TY - JOUR
T1 - The reduction of faecal calprotectin during exclusive enteral nutrition is lost rapidly after food re-introduction
AU - Logan, Michael
AU - Clark, Clare M.
AU - Ijaz, Umer Zeeshan
AU - Gervais, Lisa
AU - Duncan, Hazel
AU - Garrick, Vikki
AU - Curtis, Lee
AU - Buchanan, Elaine
AU - Cardigan, Tracey
AU - Armstrong, Lawrence
AU - Delahunty, Caroline
AU - Flynn, Diana M.
AU - Barclay, Andrew R.
AU - Tayler, Rachel
AU - McDonald, Elizabeth
AU - Milling, Simon
AU - Hansen, Richard K.
AU - Gerasimidis, Konstantinos
AU - Russell, Richard K.
N1 - Funding Information:
The work of the IBD team in Glasgow is supported by the Catherine McEwen foundation. UZI is funded by NERC Independent Research Fellowship NE/ L011956/1. KG received research grants, speakers fees and had conference attendance paid by Nutricia/Nestle and DrFalk. RH has received speakers/consultancy fees or conference support from Nutricia, Dr Falk, MSD Immunology and 4D Pharma. RKR has received speaker's fees, travel support and/ or participated in medical board meetings
Publisher Copyright:
© 2019 The Authors. Alimentary Pharmacology & Therapeutics Published by John Wiley & Sons Ltd.
PY - 2019/9
Y1 - 2019/9
N2 - Background: Faecal calprotectin decreases during exclusive enteral nutrition in children with active Crohn's disease. It is unknown how faecal calprotectin changes during food re-introduction and the influence of maintenance enteral nutrition. Aims: To study changes to faecal calprotectin during exclusive enteral nutrition and at food reintroduction, and explore associations with maintenance enteral nutrition. Methods: Children with Crohn's disease were followed during exclusive enteral nutrition and during food-reintroduction. Faecal calprotectin was measured before, at 33 and 54 days of exclusive enteral nutrition, and at 17, 52 and 72 days after food-reintroduction. Maintenance enteral nutrition use was recorded with estimated weight food diaries. Data are presented with medians and Q1:Q3. Results: Sixty-six patients started exclusive enteral nutrition and 41 (62%) achieved clinical remission (weighted paediatric Crohn's disease activity index <12.5). Baseline faecal calprotectin (mg/kg) decreased after 4 and 8 weeks of exclusive enteral nutrition (Start: 1433 [Q1: 946, Q3: 1820] vs 33 days: 844 [314, 1438] vs 54 days: 453 [165, 1100]; P <.001). Within 17 days of food reintroduction, faecal calprotectin increased to 953 [Q1: 519, Q3: 1611] and by 52 days to 1094 [660, 1625] (both P <.02). Fifteen of 41 (37%) children in remission used maintenance enteral nutrition (333 kcal or 18% of energy intake). At 17 days of food reintroduction, faecal calprotectin was lower in maintenance enteral nutrition users than non-users (651 [Q1: 271, Q3: 1781] vs 1238 [749, 2102], P =.049) and correlated inversely with maintenance enteral nutrition volume (rho: −0.573, P =.041), kcals (rho: −0.584, P =.036) and % energy intake (rho: −0.649, P =.016). Maintenance enteral nutrition use was not associated with longer periods of remission (P =.7). Faecal calprotectin at the end of exclusive enteral nutrition did not predict length of remission. Conclusions: The effect of exclusive enteral nutrition on faecal calprotectin is diminished early during food reintroduction. Maintenance enteral nutrition at ~18% of energy intake is associated with a lower faecal calprotectin at the early phase of food reintroduction but is ineffective in maintaining longer term remission.
AB - Background: Faecal calprotectin decreases during exclusive enteral nutrition in children with active Crohn's disease. It is unknown how faecal calprotectin changes during food re-introduction and the influence of maintenance enteral nutrition. Aims: To study changes to faecal calprotectin during exclusive enteral nutrition and at food reintroduction, and explore associations with maintenance enteral nutrition. Methods: Children with Crohn's disease were followed during exclusive enteral nutrition and during food-reintroduction. Faecal calprotectin was measured before, at 33 and 54 days of exclusive enteral nutrition, and at 17, 52 and 72 days after food-reintroduction. Maintenance enteral nutrition use was recorded with estimated weight food diaries. Data are presented with medians and Q1:Q3. Results: Sixty-six patients started exclusive enteral nutrition and 41 (62%) achieved clinical remission (weighted paediatric Crohn's disease activity index <12.5). Baseline faecal calprotectin (mg/kg) decreased after 4 and 8 weeks of exclusive enteral nutrition (Start: 1433 [Q1: 946, Q3: 1820] vs 33 days: 844 [314, 1438] vs 54 days: 453 [165, 1100]; P <.001). Within 17 days of food reintroduction, faecal calprotectin increased to 953 [Q1: 519, Q3: 1611] and by 52 days to 1094 [660, 1625] (both P <.02). Fifteen of 41 (37%) children in remission used maintenance enteral nutrition (333 kcal or 18% of energy intake). At 17 days of food reintroduction, faecal calprotectin was lower in maintenance enteral nutrition users than non-users (651 [Q1: 271, Q3: 1781] vs 1238 [749, 2102], P =.049) and correlated inversely with maintenance enteral nutrition volume (rho: −0.573, P =.041), kcals (rho: −0.584, P =.036) and % energy intake (rho: −0.649, P =.016). Maintenance enteral nutrition use was not associated with longer periods of remission (P =.7). Faecal calprotectin at the end of exclusive enteral nutrition did not predict length of remission. Conclusions: The effect of exclusive enteral nutrition on faecal calprotectin is diminished early during food reintroduction. Maintenance enteral nutrition at ~18% of energy intake is associated with a lower faecal calprotectin at the early phase of food reintroduction but is ineffective in maintaining longer term remission.
UR - https://www.scopus.com/pages/publications/85069859161
U2 - 10.1111/apt.15425
DO - 10.1111/apt.15425
M3 - Article
C2 - 31342536
SN - 0269-2813
VL - 50
SP - 664
EP - 674
JO - Alimentary Pharmacology and Therapeutics
JF - Alimentary Pharmacology and Therapeutics
IS - 6
ER -