Partial Enteral Nutrition With a Unique Diet vs. Exclusive Enteral Nutrition for the Treatment of Pediatric Crohn's Disease
|Crohn's Disease||Other: Unique Diet+Partial Enteral Nutrition Other: Exclusive Enteral Nutrition (Modulen)|
|Study Design:||Allocation: Randomized
Intervention Model: Parallel Assignment
Masking: No masking
Primary Purpose: Treatment
|Official Title:||Comparison of Partial Enteral Nutririon (Modulen) With a Unique Diet to Exclusive Enteral Nutrition (Modulen) for the Treatment of Pediatric Crohn's Disease. A Prospective Randomized Controlled Trial.|
- patient's adherence with the diet assessed by cessation of therapy because of patients refusal to continue and by a MARS questionnaire [ Time Frame: 6 weeks ]
- Response, defined as a drop in PCDAI of 12.5 points or remission, on an intention to treat analysis. [ Time Frame: 6 weeks ]
- Remission at week 6 and week 12 (defined as PCDAI≤10, or less than 7.5 without height component), [ Time Frame: 6 weeks and 12 weeks ]
- Bone health [ Time Frame: at the 3, and 6 month visits ]change in serum bone biomarkers from baseline and their correlation with DEXA (optional)
- CRP at week 12 [ Time Frame: 12 weeks ]
- Physician assessment of compliance [ Time Frame: 6 weeks ]
|Study Start Date:||January 2013|
|Estimated Study Completion Date:||July 2017|
|Estimated Primary Completion Date:||July 2017 (Final data collection date for primary outcome measure)|
Experimental: Unique Diet+Partial Enteral Nutrition
Unique Diet+Partial Enteral Nutrition (PEN): This group will receive as follows:
Weeks 1-6: 50% of dietary needs from PEN (Modulen, Nestle) and 50% from a limited whole food diet.
Weeks 7-12: 25% of dietary needs from PEN (Modulen, Nestle) and 75% from a limited whole food diet.
Other: Unique Diet+Partial Enteral Nutrition
Modulen - liquid dietary formula
Other Name: Modulen, Nestle
Active Comparator: Exclusive Enteral Nutrition (Modulen)
Exclusive Enteral Nutrition(EEN): This group will receive as follows:
Weeks 1-6: EEN(100% of dietary needs from Modulen) Weeks 7-12: 25% of dietary needs from Modulen and 75% from a free diet.
Other: Exclusive Enteral Nutrition (Modulen)
Other Name: Modulen, Nestle
Background: Crohn's disease is clearly on the rise in countries exposed to industrialization and western diet. Several factors may implicate diet in the pathogenesis of CD or in disease activity. The strongest argument for an effect of diet is the effect of exclusive enteral nutrition (EEN) on disease activity in CD. 40-80% of children , fed an exclusive liquid diet, irrespective of which diet, will enter complete remission, often with normalization of inflammatory markers. The effect of formula has been shown to be independent of fat or protein composition in pediatric studies, but to be dependent on exclusion of normal diet.Thus, rather than the composition of EEN being associated with remission of disease it may be the exclusion of certain components of the Western diet may be responsible for improvement.
Methods:This is a prospective randomized controlled trial, in patients with a recent diagnosis of CD (up to two years),aged 4-18, comparing two arms over 12 weeks of therapy.
Group 1:will receive 50% of their dietary needs from a polymeric formula ( Modulen, Nestle) and a limited whole food diet for 6 weeks/ Group 2: will receive EEN with Modulen for 6 weeks. At the end of 6 weeks, all patients entering remission (irrespective of randomization) will enter the second 6 week phase, continuing 25 % of calories as Modulen in both groups. Patients in remission from group 2 will continue to consume 25% of calories as Modulen and be allowed free diet , patients in Group 1 will continue 25% of calories from Modulen but continue restricted diet.
Patients will be seen at onset (week 0), weeks 3 and 6, 12 and 24 weeks.
We hypothesize that by withdrawing the offending dietary agents we can achieve an equal remission rate with improved tolerability. This study will evaluate response, remission and tolerability in both groups, as well as the effects of nutrition on bone health.
Please refer to this study by its ClinicalTrials.gov identifier: NCT01728870
|Contact: Arie Levine, MDfirstname.lastname@example.org|
|University of Alberta||Not yet recruiting|
|Edmonton, Alberta, Canada, T6G 1C9|
|Contact: Eytan Wine, MD, PhD 780-248-5420 email@example.com|
|Principal Investigator: Eytan Wine, MD, PhD|
|Canada, Nova Scotia|
|IWK Health Centre||Recruiting|
|Halifax, Nova Scotia, Canada, B3K 6R8|
|Contact: Johan Van Limbergen, MD,PhD 902 470 8784 firstname.lastname@example.org|
|Principal Investigator: Johan Van Limbergen, MD,PhD|
|The E. Wolfson.Medical Center||Active, not recruiting|
|Holon, Israel, 58100|
|Principal Investigator:||Arie Levine, MD||Pediatric Gastroenterology and Nutrition unit, Wolfson MC|