Enteral nutrition improves malnutrition, disease status in pediatric IBD

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December 20, 2021

2 min read


Stoner NL. The impact of nutrition intervention in very early onset inflammatory bowel disease. Presented at: North American Society for Pediatric Gastroenterology, Hepatology & Nutrition Annual Meeting; Dec. 12-18, 2021 (virtual meeting).

Stoner reports support from the CPNP Nutrition Research Grant.

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Exclusive enteral nutrition intervention improved malnutrition and disease status among pediatric patients with very early-onset inflammatory bowel disease, according to a speaker.

“Children with the very early-onset (VEO) IBD suffer from devastating complications, including malnutrition, growth failure and nutrient deficiencies, which a lot of times are present at the time of diagnosis; there is a higher risk of poor oral intake and immune-mediated disease in the very early-onset group,” Natalie L. Stoner, RD, CSP, LDN, outpatient clinical dietitian with the VEO-IBD program at the Center for Pediatric Inflammatory Bowel Disease at Children’s Hospital of Philadelphia, said during the North American Society for Pediatric Gastroenterology, Hepatology & Nutrition Annual Meeting. “Due to the frequent refractory nature of the VEO-IBD, synergistic therapeutic strategies are needed. Nutritional support is one such approach.”

Malnutrition severity status following exclusive enteral nutrition intervention therapy:  ‘Week 16’ – Baseline ‘Week 24’ – 12 weeks  ‘Group A’ – Mild; (top to bottom): 58%, 10% ‘Group B’ – Moderate; 16%, 0% ‘Group C’ – Severe; 26%, 11%

To determine whether exclusive enteral nutrition (EEN) therapy improves the ability to achieve a response, Stoner and colleagues conducted a prospective, observational study of 38 malnourished pediatric patients aged 13 months to 6 years with VEO-IBD. They further compared patients who underwent EEN (n = 19) with controls who underwent non-EEN intervention (n = 19) and recorded change in malnutrition status and clinical disease activity at baseline and 12 weeks. Therapy protocol included 80% of estimated caloric needs from formula and 20% of estimated caloric needs from an anti-inflammatory diet administered through nasogastric tube, oral ingestion or a combination of both.

Compared with baseline, patients who underwent EEN therapy saw improvement in malnutrition severity (mild: 58% vs. 10%; moderate: 16% vs. 0%; severe: 26% vs. 11%); at study conclusion, 79% of patients were no longer malnourished. Controls who underwent non-EEN intervention also saw improvement in malnutrition severity (mild: 42% vs. 26%; moderate: 16% vs. 10%; severe: 42% vs. 11%); 53% achieved a non-malnourished status. Further evaluation of both groups yielded an increased percentage of total fat, total dietary fiber, carbohydrates and caloric intake. Stoner also noted improvement at 12 weeks in iron, vitamin D and calcium percentages.

“Malnutrition is a huge problem in patients with newly diagnosed very early-onset IBD and can greatly impact our therapeutic responses. EEN and non-EEN nutritional interventions can be effective in improving malnutrition and, ultimately, disease status,” Stoner concluded. “Next we’re hoping to really look into the data to make some pilot data for understanding micronutrient deficits and develop screening guidelines in the VEO-IBD population. … Larger prospective studies are essential to guide treatment decisions and identify which patients might benefit from EEN.”