EFFICACY AND FEASIBILITY OF THE KOREAN CROHN’S DISEASE EXCLUSION DIET (K-CDED) IN PEDIATRIC CROHN’S DISEASE

Abstract BACKGROUND Exclusive enteral nutrition (EEN) is the first-line induction therapy for mild to moderate pediatric Crohn’s disease, but its use is limited by poor adherence. The Crohn’s disease exclusion diet (CDED) has shown efficacy comparable to EEN with better tolerability, though evidence is largely from Western populations. Data in Asian children are scarce. We evaluated the efficacy and feasibility of a Korean-adapted CDED (K-CDED) in pediatric Crohn’s disease. METHODS We retrospectively analyzed pediatric Crohn’s disease patients who received induction therapy with either K-CDED or EEN at a tertiary referral center. Clinical and biochemical parameters were assessed at baseline and weeks 2, 4, 8, and 12. Outcomes included fecal calprotectin (FC), C-reactive protein (CRP), erythrocyte sedimentation rate (ESR), and the Pediatric Crohn’s Disease Activity Index (PCDAI). Changes over time were compared between groups. RESULTS A total of 24 children were included (EEN n = 14, K-CDED n = 10). Baseline demographics, disease activity, and laboratory parameters showed no significant differences between groups. During induction (weeks 0–4), both groups achieved clinical and biochemical improvements. FC decreased significantly in both groups, with reductions evident by week 2 in EEN (p = 0.0055) and by week 4 in K-CDED (p = 0.0265). CRP declined significantly from week 2 in EEN (p = 0.0004), while K-CDED showed a gradual but non-significant reduction. ESR decreased significantly in EEN as early as week 2 (p < 0.001), whereas in K-CDED significant reductions were observed only from week 8 (p = 0.008). PCDAI decreased significantly from baseline in both groups (EEN from week 2, p < 0.001; K-CDED from week 2, p = 0.008), with improvements maintained through week 12. During maintenance (up to week 12), improvements in PCDAI, CRP, ESR, and FC were sustained in both groups. Overall, both groups showed comparable improvements without significant between-group differences. CONCLUSION K-CDED demonstrated efficacy in reducing inflammation and improving clinical outcomes in pediatric Crohn’s disease, with favorable feasibility compared with EEN. Although EEN induced more rapid responses, K-CDED provided meaningful and sustained improvements, supporting its role as a culturally adapted, tolerable dietary therapy for Asian children with Crohn’s disease.