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OP018 The impact of Crohns Disease-TReatment-with-EATing diet (CD-TREAT diet) and exclusive enteral nutrition on healthy gut bacteria metabolism

V. Svolos*1, R. Hansen2, K. Hughes1, U. Z. Ijaz3, C. Quince4, D. Gaya5, R. Russell2, K. Gerasimidis1

1Human Nutrition, School of Medicine, College of Medical, Veterinary and Life Sciences, University of Glasgow, Glasgow Royal Infirmary, Glasgow, United Kingdom, 2Department of Paediatric Gastroenterology, Hepatology and Nutrition, Royal Hospital for Children, Glasgow, United Kingdom, 3School of Engineering, University of Glasgow, Glasgow, United Kingdom, 4Warwick Medical School, University of Warwick, Warwick, United Kingdom, 5Department of Gastroenterology, Glasgow Royal Infirmary, Glasgow, United Kingdom

Background

We have demonstrated an extensive modulation of gut microbiome in children with Crohn’s disease on induction treatment with exclusive enteral nutrition (EEN) (1,2). This observation offers clues about the potential mode of EEN action and advocates towards the development of novel therapies through dietary manipulation of the gut microbiota. This crossover, RCT compared the effect of a novel ‘ordinary’ food-based diet (CD-TREAT diet) and EEN on healthy gut microbiota.

Methods

Healthy adults followed 2 experimental diets for 7 days with a 15-day washout period in between: EEN and CD-TREAT, an ‘ordinary’ food diet that has similar nutrient and food ingredient composition to EEN (eg, fibre content, fatty acid composition, and lactose- and gluten-free content). Participants were randomly allocated to start with EEN or CD-TREAT first. Fresh faecal samples were collected before and after each dietary intervention (4 different time points), and faecal short chain fatty acids (SCFA), pH, ammonia, and sulphide were measured.

Results

From 25 healthy subjects, 100 samples were collected. Faecal concentration of total SCFA and acetic, propionic, butyric, and caproic acid significantly decreased during both dietary interventions (ΔMedian μmol/g; EEN, -167.27, -135.61, -15.47, -21.01, -2.02, vs CD-TREAT, -165.18, -68.92, -25.5, -34.99, -1.36, all p < 0.01). Proportional ratio (% of total SCFA) was significantly reduced for butyric and caproic acid (ΔMedian %: EEN, -2.92%, -0.47%; CD-TREAT, -5.04%, -0.21%, all p <0.01); but did not change for the other SCFA. Faecal concentration of iso-butyric and iso-valeric acid was significantly increased after EEN only (ΔMedian μmol/g; EEN, 2.33, 2.59), whilst their proportional ratio increased after both diets (ΔMedian %; EEN, 1.95%, 2.13%; CD-TREAT, 0.72%, 0.88%, all p < 0.001). Faecal pH significantly changed from a neutral baseline level to the alkaline range (ΔMedian pH units; EEN, 1.39, vs CD-TREAT, 0.97, both p < 0.001). Likewise, total sulphide significantly increased during both diets (ΔMedian μmol/g; EEN, 3.1; CD-TREAT, 0.92, both p < 0.001). Faecal ammonia and free sulphide concentration did not differ between the 4 time points.

Conclusion

We have developed an ‘EEN composition alike’ food-based diet which induces similar effects on gut microbial metabolites with EEN. Further analysis including high-throughput deep sequencing techniques will provide additional scientific evidence before we move this novel dietary treatment towards a subsequent clinical trial in people with active CD.