Abstract
Purpose: Maintenance enteral nutrition (MEN) is a dietary strategy that can be used to sustain remission in children with Crohn's disease (CD) following induction therapy with exclusive enteral nutrition (EEN) or corticosteroids. Unlike EEN, MEN involves partial nutritional intake (typically 25-60% of energy needs) via polymeric or elemental formula given alongside regular food. This systematic review aimed to evaluate the clinical effectiveness of MEN for maintaining remission and supporting growth. To determine whether MEN is effective in maintaining remission in children with CD and to assess its impact on inflammatory markers and anthropometric outcomes.
Methods: Five databases (Medline, Embase, CINAHL, Scopus, Web of Science) were searched up to April 30 2025. Eligible studies included children (≤18 years) with CD who initiated MEN following defined induction with EEN or corticosteroids and reported outcomes related to relapse, remission, or growth. Risk of bias was assessed using ROBINS-I and RoB 2 tools. Random-effects meta-analyses were used for synthesis. Although this review was not prospectively registered, a predefined protocol was developed and followed.
Results: Five studies were included, enrolling a total of 271 participants with usable relapse data. MEN was associated with significantly lower relapse risk compared to controls (pooled odds ratio, 0.455; 95% confidence interval, 0.216-0.957; p=0.038). Improvements in Pediatric Crohn's Disease Activity Index scores and faecal calprotectin levels were reported, though statistical significance varied. Modest gains in body mass index and height z-scores were observed, especially in prepubertal children. Evidence was limited by small sample sizes, observational designs, and protocol heterogeneity. Certainty of evidence was low for relapse and secondary outcomes.
Conclusion: MEN is associated with reduced risk of relapse and improved nutritional status in children with CD. Standardized protocols and high-quality trials are needed to confirm optimal use.