Long-Term Outcomes of Mediterranean-Adapted Crohn’s Disease Exclusion Diet in Mild Pediatric Crohn’s Disease: A Real-Life Study from a Referral IBD Center

Background: Exclusive enteral nutrition (EEN) is the recommended first-line therapy for induction of remission in pediatric mild-to-moderate Crohn’s disease (CD), but its restrictive nature often limits adherence and long-term sustainability. A modified version of the Crohn’s Disease Exclusion Diet (CDED), integrating Mediterranean dietary principles, was developed to offer a more acceptable alternative while preserving therapeutic efficacy. Methods: We conducted a retrospective, single-center study comparing short- and long-term outcomes of a Mediterranean-adapted CDED (M-CDED) with partial enteral nutrition (PEN) versus standard EEN in children with mild-to-moderate CD. Clinical remission was assessed after 8 and 16 weeks, while long-term outcomes were assessed after 1 and 2 years. Results: Data collected from thirty-two patients were analyzed (EEN, 14; M-CDED, 18). Clinical remission rates were comparable after 8 weeks (92.8% EEN vs. 94.4% M-CDED) and 16 weeks (100% in both groups). However, at 12 and 24 months, M-CDED was associated with significantly higher rates of clinical and biochemical remission and a markedly lower need for biologic drugs (12-month biologic initiation: 50% EEN vs. 11.1% M-CDED; p = 0.01). Adherence to M-CDED was excellent throughout follow-up. Conclusions: M-CDED with PEN appears to be as effective as EEN for remission induction, with improved long-term disease control and reduced therapeutic escalation. These findings support the feasibility of M-CDED as a sustainable option for long-term management of pediatric CD. Prospective studies are needed to confirm these results.