Dietary Fat Composition May Influence Remission in Crohn's Disease

Laurie Barclay, MD

July 29, 2002

July 30, 2002 — Fat composition in the diet may help explain the benefits of enteral nutrition in inducing remission from Crohn's disease, according to the results of a double-blind, randomized, multicenter European trial reported in the August issue of Gut.

"The therapeutic mechanisms of enteral nutrition in Crohn's disease are unknown," write M. A. Gassull, from Hospital Universitari Germans Trias i Pujol in Badalona, Spain, and colleagues. "This is the first trial to show that fat may play a key role in the primary therapeutic effect of enteral nutrition in active Crohn's disease."

For not more than four weeks, 62 patients with active Crohn's disease were randomized to receive a polymeric enteral diet containing 35 g of lipids per 1,000 kcal, high in oleate (79%) and low in linoleate (6.5%) (PEN1); an identical enteral diet except for the type of fat, which was high in linoleate (45%) and low in oleate (28%) (PEN2); or oral prednisone (1 mg/kg/day) and a conventional ward diet.

By intention-to-treat analysis, overall remission rates were seen in 4 (20%) of 20 patients in PEN1, 12 (52%) of 23 patients in PEN2, and 15 (79%) of 19 patients in the steroids group (overall P=.001; for steroids vs. PEN1, P<.0005; and for PEN2 vs. PEN1, P=.056). Exclusion of those patients who were noncompliant during the first week gave similar results. After adjusting for confounding variables, PEN1 remained significantly associated with a poor response.

"This study suggests that the type of fat in enteral nutrition may be of importance in inducing remission in active Crohn's disease, and that an excess of synthetic oleate in the enteral diet may preclude this effect or even be detrimental in these patients," the authors write.

Gut. 2002;51:164-168

Reviewed by Gary D. Vogin, MD

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