CDED + PEN: An Alternative Diet to Exclusive Enteral Nutrition?

T Niseteo et al Nutr Clin Pract 2021: 1-7. Modified Crohn’s disease exclusion diet is equally effective as exclusive enteral nutrition: Real-world data Thanks to Kipp Ellsworth for this reference.

This was a retrospective study with 61 children, median age, 14.4 years; overall, 42 (69%) achieved clinical remission based on weighted PCDAI. The study compared a modified Crohn’s disease exclusion diet (CDED) (modified as 80% in this group had 1–2 weeks of EEN initially) to EEN; PEN accounted for ~50% of calories CDED/PEN group received mainly modulen whereas EEN received a number of standard polymeric isocaloric formulas (eg. pediasure, osmolite, ensure plus). Concomitant medical therapy was used in ~80% of patients (most often azathioprine).

Key finding: Clinical remission was similar in both groups: 27 of 41 (65.9%) received EEN and 15 of 20 (75.0%) received CDED + PEN after 6-8 weeks of treatment. In addition, both groups had improvement in CRP and Hemoglobin.

*Several authors grants/payments from formula manufacturers.

My take: This study while favorable towards a combination of CDED/PEN is limited by small numbers, retrospective design, limited followup and absence of data on mucosal healing.

Related blog posts:

K Lambert et al. AP&T 2021; Systematic review with meta-analysis: dietary intake in adults with inflammatory bowel disease. Thanks to Ben Gold for this reference.

This meta-analysis included 19 studies of adults with IBD involving dietary intake. Results “show inadequate energy for all subgroups of adults with IBD (mean intake in adults with IBD 1980 ± 130 kcal), as well as fiber (14 ± 4 g), folate (246 ± 33 mg) and calcium (529 ± 114 mg) per day.” Further, “In comparison to the healthy control groups, IBD patients consumed significantly less dietary fiber (SMD −0.59; 95% CI, −0.73 to −0.46).” 

3 thoughts on “CDED + PEN: An Alternative Diet to Exclusive Enteral Nutrition?

  1. Dr. Hochman,

    I hope you’re doing well. Thank you for your continued review and support of dietary information. I’d like to ask if you would consider listing our organization as a resource for dietary information for clinicians and patients on your dietary review pages?

    We have some exciting ongoing projects to provide additional resources for clinicians and patients that I’d like to share in more detail with you when it may be possible to speak directly. Are you attending NASPGHAN this year? We intend to have our annual exhibit there again, however, like all are watching the delta variant.

    Take care,


    Kim S. Beall, Pharm.D. Cofounder and Board Chair Nutritional Therapy for IBD 843-364-4631


  2. Pingback: Dietary Therapy for Adults with Crohn’s Disease | gutsandgrowth

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