Very low fat content (< 3 g/1000 kCal) and very low long chain triglycerides demonstrated higher remission rates than higher content EN formulas.

An analysis of 7 trials including 209 patients treated with EN formulas of differing fat content (low fat: 20 g/1000 kCal) demonstrated no difference in remission rates (RR 1.03 95% CI 0.85 to 1.26). Subgroup analyses performed to evaluate the different types of elemental and non‐elemental diets (elemental, semi‐elemental and polymeric) showed no differences in remission rates. A per‐protocol analysis (346 participants) produced similar results (RR 1.04, 95% CI 0.91 to 1.18). Sixty‐four per cent (134/210) of patients in the elemental group achieved remission compared to 62% (105/168) of patients in the non‐elemental group (RR 1.02, 95% CI 0.88 to 1.18 GRADE very low quality). Meta‐analysis of 11 trials (378 participants) demonstrated no difference in remission rates. Seventeen trials compared different formulations of EN, 13 studies compared one or more elemental formulas to a non‐elemental formula, three studies compared EN diets of similar protein composition but different fat composition, and one study compared non‐elemental diets differing in glutamine enrichment. Seven studies were rated as high risk of bias and 17 were rated as unclear risk of bias due to insufficient information. Three studies were rated as low risk of bias. Twenty‐seven studies (1,011 participants) were included. We used the GRADE criteria to assess the overall quality of the evidence supporting the primary outcome and selected secondary outcomes. We used the Cochrane risk of bias tool to assess study quality. Sensitivity analyses included abstract publications and poor quality studies. Subgroup analyses were based on formula composition and age. The studies were separated into two comparisons: one EN formulation compared to another EN formulation and EN compared to corticosteroids. Heterogeneity was explored using the Chi 2 and I 2 statistics. We performed intention‐to‐treat and per‐protocol analyses for the primary outcome. A random‐effects model was used to pool data.

For dichotomous outcomes, we calculated the risk ratio (RR) and 95% confidence interval (CI). Secondary outcomes included adverse events, serious adverse events and withdrawal due to adverse events. The primary outcome was clinical remission. Data were extracted independently by at least two authors.

Watch sherlock holmes 2009 tubeplus