Whole-food diet therapies for children with Crohn’s disease: a systematic review

Background: Children with Crohn’s disease (CD) experience gastrointestinal symptoms that impair nutrition, growth and quality of life. Exclusive enteral nutrition is recommended as a first-line remission induction treatment. However, compliance is challenging due to monotony and the social impact of excluding whole foods, increasing interest in whole-food diet therapies. Objectives: This systematic review aimed to summarise current evidence regarding the impact of whole-food therapies on clinical remission (as defined by each study using validated measures) and related health outcomes in children with CD. Design: We performed a systematic review of studies assessing whole-food interventions in children with CD. Data sources and methods: A systematic search was conducted in electronic databases for research published in English from 1 January 2012 to 16 August 2024. Randomised controlled trials (RCTs), quasi-experimental studies, cohort studies, case-control studies and case series were included. Results: Twenty-eight studies ( n = 4 RCTs, n = 3 non-RCTs, n = 16 observational studies, n = 5 post hoc analyses) met inclusion criteria and examined six types of diets. Most of the children being treated had uncomplicated, mild–moderate disease activity and were on concomitant medications. Those on whole-food therapies demonstrated a median clinical remission rate of 75% (interquartile range 62%–85%; n = 18 studies), mucosal improvement and healing ( n = 5/6 studies), improved inflammatory biomarkers ( n = 18/19 studies) and enhanced growth parameters ( n = 11/13 studies). Outcomes related to microbial changes were inconsistent. Overall, studies were low–medium quality due to small, non-randomised, uncontrolled studies using a variety of concomitant medications and different definitions for clinical remission, preventing definitive conclusions. Conclusion: The findings suggest whole-food diet therapies can potentially be used to treat children with mild to moderate CD and that a flexible, nutrient-balanced dietary approach tailored to the individual child may be possible. However, large-scale, RCTs with standardised outcome measures are needed to further support the routine use of whole-food therapies in paediatric CD. Trial registration: PROSPERO registration number CRD42024580134.