Abstract:
Background: Dietary therapy is increasingly recognized as an effective treatment for pediatric Crohn's disease (CD). However, the comparative efficacy of Exclusive Enteral Nutrition (EEN), Crohn's Disease Exclusion Diet (CDED), partial enteral nutrition (PEN), and other dietary approaches remains uncertain. This network meta-analysis compared and ranked dietary interventions for remission induction in pediatric CD.
Methods: A systematic search of PubMed, Scopus, Web of Science, and the Cochrane Library was conducted through March 2026. Randomized and controlled trials evaluating dietary therapies in children and adolescents with active CD were included. A random-effects frequentist network meta-analysis was performed using EEN as the reference intervention. Treatments were ranked using Surface Under the Cumulative Ranking Curve (SUCRA).
Results: Sixteen randomized controlled trials were included in the primary analysis. CDED demonstrated the highest probability of achieving clinical remission (SUCRA = 0.86), followed by CDED combined with PEN. Although no dietary intervention significantly outperformed EEN for remission, CDED significantly improved clinical response compared with EEN (RR 1.61, 95% CI 1.10–2.36). Corticosteroids were significantly inferior to EEN for mucosal healing (RR 0.43, 95% CI 0.23–0.81). PEN alone consistently demonstrated poorer outcomes across disease activity and nutritional markers.
Conclusions: CDED, CDED plus PEN, and EEN remain the leading dietary strategies for inducing remission in pediatric Crohn's disease. Exclusion-based dietary therapy provides efficacy comparable to EEN while potentially improving treatment acceptability. PEN alone should not be used as monotherapy for active disease. Further high-quality randomized trials are required to strengthen the comparative evidence base.
