P832 EEN and CDED produce broadly similar taxonomic changes during the induction of remission, but many taxa rebound upon the transition from EEN back to free diet
Bibliographic record
Abstract
Exclusive enteral nutrition (EEN; a liquid formula diet) is the treatment of choice in mild-to-moderate paediatric Crohn’s disease (CD). The Crohn’s disease exclusion diet [CDED; a whole food diet supplemented with partial enteral nutrition (PEN)] has been proposed as an alternative, more tolerable induction therapy. In both therapies it is hypothesised that through changes in dietary components the intestinal barrier integrity and microbiome community is affected and these lead to remission. A 12-week study compared remission rates and tolerance of diet in children with mild-to-moderate CD using either EEN or CDED as a first-line induction therapy. CDED patients received 6 weeks of CDED +50% PEN followed by 6 weeks of CDED + 25% PEN. EEN patients received 6 weeks of EEN followed by 6 weeks of free diet + 25% PEN. Patients collected stool samples at the start (BL), Weeks 6 (W6) and Week 12 (W12) of therapy. 16S rRNA gene (V4V5) and shotgun metagenome sequences were conducted on stool samples. Changes in the microbiome at BL, W6 and W12 for EEN and CDED were analysed using Kruskal–Wallis, linear discriminant analysis and Bayesian methods to examine community changes. DNA sequences from stool samples were collected for 70 patients, 38 CDED patients (25 at all 3 times points) and 32 EEN patients (21 at all 3 times points). At W12, 21 of 25 CDED patients were in remission. Microbiome comparison of BL, W6 and W12 showed significant (p < 0.05) decreases in Haemophilus, Veillonella, Bifidobacterium, Prevotella, and Anaerostipes, and increases in Oscillibacter, and Roseburia. In EEN patients at W12, 14 of 21 were in remission. A comparison across timepoints in EEN identified significant (p < 0.05) differences in many of the same taxa identified in CDED. In addition, Lachnospira decreased and Subdoligranulum, Blautia, Ruminococcus and Erysipelotrichaceae increased. Although similar taxa were identified, the pattern between the two groups differed. CDED continued to change between W6 and W12 while EEN generally rebounded to pre-treatment levels at W12. In addition, linear discriminate analyses between W6 and W12 in EEN appear to show a return in W12 of some taxa seen pre-treatment. Finally, in CDED there were on average increases in diversity over treatment, while EEN saw on average decreases in diversity at W6, and increases at W12. Both EEN and CDED resulted in remission and showed similar taxa changes during treatment. An examination of the taxonomic trends in the EEN study however, suggests that after the switch from EEN in W6 to a free diet + PEN, there is a rebound to a more pre-treatment distribution of taxa despite the use of PEN.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.000 | 0.000 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.001 | 0.000 |
| Bibliometrics | 0.000 | 0.000 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.000 | 0.000 |
| Open science | 0.000 | 0.000 |
| Research integrity | 0.000 | 0.001 |
| Insufficient payload (model declined to judge) | 0.004 | 0.001 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".