Effect of low- and high-fat, peptide-based diets on body composition and disease activity in adolescents with active Crohn's disease

Background: The effect of nasogastric feeding with high- and low-fat, peptide-based diets on body composition and disease activity was studied in adolescents with active Crohn's disease. Methods: Fourteen patients with active Crohn's disease (12 to 17 years) were fed exclusively through nasogastric feedings with two isocaloric, isonitrogenous, peptide-based diets, either with low- or high-fat content, for 3 weeks each in a randomized manner then were 'crossed over' to the other diet for another 3 weeks of feeding. At the end of each 3-week period, urine and stools were collected for 72 hours for measuring energy absorption and nitrogen utilization (n = 6). Weight, height, triceps skin folds, fat free body mass, and disease activity were also monitored (n = 14). Results: There was no difference in any parameter of energy absorption or nitrogen utilization between the two formulas irrespective of the order in which they were administered. The changes in nutritional parameters were also comparable with both formulas. There was a significant increase in weight, fat free body mass and triceps skinfold thickness during both the 3-week periods of feeding (p < .05). This was accompanied by a significant reduction in the pediatric Crohn's disease activity index (p < .05). Conclusions: Peptide-based diets may be useful in restoring the fat free body mass and improving the disease activity in patients with Crohn's disease. A high fat (high medium-chain triglycerides) diet did not offer any nutritional advantage over a similar but low-fat diet. The improvement in disease activity during feeding with a low-fat diet was comparable to that with a high-fat diet. The improvement in disease activity seems to be associated with improvement in lean body mass irrespective of the type of diet used to achieve it.