Effects of Modified Crohn’s Disease Exclusion Diet as Adjunctive Therapy on Clinical Remission and Nutrition in Pediatric Crohn’s Disease: A Real-World Study from China

Background/Objective: Crohn’s disease exclusion diet (CDED) is used to induce remission and maintenance treatment of Crohn’s disease (CD), but its efficacy as adjuvant treatment of biological agents is not clear, especially for children with CD in China. The aim is to compare the synergistic induction of remission, as well as the effects on physical growth and nutritional indicators, of the CDED and Exclusive Enteral Nutrition (EEN), when used alongside infliximab as adjunctive therapies for children with CD. Methods: A retrospective analysis was conducted on newly diagnosed children with CD who were receiving infliximab treatment in combination with either CDED or EEN at the Department of Gastroenterology at Beijing Children’s Hospital between April 2022 and June 2025. The patients were divided into two groups: CDED and EEN. Changes in disease activity, physical growth indicators, nutritional status, and inflammatory markers were then compared between the two groups at six and twelve weeks post-treatment. Results: A total of 45 children with CD who met the inclusion and exclusion criteria were included in the study. Of these, 27 were boys (60%) and 18 were girls (40%), with an average age of (11.6 ± 2.9) years. Based on nutritional intervention, 19 patients were assigned to the CDED group and 26 to the EEN group. The clinical remission rates were 89.5% and 94.7% at 6 and 12 weeks post-treatment, respectively, in the CDED group and 88.5% and 84.6%, respectively, in the EEN group. At 12 weeks, the endoscopic remission rates were 47.1% (8/17) and 24.0% (5/26), respectively, in the CDED and EEN groups. There were no statistically significant differences between the two groups in terms of clinical remission or endoscopic remission (p > 0.05). Comparisons of physical growth indicators showed that, after 6 and 12 weeks of treatment, children in the CDED group had a significantly higher body mass index (BMI) for age Z-score than those in the EEN group (p < 0.05). Comparisons of serum nutritional and inflammatory markers revealed that, after 12 weeks of treatment, fecal calprotectin levels were significantly lower in the CDED group than in the EEN group (p < 0.05), with no significant differences observed in other markers. Conclusions: For children with moderate-to-severe or high-risk factors, CDED and EEN therapy as adjunctive treatment to infliximab demonstrate comparable efficacy in inducing disease remission. However, CDED was more effective than EEN at improving physical growth and reducing intestinal inflammation.