781 COMPARATIVE EFFECTIVENESS OF MEDITERRANEAN DIET AND SPECIFIC CARBOHYDRATE DIET FOR CROHN'S DISEASE

Objective Therapeutic diets have been used to treat symptomatic Crohn's disease (CD). The Specific Carbohydrate Diet (SCD) and Mediterranean Diet (MD) have been associated with reduced CD symptoms. This study compared the effectiveness of these two diets for mild to moderate CD symptoms. Methods The Diet to INducE Remission in Crohn's Disease (DINE CD) study was a multicenter randomized comparative effectiveness trial of SCD vs MD. The study included adult patients with CD and with mild-moderate symptoms defined as a short Crohn's Disease Activity Index (sCDAI) score 176-399. Patients were randomly assigned 1:1, stratified by use of biologic medications, to consume either the SCD or MD for 12 weeks. For the first 6 weeks, participants received prepared meals and snacks compliant with their assigned diet. After 6 weeks, participants could purchase some or all of their food while following the diet on their own. The primary outcome was symptomatic remission (sCDAI 50% from baseline among those with baseline FC >250 μg/g), C Reactive Protein (CRP) response (high-sensitivity CRP (hsCRP) 50% reduction from baseline among those with hsCRP >5mg/L), short IBDQ and PROMIS measures of fatigue, pain, sleep and social isolation. Comparisons between groups used Cochrane-Mantel-Haenszel chi2 or t-test and within groups used paired t-test. Results 194 patients were randomized, but due to an error, 3 participants had a baseline sCDAI 0.2 for all comparisons). The percentage of participants who achieved symptomatic remission at week 6 did not differ by diet (43.5% with MD and 46.5% with SCD; p=0.77) (Figure). Clinical remission was achieved in 47.8% with MD and 48.5% with SCD (p=0.93). FC response was achieved in 4 participants (30.8%) with MD and 8 participants (34.8%) with SCD (p=0.83). CRP response was achieved in only 1 participant (3.6%) with MD and 2 participants (5.4%) with SCD (p=0.68). There was no evidence of heterogeneity of response based on presence or absence of confirmed inflammation at screening (Figure; test for interaction P=0.68). Conclusions Symptomatic remission was achieved in ≥40% with both diets regardless of confirmed inflammation. CRP response was uncommon. None of the effectiveness measures were significantly different by treatment group. Download : Download high-res image (86KB) Download : Download full-size image Table 1 . Change in symptoms from screening to week 6 by treatment arm Download : Download high-res image (73KB) Download : Download full-size image Figure 1 . Comparative effectiveness of Specific Carbohydrate Diet and Mediterranean Diet