Whole-food diet therapies for children with Crohn's disease: a systematic review

Abstract

BACKGROUND: Children with Crohn's disease (CD) experience gastrointestinal symptoms that impair nutrition, growth and quality of life. Exclusive enteral nutrition is recommended as a first-line remission induction treatment. However, compliance is challenging due to monotony and the social impact of excluding whole foods, increasing interest in whole-food diet therapies. OBJECTIVES: This systematic review aimed to summarise current evidence regarding the impact of whole-food therapies on clinical remission (as defined by each study using validated measures) and related health outcomes in children with CD. DESIGN: We performed a systematic review of studies assessing whole-food interventions in children with CD. DATA SOURCES AND METHODS: A systematic search was conducted in electronic databases for research published in English from 1 January 2012 to 16 August 2024. Randomised controlled trials (RCTs), quasi-experimental studies, cohort studies, case-control studies and case series were included. RESULTS: Twenty-eight studies (n = 4 RCTs, n = 3 non-RCTs, n = 16 observational studies, n = 5 post hoc analyses) met inclusion criteria and examined six types of diets. Most of the children being treated had uncomplicated, mild-moderate disease activity and were on concomitant medications. Those on whole-food therapies demonstrated a median clinical remission rate of 75% (interquartile range 62%-85%; n = 18 studies), mucosal improvement and healing (n = 5/6 studies), improved inflammatory biomarkers (n = 18/19 studies) and enhanced growth parameters (n = 11/13 studies). Outcomes related to microbial changes were inconsistent. Overall, studies were low-medium quality due to small, non-randomised, uncontrolled studies using a variety of concomitant medications and different definitions for clinical remission, preventing definitive conclusions. CONCLUSION: The findings suggest whole-food diet therapies can potentially be used to treat children with mild to moderate CD and that a flexible, nutrient-balanced dietary approach tailored to the individual child may be possible. However, large-scale, RCTs with standardised outcome measures are needed to further support the routine use of whole-food therapies in paediatric CD. TRIAL REGISTRATION: PROSPERO registration number CRD42024580134.