A randomised controlled trial of high versus low long chain triglyceride whole protein feed in active Crohn's disease

Background-Polymeric feeds have shown variable efficacy in active Crohn's d isease (CD) with remission rates from 36% to 82%. Meta-analyses of elementa l, peptide, and whole protein feeds have shown a strong negative correlatio n between remission rate in CD and the long chain triglyceride (LCT) conten t of the feed. We performed a randomised controlled double blind trial in p atients with active CD comparing two single whole protein feeds with LCT su pplying 5% or 30% of the total energy. Methods-Fifty four patients with active CD (Crohn's disease activity index (CDAI) > 200, serum C reactive protein (CRP) 10 mg/1) were randomised to a high or low LCT feed for three weeks. The total amount of energy supplied b y fat was identical in the two feeds. Remission was defined as a CDAI less than or equal to 150 and response as a fall in CDAI of greater than or equa l to 70 or a CRP < 10 mg/l. Results-Overall remission rate by intention to treat was 26% for the low LC T feed and 33% for the high LCT feed (p=0.38). Response was achieved in 33% with the low LCT and in 52% with the high LCT feed (p=0.27). CRP < 10 mg/l was achieved in 30% in the low LCT and 33% in the high LCT group (p=0.99). Thirty nine per cent (21/54) of patients withdrew before three weeks becau se of inability to tolerate the diet. Excluding patients unable to tolerate the diet, remission rates were 46% for low LCT and 45% for high LCT (p=0.9 9). Discussion-This trial has shown no difference in the effect of low and high LCT whole protein feeds in active CD. The previously reported correlation between LCT content of diet and response in active CD is unlikely to be due to LCT itself and may be due to some other component of high LCT feeds.