Personalized Research on Diet in Ulcerative Colitis and Crohn's Disease

NCT ID: NCT03301311

Last Updated: 2022-06-28

Study Results

Results pending

The study team has not published outcome measurements, participant flow, or safety data for this trial yet. Check back later for updates.

Basic Information

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Recruitment Status

COMPLETED

Clinical Phase

NA

Total Enrollment

54 participants

Study Classification

INTERVENTIONAL

Study Start Date

2018-04-10

Study Completion Date

2020-09-08

Brief Summary

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A series of N-of-1 trials will be used to determine the effectiveness of a specific carbohydrate diet (SCD) versus a modified SCD in patients in reducing symptoms and inflammatory burden at both the individual and population level. This is a four-year study. The study staff will recruit up to 60 patients across up to 21 sites in patients aged 7-18 with mild to moderate disease activity.

Detailed Description

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Conditions

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Inflammatory Bowel Diseases Crohn Disease Ulcerative Colitis Indeterminate Colitis

Study Design

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Allocation Method

RANDOMIZED

Intervention Model

CROSSOVER

We are using a series of N-of-1 trials where patients alternate (cross) between the two study interventions at set intervals. N-of-1 trial results will be examined at the individual and population level (through meta-analysis of individual N-of-1 trials)
Primary Study Purpose

TREATMENT

Blinding Strategy

NONE

Study Groups

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Specific Carbohydrate Diet (First)

Participants will be following the Specific Carbohydrate Diet (SCD). Allowed foods include meat/fish/poultry, eggs, some legumes (e.g., lentils and split peas are permitted, chickpeas and soybeans are not), fully fermented yogurt, non-starchy vegetables, ripe fruit, nuts/seeds, honey and nut flours (e.g. almond flour or coconut flour). Restricted foods include all grains, milk products aside from 24-hour fermented SCD yogurt and cheeses aged greater than 30 days, starchy vegetables, processed foods with food additives and sweeteners other than honey.

Group Type EXPERIMENTAL

Specific Carbohydrate Diet (SCD)

Intervention Type OTHER

Patients will be randomized to start with either a strict SCD or modified SCD. Participants will alternate between each diet in 8-week intervals for a total duration of approximately 34 weeks. Participants will complete two 8-week intervention periods on each diet.

Modified Specific Carbohydrate Diet (MSCD)

Intervention Type OTHER

Patients will be randomized to start with either a strict SCD or modified SCD. Participants will alternate between each diet in 8-week intervals for a total duration of approximately 34 weeks. Participants will complete two 8-week intervention periods on each diet.

Modified Specific Carbohydrate Diet (First)

Participants will be following a modified Specific Carbohydrate Diet (MSCD). In addition to the foods in the SCD, allowed foods will expand to include organic rice, oats, sweet potatoes, grade A maple syrup and cocoa. Gluten, corn products, milk products (except yogurt and hard cheeses), sweeteners (except honey), and process foods are still restricted.

Group Type EXPERIMENTAL

Specific Carbohydrate Diet (SCD)

Intervention Type OTHER

Patients will be randomized to start with either a strict SCD or modified SCD. Participants will alternate between each diet in 8-week intervals for a total duration of approximately 34 weeks. Participants will complete two 8-week intervention periods on each diet.

Modified Specific Carbohydrate Diet (MSCD)

Intervention Type OTHER

Patients will be randomized to start with either a strict SCD or modified SCD. Participants will alternate between each diet in 8-week intervals for a total duration of approximately 34 weeks. Participants will complete two 8-week intervention periods on each diet.

Interventions

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Specific Carbohydrate Diet (SCD)

Patients will be randomized to start with either a strict SCD or modified SCD. Participants will alternate between each diet in 8-week intervals for a total duration of approximately 34 weeks. Participants will complete two 8-week intervention periods on each diet.

Intervention Type OTHER

Modified Specific Carbohydrate Diet (MSCD)

Patients will be randomized to start with either a strict SCD or modified SCD. Participants will alternate between each diet in 8-week intervals for a total duration of approximately 34 weeks. Participants will complete two 8-week intervention periods on each diet.

Intervention Type OTHER

Eligibility Criteria

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Inclusion Criteria

* Diagnosis of Crohn's Disease (CD) or ulcerative colitis (UC) or Indeterminate colitis (IC)
* Age 7-18 years
* Enrolled in the ImproveCareNow (ICN2) registry
* Evidence of acute inflammation and/or elevated acute phase reactant as measured by Fecal calprotectin 1.5 times the upper limit of normal, Lactoferrin 1.5 times the upper limit of normal, CRP 1.15 times the upper limit of normal, or ESR 1.15 times the upper limit of normal (based on local reference ranges) obtained within 8 weeks of enrollment.

* Potential participants who are close to meeting one of the acute inflammation and/or elevated acute phase reactant markers and who meet all other study criteria will be considered for study participation on a case by case basis by the investigative study team in consultation with the patient's primary gastroenterologist.

Exclusion Criteria

Complex and Unstable IBD:

* Currently or within the past 9 months has had an abscess, fistula, stricturing CD, or ostomy
* Severe disease activity as measured by a short Pediatric Crohn's Disease Activity Index (SPCDAI) score of \>45 or Pediatric Ulcerative Colitis Activity Index (PUCAI) score of \>60 assessed within three weeks of enrollment
* Ever had history of full colectomy
* Hospitalization or surgery planned within 3 months
* Ongoing active gastrointestinal infection
* Severe Malnutrition (BMI less than 5th percentile)
* Recent medication changes including:

* Thiopurines, natalizumab, or methotrexate started within 8 weeks prior to enrollment
* Anti TNF (infliximab, adalimumab) started within 8 weeks prior to enrollment
* Vedolizumab started within 16 weeks prior to enrollment
* Increase in corticosteroids within 4 weeks of screening or have dose \>20 mg prednisone or equivalent

Evidence of Other Complicating Medical Issues:

* Other serious medical conditions, such as neurological, liver, kidney, or systemic disease
* Serious psychological or psychiatric conditions such as eating disorders or self-harm
* Pregnancy
* Tobacco, alcohol, or illicit drug abuse

Inability to Complete the Protocol

* Non-English speaking participants
* On SCD or modified SCD anytime within 8 weeks of enrollment

* If an otherwise eligible patient is on SCD or modified SCD within 8 weeks of enrollment but they are noncompliant per the determination of the patient's dietitian/primary gastroenterologist, then this patient is eligible to participant in the study.
* Participants on a vegan diet
* Lack of smart phone and data plan for participating caregiver
* Participating in another concurrent intervention study
Minimum Eligible Age

7 Years

Maximum Eligible Age

18 Years

Eligible Sex

ALL

Accepts Healthy Volunteers

No

Sponsors

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University of California, San Francisco

OTHER

Sponsor Role collaborator

Seattle Children's Hospital

OTHER

Sponsor Role collaborator

Dayton Children's Hospital

OTHER

Sponsor Role collaborator

Brown University

OTHER

Sponsor Role collaborator

Children's Hospital Medical Center, Cincinnati

OTHER

Sponsor Role lead

Responsible Party

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Responsibility Role SPONSOR

Principal Investigators

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Heather C Kaplan, MD

Role: PRINCIPAL_INVESTIGATOR

Children's Hospital Medical Center, Cincinnati

Lisa Opipari-Arrigan, PhD

Role: PRINCIPAL_INVESTIGATOR

Children's Hospital Medical Center, Cincinnati

Locations

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Arkansas Children's Hospital

Little Rock, Arkansas, United States

Site Status

Children's Hospital of Los Angeles

Los Angeles, California, United States

Site Status

UCSF Benioff Children's Hospital Oakland

Oakland, California, United States

Site Status

Lucile Packard Children's Hospital

Palo Alto, California, United States

Site Status

University of California San Francisco Benioff Children's Hospita;

San Francisco, California, United States

Site Status

Nemours, Alfred I duPont Hospital for Children

Wilmington, Delaware, United States

Site Status

Nemours Children's Speciality Care

Jacksonville, Florida, United States

Site Status

Nemours Children's Hospital

Orlando, Florida, United States

Site Status

GI Care for Kids

Atlanta, Georgia, United States

Site Status

Riley Hospital for Children

Indianapolis, Indiana, United States

Site Status

Massachusetts General Hospital

Boston, Massachusetts, United States

Site Status

Children's Mercy Hospital

Kansas City, Missouri, United States

Site Status

Levine Children's Hospital

Charlotte, North Carolina, United States

Site Status

Nationwide Children's Hospital

Columbus, Ohio, United States

Site Status

Oregon Health Sciences University

Portland, Oregon, United States

Site Status

Dell Children's Medical Center of Central Texas

Austin, Texas, United States

Site Status

UT Soutwestern Medical Center

Dallas, Texas, United States

Site Status

Pediatric Specialists of Virginia

Fairfax, Virginia, United States

Site Status

Children's Hospital of the King's Daughters

Norfolk, Virginia, United States

Site Status

Seattle Children's

Seattle, Washington, United States

Site Status

Countries

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United States

References

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Kaplan HC, Opipari-Arrigan L, Yang J, Schmid CH, Schuler CL, Saeed SA, Braly KL, Chang F, Murphy L, Dodds CM, Nuding M, Liu H, Pilley S, Stone J, Woodward G, Yokois N, Goyal A, Lee D, Yeh AM, Lee P, Gold BD, Molle-Rios Z, Zwiener RJ, Ali S, Chavannes M, Linville T, Patel A, Ayers T, Bassett M, Boyle B, Palomo P, Verstraete S, Dorsey J, Kaplan JL, Steiner SJ, Nguyen K, Burgis J, Suskind DL; ImproveCareNow Pediatric IBD Learning Health System. Personalized Research on Diet in Ulcerative Colitis and Crohn's Disease: A Series of N-of-1 Diet Trials. Am J Gastroenterol. 2022 Jun 1;117(6):902-917. doi: 10.14309/ajg.0000000000001800. Epub 2022 Apr 20.

Reference Type RESULT
PMID: 35442220 (View on PubMed)

Provided Documents

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Document Type: Study Protocol and Statistical Analysis Plan

View Document

Other Identifiers

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CIN001-PRODUCE

Identifier Type: -

Identifier Source: org_study_id

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