Supplementary Material for: Effectiveness of the Crohn’s Disease Exclusion Diet for the Treatment of Crohn’s Disease in the Older-Adult Population: Real-World Experience

Introduction: The management of Crohn's disease (CD) in older-adult patients is challenging due to age-related immune decline, comorbidities, and the excessive risk of adverse effects from pharmacological treatments. The Crohn’s Disease Exclusion Diet (CDED) has shown promise in treating younger populations, but its effectiveness in older-adults remains understudied. This study aimed to evaluate the CDED effectiveness in older-adults with CD.

Methods: A single center retrospective cohort study, including patients over 60 years old with CD who initiated CDED between 2018 and 2024. Patients were categorized based on baseline disease clinical activity using the Harvey Bradshaw Index (HBI). Clinical and biochemical outcomes (fecal calprotectin [FCAL] and C-reactive protein) were assessed over a 24-week follow-up.

Results: The study included 40 patients, 70% females, mean age of 69.2±7.6 years, and mean Charlson Comorbidity Index score of 3.37±1.4. Most of the patients (85%) initiated the CDED in phase 1. At baseline, 60% were in clinical remission and 40% had active disease. Patients with active disease demonstrated a significant clinical (HBI) improvement at week 6 which was sustained throughout week 12 (p<0.05), while patients in remission maintained stable HBI. A Significant decrease in FCAL was observed at week 12 (p=0.02).

Conclusion: The CDED appears to be an effective dietary intervention for managing CD in older-adults, offering potential benefits both in treating active disease and maintaining clinical remission. This diet could serve as an alternative or adjunct approach to pharmacological therapies, particularly for patients with mild disease or those at risk of adverse effects from advanced treatments.