Biomarkers of dietary intake in faeces of children with Crohn’s disease and their role in disease recurrence following treatment with exclusive enteral nutrition

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Abstract Background and aims This study aims to profile biomarkers of dietary intake in faeces of children with Crohn’s disease (CD) and explore their role in disease recurrence following induction treatment with exclusive enteral nutrition. Methods We will profile and quantify biomarkers of dietary intake in 928 banked faecal samples of 116 children with CD collected during the first 30 days of food reintroduction, following successful treatment with exclusive enteral nutrition (EEN), and in spot samples from 53 matched healthy controls. In faecal samples, a wide range of carbohydrates (e.g. galactose, rhamnose, glucose, xylose), polysaccharides (e.g resistant starch) and oligosaccharides (e.g. β-fructans), total nitrogen, as well as nitrogen-containing compounds (e.g. amino acids, dipeptides) will be measured with a combination of 1H-NMR, UHPLC-MS, anion exchange chromatography, the Kjeldahl AOAC method and proprietary kits. Faecal biomarkers of dietary intake will be associated with risk of disease recurrence (indicated by the rapid rise in faecal calprotectin) during the first 30 days of food reintroduction, following successful treatment with EEN. Next, this study will explore whether identified biomarkers of dietary intake in faeces relate with patients’ actual dietary intake, and whether the two datasets complement or supersede each other in prediction of disease recurrence. Last, we will identify common dietary biomarkers of disease recurrence between two distinct cohorts of patients; one which returned to unrestricted diet, post-EEN, and another which followed a novel exclusion diet (CD-TREAT) for the management of CD. Anticipated impact This study has the potential to address one of the most frequently asked questions from patients to healthcare professionals; “What should I eat to control my disease and prevent disease relapse?” Identification of dietary triggers may lead to the development of food reintroduction protocols following EEN completion; hence offering better long-term disease control and improving the quality of life of patients with CD.

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