Development and Validation of the Glasgow Exclusive Enteral Nutrition Index of Compliance

Aleksandra Jatkowska, Bernadette White, Ben Nichols, Vaios Svolos, Konstantinos Gkikas, Richard Hansen, Richard K. Russell, Daniel Gaya, Emily Brownson, John Paul Seenan, Simon Milling, Jonathan MacDonald, Konstantinos Gerasimidis (Lead / Corresponding author)

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    3 Citations (Scopus)
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    Background and Aims: Treatment adherence is key to the efficacy of exclusive enteral nutrition [100% EN] in active Crohn’s disease [CD], but there are no biomarkers to objectively estimate this. We explored faecal parameters as biomarkers of compliance with 100% EN, and subsequently developed and validated the Glasgow Exclusive Enteral Nutrition Index of Compliance [GENIE]. Methods: Healthy adults replaced all [100% EN] or part [85% EN, 50% EN, 20% EN] of their diet with a formula for 7 days. Faecal pH, water content, short chain fatty acids, and branched chain fatty acids [BCFAs] were measured before [D0] and after [D7] each intervention. Optimal biomarkers and threshold values were derived using receiver operating characteristic curve analyses and machine learning to develop the GENIE. The GENIE was then validated in 30 CD children, during and after 100% EN. Results: In all, 61 adults were recruited. D7 faecal pH and the ratios of BCFAs to either acetate or butyrate performed the best to differentiate between patients on 100% EN from <100% EN. Two models were generated; one included faecal metabolites (Laboratory GENIE, L-GENIE; sensitivity, specificity, and positive predictive value [PPV] of 88%, 94%, and 92%) and a second one [Clinical Genie, C-GENIE] which considers only faecal pH [sensitivity, specificity, and PPV of 84%, 86%, and 81%]. Validation of GENIE in CD children found that C-GENIE outperformed L-GENIE, producing a sensitivity, specificity, and PPV of 85%, 88%, and 88%, respectively. Conclusions: GENIE can help predict adherence to 100% EN and may complement current conventional dietary assessment.

    Original languageEnglish
    Pages (from-to)1426-1435
    Number of pages10
    JournalJournal of Crohn's and Colitis
    Issue number9
    Early online date2 Apr 2023
    Publication statusPublished - 1 Sept 2023


    • Biomarkers
    • exclusive enteral nutrition
    • paediatrics

    ASJC Scopus subject areas

    • General Medicine


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