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Nutrients
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Nutritional Strategies in Inflammatory Bowel Disease
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Nutritional Strategies in Inflammatory Bowel Disease

A special issue of Nutrients (ISSN 2072-6643). This special issue belongs to the section "Clinical Nutrition".

Deadline for manuscript submissions: closed (15 October 2024) | Viewed by 15103

Special Issue Editors

Dr. Fliss-Isakov Naomi

E-Mail Website
Guest Editor
School of Public Health, Faculty of Medicine, Tel Aviv University, Tel Aviv 6997801, Israel
Interests: diet; public health nutrition; inflammatory bowel diseases; nutritional epidemiology
Dr. Lihi Godny

E-Mail Website
Co-Guest Editor
Division of Gastroenterology and Nutrition Unit, Rabin Medical Center, Petaḥ Tikva 4941492, Israel
Interests: mediterranean diet; inflammatory bowel disease; microbiome

Special Issue Information

Dear Colleagues,

Nutritional therapy for inflammatory bowel disease (IBD) has been the subject of extensive research in recent years, resulting in the accumulation of substantial evidence highlighting the crucial connection between diet and gastrointestinal mucosal inflammation. Whether aimed at mitigating active inflammation, ameliorating functional symptoms or sustaining remission, scholars and practitioners in the field of nutritional therapy for IBD have been instrumental in instigating significant shifts in dietary practices for these patients.

This Special Issue of Nutrients entitled “Nutritional Strategies in Inflammatory Bowel Disease” welcomes original research and reviews of the literature concerning this important topic.

Dr. Fliss-Isakov Naomi
Dr. Lihi Godny
Guest Editors

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Keywords

  • dietary therapy
  • inflammatory bowel disease (IBD)
  • remission of inflammation
  • functional symptoms

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Published Papers (6 papers)

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Research

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18 pages, 1061 KiB  
Article
Cultural Perspectives on the Efficacy and Adoption of the Crohn’s Disease Exclusion Diet across Diverse Ethnicities: A Case-Based Overview
by Rotem Sigall Boneh, Sowon Park, Maria Soledad Arcucci, Marta Herrador-López, Chen Sarbagili-Shabat, Nitzan Kolonimos, Nicolette Wierdsma, Min Chen, Einat Hershkovitz, Eytan Wine and Johan Van Limbergen
Nutrients 2024, 16(18), 3184; https://doi.org/10.3390/nu16183184 - 20 Sep 2024
Viewed by 1374
Abstract
Background: The Crohn’s Disease Exclusion Diet (CDED) is a whole-foods regimen that has demonstrated efficacy in inducing remission among children and adults with mild-to-moderate disease. While initial studies predominantly originated from Israel, recent years have witnessed the expansion of experiences to diverse cultures, [...] Read more.
Background: The Crohn’s Disease Exclusion Diet (CDED) is a whole-foods regimen that has demonstrated efficacy in inducing remission among children and adults with mild-to-moderate disease. While initial studies predominantly originated from Israel, recent years have witnessed the expansion of experiences to diverse cultures, culminating in the recognition of CDED in the latest ESPEN guidelines. However, implementing dietary therapy poses significant challenges across various cultures, necessitating adaptations. Aim and Methods: This case-based study aims to present the collective experience from different cultures, shedding light on the encountered challenges and the corresponding solutions devised to surmount them by convening healthcare providers (dietitians and physicians across six countries and eight cultural settings) with extensive experience in utilizing the CDED. Results and Conclusions: Our findings underscore the efficacy of CDED across diverse cultural contexts and emphasize the pivotal role of dietitians in tailoring the diet to accommodate patients’ cultural behaviors and traditions. We highlight challenges encountered and delineate strategies for overcoming them by customizing the diet and offering tailored guidance. Additionally, we provide insights into implementing CDED in various regions through adjusted recipes and personalized counseling from dietitians. This study contributes to the growing body of literature on CDED, and offers practical guidance for its effective adoption in diverse cultural settings. Full article
(This article belongs to the Special Issue Nutritional Strategies in Inflammatory Bowel Disease)
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14 pages, 1509 KiB  
Article
Development of Novel High and Low Emulsifier Diets Based upon Emulsifier Distribution in the Australian Food Supply for Intervention Studies in Crohn’s Disease
by Jessica A. Fitzpatrick, Peter R. Gibson, Kirstin M. Taylor and Emma P. Halmos
Nutrients 2024, 16(12), 1922; https://doi.org/10.3390/nu16121922 - 18 Jun 2024
Cited by 5 | Viewed by 1338
Abstract
Background: The aims of this study were to develop and evaluate a high/low-emulsifier diet and compare emulsifier content with preclinical studies that have associated Crohn’s disease with emulsifiers. Methods: Supermarkets were audited with a seven-day high- (HED) and low-emulsifier diet (LED) meal plan [...] Read more.
Background: The aims of this study were to develop and evaluate a high/low-emulsifier diet and compare emulsifier content with preclinical studies that have associated Crohn’s disease with emulsifiers. Methods: Supermarkets were audited with a seven-day high- (HED) and low-emulsifier diet (LED) meal plan developed. The emulsifier content of food was sought from food manufacturers, compared to acceptable daily intake (ADI), and doses were provided in trials. Nutritional composition analysis was completed. Healthy adults ate these diets for seven days in a randomized single-blinded cross-over feeding study to assess palatability, tolerability, satiety, food variety, dietary adherence, blinding and the ease of following the meal plan via visual analogue scale. Results: A database of 1680 foods was created. There was no difference in nutritional content between the HED and LED, except HED had a higher ultra-processed food content (p < 0.001). The HED contained 41 emulsifiers, with 53% of the products able to be quantified for emulsifiers (2.8 g/d), which did not exceed the ADI, was similar to that in observational studies, and was exceeded by doses used in experimental studies. In ten participants, diets were rated similarly in palatability—HED mean 62 (5% CI 37–86) mm vs. LED 68 (54–82) mm—in tolerability—HED 41 (20–61) mm vs. LED 55 (37–73) mm—and in satiety HED 57 (32–81) mm vs. LED 49 (24–73) mm. The combined diets were easy to follow (82 (67–97) mm) with good variety (65 (47–81)) and excellent adherence. Conclusion: Nutritionally well-matched HED and LED were successfully developed, palatable and well tolerated. Full article
(This article belongs to the Special Issue Nutritional Strategies in Inflammatory Bowel Disease)
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13 pages, 2705 KiB  
Article
Exclusive Enteral Nutrition Beneficially Modulates Gut Microbiome in a Preclinical Model of Crohn’s-like Colitis
by Ramasatyaveni Geesala, Neeraja Recharla, Ke Zhang, John C. Johnson, George Golovko, Kamil Khanipov, Douglas L. Brining and Xuan-Zheng Shi
Nutrients 2024, 16(3), 363; https://doi.org/10.3390/nu16030363 - 26 Jan 2024
Cited by 4 | Viewed by 2169
Abstract
Exclusive enteral nutrition (EEN) is an established dietary treatment for Crohn’s disease (CD) by alleviating inflammation and inducing remission. However, the mechanisms of action of EEN are incompletely understood. As CD is associated with gut microbiome dysbiosis, we investigated the effect of EEN [...] Read more.
Exclusive enteral nutrition (EEN) is an established dietary treatment for Crohn’s disease (CD) by alleviating inflammation and inducing remission. However, the mechanisms of action of EEN are incompletely understood. As CD is associated with gut microbiome dysbiosis, we investigated the effect of EEN on the microbiome in a rat model of CD-like colitis. The rat model of CD-like colitis was established by an intracolonic instillation of TNBS at 65 mg/kg in 250 µL of 40% ethanol. Sham control rats were instilled with saline. Rats were fed ad libitum with either regular pellet food or EEN treatment with a clear liquid diet (Ensure). Rats were euthanized at 7 days. Fecal pellets were collected from the distal colon for 16S rRNA sequencing analysis of gut microbiota. In addition, colon tissues were taken for histological and molecular analyses in all the groups of rats. EEN administration to TNBS-induced CD rats significantly improved the body weight change, inflammation scores, and disease activity index. The mRNA expression of IL-17A and interferon-γ was significantly increased in the colonic tissue in TNBS rats when fed with regular food. However, EEN treatment significantly attenuated the increase in IL-17A and interferon-γ in TNBS rats. Our 16S rRNA sequencing analysis found that gut microbiota diversity and compositions were significantly altered in TNBS rats, compared to controls. However, EEN treatment improved alpha diversity and increased certain beneficial bacteria such as Lactobacillus and Dubosiella and decreased bacteria such as Bacteroides and Enterorhabdus in CD-like rats, compared to CD-like rats with the regular pellet diet. In conclusion, EEN treatment increases the diversity of gut microbiota and the composition of certain beneficial bacteria. These effects may contribute to the reduced inflammation by EEN in the rat model of CD-like colitis. Full article
(This article belongs to the Special Issue Nutritional Strategies in Inflammatory Bowel Disease)
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13 pages, 762 KiB  
Article
Medical Cannabis Increases Appetite but Not Body Weight in Patients with Inflammatory Bowel Diseases
by Naomi Fliss Isakov, Chen Seidenberg, David Meiri, Michal Yackobovitch-Gavan, Nitsan Maharshak and Ayal Hirsch
Nutrients 2024, 16(1), 78; https://doi.org/10.3390/nu16010078 - 26 Dec 2023
Cited by 3 | Viewed by 2547
Abstract
We aimed to elucidate the effect of Medical Cannabis (MC) on appetite and nutritional status among patients with inflammatory bowel disease (IBD). A case series of patients with IBD were initiating treatment with MC for disease-related symptoms, at the IBD clinic of a [...] Read more.
We aimed to elucidate the effect of Medical Cannabis (MC) on appetite and nutritional status among patients with inflammatory bowel disease (IBD). A case series of patients with IBD were initiating treatment with MC for disease-related symptoms, at the IBD clinic of a tertiary referral medical center. Patients’ demographics, anthropometrics, medical history and treatment and MC use were systematically recorded. An appetite and food frequency questionnaire (SNAQ and FFQ) were filled before, and at 3 and 6 months of treatment. Patients with IBD initiating MC were enrolled (n = 149, age 39.0 ± 14.1 years, 42.3% female), and 33.6% (n = 50) were treated for improvement of nutritional status. A modest increase in appetite after 3 months was detected among all patients enrolled (Pv = 0.08), but there were no significant differences in energy or macronutrient intake, and in patients’ body mass index (BMI). A significant appetite improvement after 3 months was detected among 34.0% (n = 17) of patients, but this was not associated with increased caloric intake or BMI at 3 or 6 months. Among patients without increased appetite after 3 months of MC therapy, BMI decreased at 6 months (24.1 ± 3.7 vs. 23.4 ± 3.6, Pv = 0.010). MC may be a potential strategy to improve appetite among some patients with IBD, but not caloric intake or BMI. Full article
(This article belongs to the Special Issue Nutritional Strategies in Inflammatory Bowel Disease)
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14 pages, 977 KiB  
Article
Risk Factors of Low Bone Mineral Density in Newly Diagnosed Pediatric Inflammatory Bowel Disease
by Moon Bae Ahn and In Hyuk Yoo
Nutrients 2023, 15(24), 5048; https://doi.org/10.3390/nu15245048 - 8 Dec 2023
Cited by 3 | Viewed by 1856
Abstract
Inflammatory bowel disease (IBD) is a chronic inflammatory disorder of the gastrointestinal tract with an increasing worldwide incidence. IBD is frequently diagnosed during childhood in the adolescent period of ongoing growth and development, and it can affect patients’ linear growth, puberty, nutrition, and [...] Read more.
Inflammatory bowel disease (IBD) is a chronic inflammatory disorder of the gastrointestinal tract with an increasing worldwide incidence. IBD is frequently diagnosed during childhood in the adolescent period of ongoing growth and development, and it can affect patients’ linear growth, puberty, nutrition, and bone health. Therefore, its treatment and monitoring are critical to prevent secondary outcomes. However, few studies have highlighted the association between pediatric IBD and skeletal outcomes in Asian populations. We aimed to identify the prevalence and risk factors for low bone mineral density (BMD) in Korean children and adolescents with newly diagnosed IBD. Patients aged 10–18 years diagnosed with either Crohn’s disease (CD) or ulcerative colitis (UC) who underwent lumbar spine bone mineral density (LSBMD) and femoral bone mineral density (FBMD) analyses via dual-energy X-ray absorptiometry at the time of IBD diagnosis were included. Low BMD was considered when the age- and sex-matched BMD Z-score was <−1.0. The LSBMD and FBMD Z-scores were correlated with clinical parameters, including general characteristics, anthropometry, and IBD-associated laboratory markers. Regression analyses were performed to identify the risk factors for low BMD. Although the general characteristics between CD (n = 42) and UC (n = 9) groups did not differ, the mean Z-scores of LSBMD and FBMD of the 51 subjects were −0.11 ± 1.24 and −0.58 ± 1.38, respectively. Furthermore, 7.8% and 18% of the study subjects had LSBMD and FBMD Z-scores < −2.0, whereas more than 50% had scores of 0–−1.0. Among the clinical factors, body mass index (BMI) Z-score, duration of clinical manifestations, and serum alanine aminotransferase and selenium levels were associated with LSBMD Z-scores in the final multivariate regression analyses. Odds ratios of BMI < −2.0 standard deviation for low LSBMD and FBMD Z-scores were 31.97 and 41.45, respectively. A BMI Z-score < −0.93 was determined as the best cut-off for predicting low BMD. In newly diagnosed pediatric IBD, a substantial number of children are likely to have low BMD in prior to initial treatment while lower BMI, longer duration of clinical manifestation, and higher selenium concentration could affect initial BMD status. Routine bone health surveillance from initial IBD diagnosis throughout the treatment’s completion is recommended for preventing the early development of secondary osteoporosis. Full article
(This article belongs to the Special Issue Nutritional Strategies in Inflammatory Bowel Disease)
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20 pages, 1652 KiB  
Systematic Review
Dietary Interventions in Ulcerative Colitis: A Systematic Review of the Evidence with Meta-Analysis
by Marta Herrador-López, Rafael Martín-Masot and Víctor Manuel Navas-López
Nutrients 2023, 15(19), 4194; https://doi.org/10.3390/nu15194194 - 28 Sep 2023
Cited by 1 | Viewed by 5105
Abstract
(1) Background: Ulcerative colitis (UC) is a chronic colon inflammation caused by genetic and environmental factors, including diet. This systematic review and meta-analysis aims to assess the impact of diet on UC management in children and adults (2) Methods: A comprehensive search across [...] Read more.
(1) Background: Ulcerative colitis (UC) is a chronic colon inflammation caused by genetic and environmental factors, including diet. This systematic review and meta-analysis aims to assess the impact of diet on UC management in children and adults (2) Methods: A comprehensive search across databases yielded relevant studies, and risk of bias in randomized controlled trials (RCTs) was assessed using the Cochrane Risk of Bias tool. This study was conducted in conformity to the 2020 PRISMA guidelines. The certainty of evidence for outcomes was evaluated using GRADE methodology. Meta-analysis was performed using Review Manager software version 5.4. (3) Results: Fourteen RCTs were included, results indicated higher clinical response, remission, and endoscopic remission rates in diet-treated groups. Carrageenan-free, anti-inflammatory, and cow milk protein elimination diets showed no significant advantages in maintaining clinical remission. However, a study involving fermented cow milk with bifidobacterial demonstrated favorable outcomes. Overall, pooled analysis leaned in favor of dietary intervention for sustaining clinical remission; (4) Conclusions: The relationship between diet and UC is an evolving terrain that demands deeper exploration. This systematic review and meta-analysis highlight the evolving relationship between diet and UC, necessitating further exploration. While understanding grows, adopting personalized dietary approaches could alleviate symptoms, and support a more positive disease trajectory. Full article
(This article belongs to the Special Issue Nutritional Strategies in Inflammatory Bowel Disease)
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