Exclusive Enteral Nutrition In Pediatric Crohn’s Disease

Background: Crohn’s Disease (CD) is a chronic inflammatory bowel disorder that significantly affects growth, nutritional status, and quality of life in children. In paediatric populations, Exclusive Enteral Nutrition (EEN) is recommended as first-line therapy because of its strong remission rates and steroid-sparing benefits. Beyond inducing remission, EEN has the potential to correct malnutrition, improve inflammatory markers, and restore growth trajectories. However, while short-term efficacy of EEN is well established globally, long-term outcome data—particularly from Indian clinical settings—remain limited. This study was designed to evaluate the impact of EEN not only on clinical remission but also on dietary adequacy, nutritional recovery, and sustainability of outcomes over a 12-month period.

Methods: This retrospective case-based analysis included 61 children diagnosed with Crohn’s Disease who completed EEN therapy between 2020 and 2025. The study was structured into three phases: Phase 1 (Pre-EEN Initiation): Baseline demographic data, anthropometric measurements, biochemical parameters, inflammatory markers, and dietary intake were recorded. Nutritional prescriptions were individualized, targeting 120% of Recommended Dietary Allowance (RDA) during active therapy to support catch-up growth. Phase 2 (Post6- 8 Weeks of EEN): Anthropometry, laboratory parameters, inflammatory markers, Pediatric Crohn’s Disease Activity Index (PCDAI), and percentage of dietary requirement achieved were reassessed to evaluate remission and nutritional recovery. Phase 3 (12-Month Follow-Up): Anthropometric outcomes and dietary adequacy were re-evaluated to determine sustainability of remission and long-term nutritional improvement. Statistical analysis was conducted with significance set at p < 0.05.

Results: At baseline, 58% of children were undernourished, highlighting the significant nutritional burden associated with paediatric CD. Mean energy intake was markedly inadequate (42.5% of requirement) and showed strong negative correlation with disease severity scores. Following 8 weeks of EEN: All children achieved clinical remission.The proportion of undernourished children reduced from 58% to 26%.Significant improvements were observed in weight/BMI z-scores. Inflammatory markers including ESR improved markedly. Albumin and haemoglobin levels showed significant recovery. PCDAI scores decreased substantially, indicating reduced disease activity. Dietary quality, including caloric, protein, and micronutrient intake, improved significantly. At 12-month follow-up: 92% of children were meeting at least 95% of their RDA. 91% demonstrated improved overall nutritional status. Only 9% remained undernourished. Weight/BMI gains were sustained. Height z-scores did not show significant change over 12 months. Relapse occurred in only 3.27% of patients, who responded well to a second course of EEN. The percentage of underweight children declined steadily over the one-year follow-up, demonstrating sustained nutritional recovery with structured monitoring.

Conclusion: This study demonstrates that EEN is not merely a remission-inducing therapy but a powerful nutritional intervention capable of reversing malnutrition, reducing systemic inflammation, and improving dietary adequacy in children with Crohn’s Disease. Sustained dietetic follow-up plays a critical role in maintaining remission and preventing relapse. The findings provide valuable real-world insight into the timeline of EEN response and reinforce the importance of structured nutritional therapy as a central pillar in paediatric Crohn’s Disease management. how much words

Dr. Lekha Sreedharan, RD, PhD, is the Chief Dietitian and Head of the Clinical Dietetics Department at Apollo Children’s & Women’s Hospitals, Chennai, with over 27 years of distinguished clinical experience. A certified Pediatric Dietitian, ESPEN LLL Teacher, and National Vice President of IAPEN India, she is widely recognized for her expertise in pediatric nutrition and evidence-based clinical practice. Dr. Lekha has presented her research at leading international platforms including ESPEN, ESPGHAN, WCPGHAN, and AUSPEN, and has served as a keynote speaker in global conferences. She has authored numerous publications and co-edited and co-authored key textbooks in pediatric and clinical nutrition.