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Development and Validation of the Glasgow Exclusive Enteral Nutrition Index of Compliance

BACKGROUND AND AIMS: Treatment adherence is key to the efficacy of exclusive enteral nutrition [100% EN] in active Crohn’s disease [CD], but there are no biomarkers to objectively estimate this. We explored faecal parameters as biomarkers of compliance with 100% EN, and subsequently developed and va...

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Autores principales: Jatkowska, Aleksandra, White, Bernadette, Nichols, Ben, Svolos, Vaios, Gkikas, Konstantinos, Hansen, Richard, Russell, Richard K, Gaya, Daniel, Brownson, Emily, Seenan, John Paul, Milling, Simon, MacDonald, Jonathan, Gerasimidis, Konstantinos
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Oxford University Press 2023
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Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10588781/
https://www.ncbi.nlm.nih.gov/pubmed/37004165
http://dx.doi.org/10.1093/ecco-jcc/jjad063
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author Jatkowska, Aleksandra
White, Bernadette
Nichols, Ben
Svolos, Vaios
Gkikas, Konstantinos
Hansen, Richard
Russell, Richard K
Gaya, Daniel
Brownson, Emily
Seenan, John Paul
Milling, Simon
MacDonald, Jonathan
Gerasimidis, Konstantinos
author_facet Jatkowska, Aleksandra
White, Bernadette
Nichols, Ben
Svolos, Vaios
Gkikas, Konstantinos
Hansen, Richard
Russell, Richard K
Gaya, Daniel
Brownson, Emily
Seenan, John Paul
Milling, Simon
MacDonald, Jonathan
Gerasimidis, Konstantinos
author_sort Jatkowska, Aleksandra
collection PubMed
description BACKGROUND AND AIMS: Treatment adherence is key to the efficacy of exclusive enteral nutrition [100% EN] in active Crohn’s disease [CD], but there are no biomarkers to objectively estimate this. We explored faecal parameters as biomarkers of compliance with 100% EN, and subsequently developed and validated the Glasgow Exclusive Enteral Nutrition Index of Compliance [GENIE]. METHODS: Healthy adults replaced all [100% EN] or part [85% EN, 50% EN, 20% EN] of their diet with a formula for 7 days. Faecal pH, water content, short chain fatty acids, and branched chain fatty acids [BCFAs] were measured before [D0] and after [D7] each intervention. Optimal biomarkers and threshold values were derived using receiver operating characteristic curve analyses and machine learning to develop the GENIE. The GENIE was then validated in 30 CD children, during and after 100% EN. RESULTS: In all, 61 adults were recruited. D7 faecal pH and the ratios of BCFAs to either acetate or butyrate performed the best to differentiate between patients on 100% EN from <100% EN. Two models were generated; one included faecal metabolites (Laboratory GENIE, L-GENIE; sensitivity, specificity, and positive predictive value [PPV] of 88%, 94%, and 92%) and a second one [Clinical Genie, C-GENIE] which considers only faecal pH [sensitivity, specificity, and PPV of 84%, 86%, and 81%]. Validation of GENIE in CD children found that C-GENIE outperformed L-GENIE, producing a sensitivity, specificity, and PPV of 85%, 88%, and 88%, respectively. CONCLUSIONS: GENIE can help predict adherence to 100% EN and may complement current conventional dietary assessment.
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spelling pubmed-105887812023-10-21 Development and Validation of the Glasgow Exclusive Enteral Nutrition Index of Compliance Jatkowska, Aleksandra White, Bernadette Nichols, Ben Svolos, Vaios Gkikas, Konstantinos Hansen, Richard Russell, Richard K Gaya, Daniel Brownson, Emily Seenan, John Paul Milling, Simon MacDonald, Jonathan Gerasimidis, Konstantinos J Crohns Colitis Original Articles BACKGROUND AND AIMS: Treatment adherence is key to the efficacy of exclusive enteral nutrition [100% EN] in active Crohn’s disease [CD], but there are no biomarkers to objectively estimate this. We explored faecal parameters as biomarkers of compliance with 100% EN, and subsequently developed and validated the Glasgow Exclusive Enteral Nutrition Index of Compliance [GENIE]. METHODS: Healthy adults replaced all [100% EN] or part [85% EN, 50% EN, 20% EN] of their diet with a formula for 7 days. Faecal pH, water content, short chain fatty acids, and branched chain fatty acids [BCFAs] were measured before [D0] and after [D7] each intervention. Optimal biomarkers and threshold values were derived using receiver operating characteristic curve analyses and machine learning to develop the GENIE. The GENIE was then validated in 30 CD children, during and after 100% EN. RESULTS: In all, 61 adults were recruited. D7 faecal pH and the ratios of BCFAs to either acetate or butyrate performed the best to differentiate between patients on 100% EN from <100% EN. Two models were generated; one included faecal metabolites (Laboratory GENIE, L-GENIE; sensitivity, specificity, and positive predictive value [PPV] of 88%, 94%, and 92%) and a second one [Clinical Genie, C-GENIE] which considers only faecal pH [sensitivity, specificity, and PPV of 84%, 86%, and 81%]. Validation of GENIE in CD children found that C-GENIE outperformed L-GENIE, producing a sensitivity, specificity, and PPV of 85%, 88%, and 88%, respectively. CONCLUSIONS: GENIE can help predict adherence to 100% EN and may complement current conventional dietary assessment. Oxford University Press 2023-04-02 /pmc/articles/PMC10588781/ /pubmed/37004165 http://dx.doi.org/10.1093/ecco-jcc/jjad063 Text en © The Author(s) 2023. Published by Oxford University Press on behalf of European Crohn’s and Colitis Organisation. https://creativecommons.org/licenses/by-nc/4.0/This is an Open Access article distributed under the terms of the Creative Commons Attribution-NonCommercial License (https://creativecommons.org/licenses/by-nc/4.0/), which permits non-commercial re-use, distribution, and reproduction in any medium, provided the original work is properly cited. For commercial re-use, please contact journals.permissions@oup.com
spellingShingle Original Articles
Jatkowska, Aleksandra
White, Bernadette
Nichols, Ben
Svolos, Vaios
Gkikas, Konstantinos
Hansen, Richard
Russell, Richard K
Gaya, Daniel
Brownson, Emily
Seenan, John Paul
Milling, Simon
MacDonald, Jonathan
Gerasimidis, Konstantinos
Development and Validation of the Glasgow Exclusive Enteral Nutrition Index of Compliance
title Development and Validation of the Glasgow Exclusive Enteral Nutrition Index of Compliance
title_full Development and Validation of the Glasgow Exclusive Enteral Nutrition Index of Compliance
title_fullStr Development and Validation of the Glasgow Exclusive Enteral Nutrition Index of Compliance
title_full_unstemmed Development and Validation of the Glasgow Exclusive Enteral Nutrition Index of Compliance
title_short Development and Validation of the Glasgow Exclusive Enteral Nutrition Index of Compliance
title_sort development and validation of the glasgow exclusive enteral nutrition index of compliance
topic Original Articles
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10588781/
https://www.ncbi.nlm.nih.gov/pubmed/37004165
http://dx.doi.org/10.1093/ecco-jcc/jjad063
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