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. 2023 Oct 20;17(9):1426-1435.
doi: 10.1093/ecco-jcc/jjad063.

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

Aleksandra Jatkowska  1 , Bernadette White  1 , Ben Nichols  1 , Vaios Svolos  1 , Konstantinos Gkikas  1 , Richard Hansen  2 , Richard K Russell  3 , Daniel Gaya  4 , Emily Brownson  5 , John Paul Seenan  5 , Simon Milling  6 , Jonathan MacDonald  5 , Konstantinos Gerasimidis  1
Affiliations

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

Aleksandra Jatkowska et al. J Crohns Colitis. .

Abstract

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.

Keywords: Biomarkers; exclusive enteral nutrition; paediatrics.

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Conflict of interest statement

The studentships of AJ, BW, and KGk are funded by Nestle Health Science and the University of Glasgow. KGe received research funding, speakers’ fees and travel expenses covered by Nestle Health Science. RKR received speakers fees, travel support, or has performed consultancy work with Nestle Health Sciences, AbbVie, Pharmacosmos, Lilly, Celltrion Healthcare, and Janssen. DG is funded by a senior NHS research fellowship and received speaker fees and travel support from Pfizer, BMS, Abbvie, Takeda, Janssen, and Vifor pharma. SM received research funding from Nutricia and SciRhom. JPS has received speaker fees from AbbVie, Fresenius Kabi, Galapagos, Janssen-Cilag, Pharmacosmos, Takeda, and Tillotts Pharma; and received advisory board fees from AbbVie, Bristol Myers Squibb, Dr Falk Pharma, and Galapagos. VS received consultancy fees from Chronicles Health. EB, JM, and RH have no conflicts of interest to disclose. The funders had no role in the concept, design, execution, interpretation, writing, or submission of this manuscript.

Figures

Graphical Abstract
Graphical Abstract
Figure 1.
Figure 1.
Baseline [D0] and 7-day [D7] faecal pH measurements.
Figure 2.
Figure 2.
Decision tree for group classification into 100% EN [n = 25] or <100% EN [n = 36] groups using machine learning algorithm and all 7-day faecal metabolite parameters. EN, enteral nutrition.
Figure 3.
Figure 3.
Decision tree for group classification into 100% EN [n = 25] or < 100% EN [n = 36] groups using machine learning algorithm and 7-day faecal pH measurements. EN, enteral nutrition.
Figure 4.
Figure 4.
Glasgow Exclusive Enteral Nutrition Index of Compliance [GENIE].
Figure 5.
Figure 5.
A clinical application example of Clinical Glasgow Exclusive Enteral Nutrition Index of Compliance [C-GENIE] in patients with active Crohn’s disease treated with 100% EN. EN, enteral nutrition.
See this image and copyright information in PMC

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