TONIC: Intermittent Caloric Restriction in Patients With Mild to Moderate Crohn's Disease
Crohn's disease (CD) is a chronic inflammatory disease of the gastrointestinal (GI) tract. CD is a common inflammatory bowel disease (IBD), frequent (150,000 patients in France and 1.5 million in Europe), disabling and incurable. The environmental factors, and in particular diet, play a major role in the pathogenesis of CD. The prevalence of CD is steadily increasing in highly industrialized countries, where the Western diet rich in saturated fats and refined sugars, is blamed for this to explain this true pandemic. On the other hand, enteral nutrition, exclusive or partial, is known to be effective in the initial treatment of CD, especially in pediatrics.
There are a number of evidence in favor of a nutritional management nutritional management of caloric restriction during inflammatory diseases such as psoriasis and rheumatoid arthritis,whose physiopathology is similar to that of IBD.
To date, and despite patient concern, there is no consensus nutritional in the management of CD to influence the natural course of the disease.
The investigators have decided to initiate a clinical study to evaluate for the first time the efficacy, acceptability and safety of intermittent caloric restriction in patients with CD.
|Condition or Disease||Intervention/Treatment||Phase|
Arms and Interventions
|Experimental: Intermittent caloric restriction
Intermittent caloric restriction during 16 weeks.
Other: Intermittent caloric restriction
Intermittente caloric restriction: st month: restriction of 50% of the caloric intake previously determined by the dietician 1 day per week nd month: restriction of 50% of the caloric intake 2 days per week rd month: restriction of 60% of the caloric intake 2 days per week th month: restriction of 75% of the caloric intake 2 days per week
|No Intervention: Routine practice
Primary Outcome Measures
- Intestinal inflammation [week 16]
Evaluate the effectiveness of personalized nutritional management of intermittent caloric restriction during 16 weeks on the level of intestinal inflammation (induction of of a biological response) in patients with mild to moderate CD mild to moderate. The effectiveness will be evaluated in each group by a biological response change, that is to say a decrease at least 50% of calprotectin fecal level.
Secondary Outcome Measures
- Induction of a clinical response [week 16]
Evaluate the impact of personalized nutritional management of intermittent caloric restriction during 16 weeks on Crohn's Disease Activity Index (CDAI) that is to say change by al least 100 points. The following cut-offs correlate with level of disease activity: Non-active disease: CDAI < 150 Mild disease activity: CDAI >= 150 and <220 Moderate disease activity: CDAI >= 220 and <450 Severe disease activity: CDAI > 450
- Induction of a clinical remission [week 16]
Evaluate the impact of personalized nutritional management of intermittent caloric restriction during 16 weeks on clinical remission, that is to say Crohn's Disease Activity Index (CDAI) < 150 The following cut-offs correlate with level of disease activity: Non-active disease: CDAI < 150 Mild disease activity: CDAI >= 150 and <220 Moderate disease activity: CDAI >= 220 and <450 Severe disease activity: CDAI > 450
- Induction of a biological remission [week 16]
Evaluate the impact of personalized nutritional management of intermittent caloric restriction during 16 weeks on biological remission that is to say fecal calprotection < 250 µg/g
- Induction of a radiological response [week 16]
Evaluate the impact of personalized nutritional management of intermittent caloric restriction during 16 weeks on radiological response that is to say change of 50% of Nancy score measured by magnetic resonance imaging (MRI) Total MRI score: 0 at 36
- Improving quality of life [week 16]
Evaluated by short-Inflammatory Bowel Disease Questionnaire (short-IBDQ) short-IBDQ is a 10-items measure that assesses self-reported quality of life. Total score ranges from 10 to 70. Higher the score is better life quality is.
- Improving work productivity [week 16]
Evaluated by Work Productivity and Activity Impairment Questionnaire (WPAI) WPAI questions measure the effect of patients health problems (any physical or emotional problem or symptom) on their ability to work and perform regular activites.
- Improving fatigue [week 16]
Evaluated by Functional Assessment of Chronic Illness Therapy - Fatigue (FACIT-F) FACIT-F is a 40-items measure that assesses self-reported fatigue and its impact upon daily activities and function.
- Improving functional disability [week 16]
Evaluated by Inflammatory Bowel Disease - Disability Index (IBD-DI) IBD-DI is a 14-items measure that assesses self-reported disability. It ranges from 0-100: 0-20 (no disability), 20-35 (mild disability), 35-50 (moderate disability) and 50-100 (severe disability)
- Improving anxiety disorder [week 16]
Evaluated by Generalized Anxiety Disorder (GAD-7) The following cut-offs correlate with level of anxiety severity: Score 0-4: Minimal Anxiety Score 5-9: Mild Anxiety Score 10-14: Moderate Anxiety Score greater than 15: Severe Anxiety
- Evaluate the safety of intermittent caloric restriction in patients with mild to moderate with mild to moderate CD. [weeks 4;8;12 and 16]
Percentage of adverse event related to intermittent caloric restriction (fatigue; nausea; headache, dizziness, hypotension, irritability, capacity reduced to concentrating, undernutrition/sarcopenia)
- Evaluate compliance of intermittent caloric restriction during 16 weeks in patients with with mild to moderate CD. [week 16]
Percentage of patient compliance measured by for example a intermittent caloric restriction during at least 21 days on the 16 weeks of the study
- Determine the level of patient satisfaction with intermittent caloric restriction [week 16]
Evaluated by Likert scale at 4 items ad-hoc 4 point likert scale for the frequency; assign each response a point value from 1 to 4.
- Estimate, in the experimental arm, the prevalence of compensatory hyperphagia after intermittent caloric restriction [48 hours after intermittent caloric restriction]
Percentage of patients having a compensatory hyperphagia after 2 days of intermittent caloric restriction.
Patients between 18 to 65 years old
Established diagnosis of Crohn's disease with a minimum disease duration of 3 months
Patient with mild to moderate Crohn's disease defined by a fecal calprotectin ≥ 250 μg/g and a CDAI score between 150 to 300
Medical treatment of Crohn's disease stable for at least 3 months
Patient compliant with an intermittent caloric restriction during 16 weeks
Person affiliated to or beneficiary of a social security plan
Person informed about study organization and having signed the informed consent
Patient with a BMI < 18.5kg/m2
Patient having a weight loss of 5% the first month and 10% during the first 6 months
Patient with active ano-perineal lesions
Patient with an ostomy
Patient with eating disorders (anorexia, bulimia)
Person referred in articles L.1121-5, L. 1121-7 and L.1121-8 of the Public Health
Pregnant, parturient or breastfeeding woman
Minor person (non-emancipated)
Adult person under legal protection (any form of public guardianship)
Adult person incapable of giving consent and not under legal protection
Person deprived of liberty for judicial or administrative decision, person under psychiatric care as referred in articles L. 3212-1 and L. 3213-1.
Contacts and Locations
LocationsNo locations specified.
Sponsors and Collaborators
- Central Hospital, Nancy, France
- Principal Investigator: CARON Bénédicte, MD, CHRU of Nancy, Hepatogastroenterology Department
Study Documents (Full-Text)None provided.
- Jiang Y, Jarr K, Layton C, Gardner CD, Ashouri JF, Abreu MT, Sinha SR. Therapeutic Implications of Diet in Inflammatory Bowel Disease and Related Immune-Mediated Inflammatory Diseases. Nutrients. 2021 Mar 10;13(3):890. doi: 10.3390/nu13030890.
- Yanai H, Levine A, Hirsch A, Boneh RS, Kopylov U, Eran HB, Cohen NA, Ron Y, Goren I, Leibovitzh H, Wardi J, Zittan E, Ziv-Baran T, Abramas L, Fliss-Isakov N, Raykhel B, Gik TP, Dotan I, Maharshak N. The Crohn's disease exclusion diet for induction and maintenance of remission in adults with mild-to-moderate Crohn's disease (CDED-AD): an open-label, pilot, randomised trial. Lancet Gastroenterol Hepatol. 2022 Jan;7(1):49-59. doi: 10.1016/S2468-1253(21)00299-5. Epub 2021 Nov 2.