RS Boneh et al. Clin Gastroenterol Hepatol 2025; 23: 2001-2011. Open Access! Modified Crohn’s Disease Exclusion Diet Maintains Remission in Pediatric Crohn’s Disease: Randomized Controlled Trial

In this “DIETOMICS” study with 56 children with mild-to-severe Crohn’s disease, after a 2 week exclusive enteral nutrition (EEN) diet, 30 patients were randomized to CDED and 26 to EEN.

Diet intervention: The CDED group followed 3 diet phases over 24 weeks: phase 1 (weeks 3–8) supplemented with 50% PEN; phase 2 (weeks 9–14) with 25% PEN, as described previously¹⁶; and phase 3 (weeks 15–24) with gradual introduction of more foods, including 1 and 2 free meals per week from weeks 15 and 18, respectively.¹⁷ Patients in EEN group received 8 weeks of EEN followed by gradual introduction of free diet with 25% PEN up to week 24.

Key findings:

This study with a relatively small number of enrolled patients had a lot of variables in dietary parameters. “An additional potential confounder in this study is the use of IMM therapy. Although both groups were recommended to initiate IMM therapy from weeks 4 to 5 to maintain remission, several CDED patients opted for monotherapy with CDED and preferred to delay medication initiation. Interestingly, 90% of patients on CDED without IMM therapy were in remission at week 14 and 100% were in remission at week 2” (possibly impacting decision not to use IMM).

My take: This study adds another piece of information to the puzzle on dietary therapy for Crohn’s disease. The authors note the following: “while CDED shows promise as a standalone therapy in some cases, in more severe cases it may be more appropriately as an adjuvant to top-down treatment with early anti-TNF.⁴ Recent research and guidelines advocate for a top-down approach (anti-TNF ± nutrition) for more severe disease, emphasizing the integration of anti-TNF therapy with nutrition.^8,29 This approach is crucial during critical growth stages, as the conventional step-up method may lead to ineffective use of IMM with prolonged steroid exposure and growth issues.¹²“

Related blog posts:

• “Tasty & Healthy” Whole Food Diet For Crohn’s Disease
• AGA Guidance: Nutritional Therapies for Inflammatory Bowel Disease
• The Quality of Evidence for Dietary Treatments in Inflammatory Bowel Disease
• CDED + PEN: An Alternative Diet to Exclusive Enteral Nutrition?
• Dr. Maria Oliva-Hemker: Positioning Therapies for Pediatric Crohn’s Disease
• More Evidence That A Proinflammatory Diet May Increase the Risk of Crohn’s Disease
• Pushing the Boundaries on Dietary Therapy for Crohn’s Disease (CD-TREAT)
• Predicting Enteral Nutrition Therapy Response in Patients with IBD
• Dietary Therapy for Adults with Crohn’s Disease
• Trial by Diet Approach for Crohn’s Disease in Children
• Dietary Therapy for Inflammatory Bowel Disease –Useful Update
• Mediterranean Diet vs Specific Carbohydrate Diet for Crohn’s Disease
• Mediterranean Diet’s Impact on Crohn’s Disease Outcomes

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