children with Crohn's disease.
BACKGROUND
Poor bone acquisition and increased fracture risk are significant complications associated with Crohn's disease (CD). The aim of this study was to determine the effects of 8 weeks of exclusive enteral nutrition (EEN) therapy upon markers of bone turnover in children with newly diagnosed CD.


METHODS
Twenty-three children with newly diagnosed CD and 20 controls (without CD) were enrolled. Children with CD were treated with 8 weeks of EEN. Inflammatory markers [C-reactive protein (CRP), erythrocyte sedimentation rate (ESR), albumin, platelets], nutritional markers (height, weight), and bone markers [C-terminal telopeptides of Type-1 collagen (CTX) and bone specific alkaline phosphatase (BAP)] were measured prior to and following therapy.


RESULTS
At diagnosis, children with CD had elevated serum CTX (2.967 +/- 0.881 ng/ml) compared to controls (2.059 +/- 0.568 ng/ml; P = 0.0003). Following the period of EEN, CTX levels fell significantly (2.260 +/- 0.547 ng/ml; P = 0.002), while serum BAP levels (51.24 +/- 31.31 microg/L at diagnosis; control serum BAP = 66.80 +/- 23.23 microg/L; P = 0.07) increased significantly (64.82 +/- 30.51 microg/L; P = 0.02), with both normalizing to control levels.


CONCLUSIONS
As well as reducing inflammation, decreasing disease activity, and improving nutrition in children with newly diagnosed CD, EEN therapy also normalized serum markers of bone turnover, suggesting an improvement in bone health. Further investigations of short- and long-term effects of EEN on bone density and overall bone health are now required.
Whitten
Kylie E
KE
Department of Nutrition and Dietetics, Sydney Children's Hospital, Sydney, Australia.
Leach
Steven T
ST
Bohane
Timothy D
TD
Woodhead
Helen J
HJ
Day
Andrew S
AS
D000293:Adolescent; D000469:Alkaline Phosphatase / Q000097:blood; D015415:Biomarkers / Q000378:metabolism; D016723:Bone Remodeling; D016022:Case-Control Studies; D002648:Child; D002675:Child, Preschool; D024042:Collagen Type I / Q000378:metabolism; D003424:Crohn Disease / Q000503:physiopathology / Q000628:therapy*; D004750:Enteral Nutrition / Q000379:methods*; D005260:Female; D006801:Humans; D007223:Infant; D007249:Inflammation / Q000209:etiology / Q000628:therapy; D008297:Male; D011446:Prospective Studies
D015415:Biomarkers; D024042:Collagen Type I; D000469:Alkaline Phosphatase