Fat composition may be a clue to explain the primary therapeutic effect of enteral nutrition in Crohn's disease:: results of a double blind randomised multicentre European trial

被引:143
作者
Gassull, MA
Fernández-Bañares, F
Cabré, E
Papo, M
Giaffer, MH
Sánchez-Lombraña, JL
Richart, C
Malchow, H
González-Huix, F
Esteve, M
机构
[1] Univ Badalona, Hosp Germans Trias & Pujol, Dept Gastroenterol, Badalona 08916, Spain
[2] Hosp Joan 23, Gastroenterol Unit, Tarragona, Spain
[3] Royal Hull Hosp NHS Trust, Dept Gastroenterol, Kingston Upon Hull, N Humberside, England
[4] Complejo Hosp Oviedo, Dept Gastroenterol, Oviedo, Spain
[5] Klinikum Leverkusen, Med Clin 2, Leverkusen, Germany
[6] Royal Hull Hosp NHS Trust, Dept Gastroenterol, Kingston Upon Hull, N Humberside, England
关键词
D O I
10.1136/gut.51.2.164
中图分类号
R57 [消化系及腹部疾病];
学科分类号
摘要
Background: Dietary fat has been suggested to determine the therapeutic effect of enteral diets in Crohn's disease. Aim: To assess the efficacy of two whole protein based diets with different fat compositions (n6 polyunsaturated fatty acids v monounsaturated fatty acids) in inducing clinical remission in active Crohn's disease compared with steroids. Methods: Sixty two patients with active Crohn's disease were randomised to receive, for not more than 4 weeks: (a) a polymeric enteral diet containing 35 9 of lipids per 1000 kcal, high in oleate (79%) and low in linoleate (6.5%) (PEN1), (b) an identical enteral diet except for the type of fat which was high in linoleate (45%) and low in oleate (28%) (PEN2), or (c) oral prednisone (1 mg/kg/day). Diets were double blindly administered. The steroid group received a conventional ward diet. Treatment failure was considered when remission was not achieved at week 4. Clinical activity and biological and nutritional parameters were monitored. Independent predictors of remission were identified by stepwise logistic regression analysis. Results: Overall remission rates (by intention to treat) were 20% (4/20) for PEN1, 52% (12/23) for PEN2, and 79% (15/19) for steroids (overall p=0.001; p<0.0005 steroids v PEN1, and p=0.056 PEN2 v PEN 1). After excluding those patients who were non-compliant during the first week (per protocol analysis), remission rates were 27%, 63%, and 79%, respectively (p=0.008, steroids and PEN2 v PEN1). After adjusting for confounding variables, PEN1 remained significantly associated with a poor response. Conclusion: The type of dietary fat may be of importance for the primary therapeutic effect of enteral nutrition in active Crohn's disease.
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页码:164 / 168
页数:5
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