Partial Enteral Nutrition in the Management of Crohn's Disease: A Systematic Review and Meta-Analysis.
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BACKGROUND: Exclusive enteral nutrition is an established treatment for active Crohn's disease but the role of partial enteral nutrition (PEN) in the broader management of the disease is less clear. This systematic review and meta-analysis reviewed the literature on the role of PEN in Crohn's disease management. METHODS: This review was conducted following Cochrane recommendations. The protocol was registered on PROSPERO. Findings were reported following the PRISMA guidelines. RESULTS: Sixty-four articles were identified, of which 11 reported data from randomized control trials. Good quality evidence suggests that PEN may be used as a maintenance and induction therapy, particularly at high dosages and/or alongside exclusion diets. A higher dosage of PEN is associated with a lower risk of subsequent disease relapse, with benefits observed at intakes above 35% of energy requirements (35%-50% PEN: OR [95% confidence intervals (CI)]: 0.42 [0.27-0.65]; > 50% PEN: OR [95% CI]: 0.27 [0.08-0.88]). Low-quality evidence suggests that postoperative use of PEN may prevent disease recurrence or enhance treatment outcomes when used as adjunct therapy to biologics. PEN can improve nutritional parameters, showing efficacy comparable to EEN in pediatric patients (weight: OR [95% CI]: -0.04 [-0.32, 0.25]). The effect of PEN on improving patients' quality of life is comparable to that of EEN and anti-tumor necrosis factor alpha therapies. CONCLUSIONS: Partial enteral nutrition may help in various aspects of Crohn's disease management but much of the current evidence is of low quality. Well-designed randomized control trials are required to confirm findings from current literature and before clinical recommendations can be made.