P81 Identifying nutritional targets in Crohn's disease: INTICO1: a time-limited trial of exclusive enteral nutrition during adult CD remission

Introduction During clinical remission in adult Crohn's disease (CD), impaired health reacted quality of life and fatigue are common, and the nutritional state may be affected by factors such as restrictive eating and altered anatomy from previous inflammation or surgeries. Adults with CD in clinical remission do not routinely undergo nutritional assessments or intervention. The INTICO1 study used a time limited trial of exclusive enteral nutrition (EEN) in adults with CD to expose and explore nutritionally sensitive aspects of CD during remission. The extent to which the nutritional state relates to the quality of CD remission and the potential role for nutritional therapies is neither well described nor understood.Methods This was a single arm longitudinal observation study with a dietary intervention. 24 adults in CD remission (Harvey Bradshaw <5, faecal calprotectin <250) underwent assessment of nutritional state at 3 time points; after habitual diet (assessment 1), after 7 days of polymeric EEN (assessment 2) and after a 2-week gradual return to habitual diet (assessment3). Assessments comprised food diary analysis, anthropometry, bio-electrical impedance analysis, routine pathology measures of micronutrient concentration, and patient reported outcome measures (PROMs).Results Assessment 1 identified individuals with multiple inadequacies of intake, micronutrient biochemistry below the laboratory range (7% (26/368) of all tests), lean mass (age corrected fat free mass index), low phase angle (PhA) and excessive fatigue (reduced SF-36 vitality). At assessment 2 (post EEN), subjects had fewer deficiencies 4% (16/368), with significant increases seen in Vitamins A, D, E, B2, B6, B9 and the minerals Ca, Cu, Po4 and Se. At visit 3 (return to free diet), micronutrient concentrations reverted toward visit 1 level, although B6 and B9 remained significantly higher. BIA measures of nutritional status (PhA) and the SF36 physical function score improved 1 and 2 (5.2 vs 5.4 p<0.01 and 95 v 100 p<0.05) and returned to baseline levels on return to free diet (Assessment 3).Conclusions A time-limited trial (7 days) of EEN, given in this setting of adults in CD remission led to changes in micronutrient biochemistry, objective improvement in the bioelectrical properties of the body (increased phase angle) and an improvement in fatigue among the subjects as captured by the SF36-PF. The study suggests that impaired nutritional state and excessive fatigue is likely to be prevalent among adults with CD during remission and may be sensitive to nutritional intervention.