{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,24]],"date-time":"2026-08-24T22:45:27Z","timestamp":1787611527543,"version":"build-2736575974"},"reference-count":31,"publisher":"MDPI AG","issue":"15","license":[{"start":{"date-parts":[[2026,8,2]],"date-time":"2026-08-02T00:00:00Z","timestamp":1785628800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Nutrients"],"abstract":"<jats:p>Background: Long-term data on the feasibility, adherence, and efficacy of the Crohn\u2019s Disease Exclusion Diet combined with partial enteral nutrition (CDED + PEN) in adults with active Crohn\u2019s disease (CD) remain limited. Methods: In this prospective, single-center cohort study, we assessed adherence, tolerability, clinical remission, nutritional and body composition changes in adults with clinically active CD following a 52-week 3-phase CDED + PEN protocol. Clinical activity, inflammatory markers, quality of life, nutritional intake, and body composition were evaluated at baseline and weeks 6, 12, and 52. Results: A total of 22 of 36 patients (61.1%, exact 95% CI:43.5\u201376.9%) remained adherent throughout the 52-week follow-up. Adherence overlapped with tolerability, as all discontinuations were attributable to poor tolerability. Adherence was higher in patients with disease duration \u22642 years (59.1% vs. 21.4%, p = 0.041) and in those with greater caloric (p = 0.012) and protein requirements (p = 0.022). All adherent patients achieved clinical remission after the 6-week induction phase, and remission was maintained at 12 months in 14\/22 (63.6%). Harvey\u2013Bradshaw Index scores decreased significantly at weeks 6 and 12, while fecal calprotectin decreased at week 6. Nutritional status improved, with sustained higher protein intake and early increases in total protein and albumin. Patients maintaining remission at 52 weeks showed greater reductions in C-reactive protein and fecal calprotectin, together with greater improvements in phase angle and muscle mass index. Conclusions: CDED + PEN is a feasible and safe long-term strategy for adults with active CD, particularly in early disease. It reduces disease activity, improves nutritional status and body composition, and supports durable remission in a substantial proportion of adherent patients.<\/jats:p>","DOI":"10.3390\/nu18152491","type":"journal-article","created":{"date-parts":[[2026,8,3]],"date-time":"2026-08-03T06:17:40Z","timestamp":1785737860000},"page":"2491","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":1,"title":["Long-Term Feasibility, Adherence, and Exploratory Clinical Outcomes of Crohn\u2019s Disease Exclusion Diet Plus Partial Enteral Nutrition in Adults with Crohn\u2019s Disease"],"prefix":"10.3390","volume":"18","author":[{"given":"Ilaria","family":"Dileo","sequence":"first","affiliation":[{"name":"Clinical Nutrition and Dietetics Unit, Citt\u00e0 della Salute e della Scienza di Torino-Molinette Hospital, 10126 Turin, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Marta","family":"Vernero","sequence":"additional","affiliation":[{"name":"Unit of Gastroenterology, Citt\u00e0 della Salute e della Scienza di Torino-Molinette Hospital, 10126 Turin, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9421-3087","authenticated-orcid":false,"given":"Davide Giuseppe","family":"Ribaldone","sequence":"additional","affiliation":[{"name":"Unit of Gastroenterology, Citt\u00e0 della Salute e della Scienza di Torino-Molinette Hospital, 10126 Turin, Italy"},{"name":"Department of Medical Sciences, University of Torino, 10126 Turin, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alessia","family":"Chiarotto","sequence":"additional","affiliation":[{"name":"Clinical Nutrition and Dietetics Unit, Citt\u00e0 della Salute e della Scienza di Torino-Molinette Hospital, 10126 Turin, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Anna","family":"Avico","sequence":"additional","affiliation":[{"name":"Clinical Nutrition and Dietetics Unit, Citt\u00e0 della Salute e della Scienza di Torino-Molinette Hospital, 10126 Turin, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Clara","family":"Bosa","sequence":"additional","affiliation":[{"name":"Clinical Nutrition and Dietetics Unit, Citt\u00e0 della Salute e della Scienza di Torino-Molinette Hospital, 10126 Turin, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Marta","family":"Ossola","sequence":"additional","affiliation":[{"name":"Clinical Nutrition and Dietetics Unit, Citt\u00e0 della Salute e della Scienza di Torino-Molinette Hospital, 10126 Turin, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3353-6808","authenticated-orcid":false,"given":"Valentina","family":"Ponzo","sequence":"additional","affiliation":[{"name":"Department of Medical Sciences, University of Torino, 10126 Turin, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0529-9481","authenticated-orcid":false,"given":"Gian Paolo","family":"Caviglia","sequence":"additional","affiliation":[{"name":"Unit of Gastroenterology, Citt\u00e0 della Salute e della Scienza di Torino-Molinette Hospital, 10126 Turin, Italy"},{"name":"Department of Medical Sciences, University of Torino, 10126 Turin, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6862-8628","authenticated-orcid":false,"given":"Simona","family":"Bo","sequence":"additional","affiliation":[{"name":"Clinical Nutrition and Dietetics Unit, Citt\u00e0 della Salute e della Scienza di Torino-Molinette Hospital, 10126 Turin, Italy"},{"name":"Department of Medical Sciences, University of Torino, 10126 Turin, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2026,8,2]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"69","DOI":"10.1001\/jama.2020.18936","article-title":"Management of Crohn Disease: A Review","volume":"325","author":"Cushing","year":"2021","journal-title":"J. Am. Med. Assoc."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"1179","DOI":"10.1016\/j.crohns.2014.04.005","article-title":"Consensus Guidelines of ECCO\/ESPGHAN on the Medical Management of Pediatric Crohn\u2019s Disease","volume":"8","author":"Ruemmele","year":"2014","journal-title":"J. Crohn\u2019s Colitis"},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"1531","DOI":"10.1093\/ecco-jcc\/jjae091","article-title":"ECCO Guidelines on Therapeutics in Crohn\u2019s Disease: Medical Treatment","volume":"18","author":"Gordon","year":"2024","journal-title":"J. Crohn\u2019s Colitis"},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"1322","DOI":"10.1097\/MIB.0b013e3182802acc","article-title":"Effects of Enteral Nutrition on Crohn\u2019s Disease: Clues to the Impact of Diet on Disease Pathogenesis","volume":"19","author":"Levine","year":"2013","journal-title":"Inflamm. Bowel Dis."},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"922","DOI":"10.1053\/j.gastro.2022.05.050","article-title":"Metabolome Changes with Diet-Induced Remission in Pediatric Crohn\u2019s Disease","volume":"163","author":"Ghiboub","year":"2022","journal-title":"Gastroenterology"},{"key":"ref_6","doi-asserted-by":"crossref","unstructured":"Hart, L., Verburgt, C.M., Wine, E., Zachos, M., Poppen, A., Chavannes, M., Van Limbergen, J., and Pai, N. (2022). Nutritional Therapies and Their Influence on the Intestinal Microbiome in Pediatric Inflammatory Bowel Disease. Nutrients, 14.","DOI":"10.3390\/nu14010004"},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"652","DOI":"10.1038\/s41575-022-00619-5","article-title":"Dietary Management of Adults with IBD: The Emerging Role of Dietary Therapy","volume":"19","author":"Fitzpatrick","year":"2022","journal-title":"Nat. Rev. Gastroenterol. Hepatol."},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"406","DOI":"10.1016\/j.cgh.2024.05.049","article-title":"Diet and Microbiome-Directed Therapy 2.0 for IBD","volume":"23","author":"Ananthakrishnan","year":"2025","journal-title":"Clin. Gastroenterol. Hepatol."},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"1888","DOI":"10.1093\/ibd\/izad255","article-title":"The Crohn\u2019s Disease Exclusion Diet: A Comprehensive Review of Evidence, Implementation Strategies, Practical Guidance, and Future Directions","volume":"30","author":"Westoby","year":"2024","journal-title":"Inflamm. Bowel Dis."},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"1353","DOI":"10.1097\/MIB.0000000000000110","article-title":"Partial Enteral Nutrition with a Crohn\u2019s Disease Exclusion Diet Is Effective for Induction of Remission in Children and Young Adults with Crohn\u2019s Disease","volume":"20","author":"Segal","year":"2014","journal-title":"Inflamm. Bowel Dis."},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"440","DOI":"10.1053\/j.gastro.2019.04.021","article-title":"Crohn\u2019s Disease Exclusion Diet Plus Partial Enteral Nutrition Induces Sustained Remission in a Randomized Controlled Trial","volume":"157","author":"Levine","year":"2019","journal-title":"Gastroenterology"},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"e14389","DOI":"10.1111\/eci.14389","article-title":"The Use of the Crohn\u2019s Disease Exclusion Diet (CDED) in Adults with Crohn\u2019s Disease: A Randomized Controlled Trial","volume":"55","author":"Pasta","year":"2025","journal-title":"Eur. J. Clin. Investig."},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"49","DOI":"10.1016\/S2468-1253(21)00299-5","article-title":"The Crohn\u2019s Disease Exclusion Diet for Induction and Maintenance of Remission in Adults with Mild-to-Moderate Crohn\u2019s Disease (CDED-AD): An Open-Label, Pilot, Randomised Trial","volume":"7","author":"Yanai","year":"2022","journal-title":"Lancet Gastroenterol. Hepatol."},{"key":"ref_14","doi-asserted-by":"crossref","unstructured":"Fliss-Isakov, N., Aviv Cohen, N., Bromberg, A., Elbert, G., Anbar, R., Ron, Y., Hirsch, A., Thurm, T., and Maharshak, N. (2023). Crohn\u2019s Disease Exclusion Diet for the Treatment of Crohn\u2019s Disease: Real-World Experience from a Tertiary Center. J. Clin. Med., 12.","DOI":"10.3390\/jcm12165428"},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"33","DOI":"10.1159\/000548931","article-title":"Effectiveness of the Crohn\u2019s Disease Exclusion Diet for the Treatment of Crohn\u2019s Disease in the Older-Adult Population: Real-World Experience","volume":"44","author":"Meir","year":"2026","journal-title":"Dig. Dis."},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"352","DOI":"10.1016\/j.clnu.2022.12.004","article-title":"ESPEN Guideline on Clinical Nutrition in Inflammatory Bowel Disease","volume":"42","author":"Bischoff","year":"2023","journal-title":"Clin. Nutr."},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"521","DOI":"10.1053\/j.gastro.2023.11.303","article-title":"AGA Clinical Practice Update on Diet and Nutritional Therapies in Patients with Inflammatory Bowel Disease: Expert Review","volume":"166","author":"Hashash","year":"2024","journal-title":"Gastroenterology"},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"2574","DOI":"10.1136\/gutjnl-2021-326575","article-title":"Diet Fuelling Inflammatory Bowel Diseases: Preclinical and Clinical Concepts","volume":"71","author":"Adolph","year":"2022","journal-title":"Gut"},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"2001","DOI":"10.1016\/j.cgh.2024.12.006","article-title":"Modified Crohn\u2019s Disease Exclusion Diet Maintains Remission in Pediatric Crohn\u2019s Disease: Randomized Controlled Trial","volume":"23","author":"Hussey","year":"2025","journal-title":"Clin. Gastroenterol. Hepatol."},{"key":"ref_20","doi-asserted-by":"crossref","unstructured":"Correia, I., Oliveira, P.A., Antunes, M.L., Raimundo, M.D.G., and Moreira, A.C. (2024). Is There Evidence of Crohn\u2019s Disease Exclusion Diet (CDED) in Remission of Active Disease in Children and Adults? A Systematic Review. Nutrients, 16.","DOI":"10.3390\/nu16070987"},{"key":"ref_21","unstructured":"European Institute of Oncology (IEO) (2026, May 14). Food Composition Database for Epidemiological Studies in Italy. Available online: https:\/\/bda.ieo.it\/?page_id=690&lang=en."},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"749","DOI":"10.1136\/gut.2005.082909","article-title":"The Montreal Classification of Inflammatory Bowel Disease: Controversies, Consensus, and Implications","volume":"55","author":"Satsangi","year":"2006","journal-title":"Gut"},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"512","DOI":"10.1053\/gast.2002.31072","article-title":"A review of activity indices and efficacy endpoints for clinical trials of medical therapy in adults with Crohn\u2019s disease","volume":"122","author":"Sandborn","year":"2002","journal-title":"Gastroenterology"},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"220","DOI":"10.1097\/00005650-199603000-00003","article-title":"A 12-Item Short-Form Health Survey: Construction of Scales and Preliminary Tests of Reliability and Validity","volume":"34","author":"Ware","year":"1996","journal-title":"Med. Care"},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"17562848251323553","DOI":"10.1177\/17562848251323553","article-title":"Patient Experiences with and Adherence to Crohn\u2019s Disease Exclusion Diet in Dutch Crohn\u2019s Disease Patients: A Cohort Study","volume":"18","author":"Wijers","year":"2025","journal-title":"Ther. Adv. Gastroenterol."},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"e18692","DOI":"10.7717\/peerj.18692","article-title":"Efficacy of Different Dietary Therapy Strategies in Active Pediatric Crohn\u2019s Disease: A Systematic Review and Network Meta-Analysis","volume":"12","author":"Ma","year":"2024","journal-title":"PeerJ"},{"key":"ref_27","doi-asserted-by":"crossref","unstructured":"Alvisi, P., Valerii, M.C., Perre, E., Barbieri, G., Rizzello, F., Congiu, M., Pranzetti, A., Dussias, N.K., Sbravati, F., and Imbesi, V. (2026). Long-Term Outcomes of Mediterranean-Adapted Crohn\u2019s Disease Exclusion Diet in Mild Pediatric Crohn\u2019s Disease: A Real-Life Study from a Referral IBD Center. Nutrients, 18.","DOI":"10.3390\/nu18081290"},{"key":"ref_28","doi-asserted-by":"crossref","unstructured":"Szczube\u0142ek, M., Pomorska, K., Kor\u00f3lczyk-Kowalczyk, M., Lewandowski, K., Kaniewska, M., and Rydzewska, G. (2021). Effectiveness of Crohn\u2019s Disease Exclusion Diet for Induction of Remission in Crohn\u2019s Disease Adult Patients. Nutrients, 13.","DOI":"10.3390\/nu13114112"},{"key":"ref_29","doi-asserted-by":"crossref","unstructured":"Dhaliwal, A., Quinlan, J.I., Overthrow, K., Greig, C., Lord, J.M., Armstrong, M.J., and Cooper, S.C. (2021). Sarcopenia in Inflammatory Bowel Disease: A Narrative Overview. Nutrients, 13.","DOI":"10.3390\/nu13020656"},{"key":"ref_30","doi-asserted-by":"crossref","unstructured":"Jab\u0142o\u0144ska, B., and Mrowiec, S. (2023). Nutritional Status and Its Detection in Patients with Inflammatory Bowel Diseases. Nutrients, 15.","DOI":"10.3390\/nu15081991"},{"key":"ref_31","doi-asserted-by":"crossref","first-page":"35","DOI":"10.1007\/s00384-025-04828-7","article-title":"Evaluating the Role of Sarcopenia in Adverse Clinical Outcomes for Crohn\u2019s Disease Patients: A Systematic Review and Meta-Analysis","volume":"40","author":"Saleh","year":"2025","journal-title":"Int. J. Colorectal Dis."}],"container-title":["Nutrients"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2072-6643\/18\/15\/2491\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,8,3]],"date-time":"2026-08-03T06:29:02Z","timestamp":1785738542000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2072-6643\/18\/15\/2491"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,8,2]]},"references-count":31,"journal-issue":{"issue":"15","published-online":{"date-parts":[[2026,8]]}},"alternative-id":["nu18152491"],"URL":"https:\/\/doi.org\/10.3390\/nu18152491","relation":{},"ISSN":["2072-6643"],"issn-type":[{"value":"2072-6643","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,8,2]]}}}