Adherence to the Mediterranean diet is associated with decreased fecal calprotectin in patients with ulcerative colitis after pouch surgery

Godny, Lihi; Reshef, Lea; Pfeffer-Gik, Tamar; Goren, Idan; Yanai, Henit; Tulchinsky, Hagit; Gophna, Uri; Dotan, Iris

doi:10.1007/s00394-019-02158-3

Cited by 52 publications

(38 citation statements)

References 64 publications

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“…Similar result was found in a third study that assessed adherence to a Mediterranean diet in a cohort of 153 UC pouch patients using the same 106‐item FFQ 113 . At the time of assessment, 99 of 153 (65%) had a history of or active pouchitis.…”

Section: Studies On the Relationship Between Diet And Pouchitissupporting

confidence: 81%

Review article: the impact of diet on ileoanal pouch function and on the pathogenesis of pouchitis

Ardalan

Yao

Sparrow

2020

Aliment Pharmacol Ther

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SummaryBackgroundThere is expanding interest in the role that diet plays in ileoanal pouch function and in the pathogenesis of pouchitis.AimsTo present a narrative review of published literature regarding the relationship of diet with pouch function and the pathogenesis of pouchitis, and to provide potentially beneficial dietary strategies.MethodsCurrent relevant literature was summarised and critically examined.ResultsDietary components influence pouch function via their effect on upper gastrointestinal transit, small bowel water content and the structure and fermentative activity of the pouch microbiota. FODMAPs in fruits and vegetables appear to affect pouch function the most, with intake positively associated with increased stool frequency and reduced consistency. Dietary factors that influence the pathogenesis of pouchitis appear different and, at times, opposite to those better for optimising function. For example, risk of pouchitis appears to be inversely associated with intake of fruits. The food components mechanistically responsible for this observation are not known, but a rich supply of fermentable fibres and micronutrients in such foods might play a beneficial role via modulation of microbial community structure (such as increasing diversity and/or changing microbial communities to favour ‘protective’ over ‘pathogenic’ bacteria) and function and/or anti‐inflammatory effects.ConclusionAvailable data are weak but suggest tailoring dietary recommendations according to pouch phenotype/behaviour and pouchitis risk might improve outcomes. More sophisticated dietary strategies that utilise the physiological and pathophysiological effects of dietary components on ileoanal pouches have potential to further improve outcomes. Well designed, adequately powered studies are required.

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Section: Studies On the Relationship Between Diet And Pouchitissupporting

confidence: 81%

Review article: the impact of diet on ileoanal pouch function and on the pathogenesis of pouchitis

Ardalan

Yao

Sparrow

2020

Aliment Pharmacol Ther

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“…Higher fruit consumption had been previously associated with increased abundance of known butyrate-producing species, and lower recurrence of pouchitis [42]. Nutritional intervention for patients with a pouch, such as the Mediterranean diet was previously associated with decreased inflammatory markers and later onset of pouchitis and is characterized by a high intake of dietary fibers [43]. Our results, therefore highlight diet as an important factor that may affect butyrate synthesis and provide further support for dietary intervention as a plausible approach to modulate the microbiota and increase the low butyrate levels in the pouch.…”

Section: Resultsmentioning

confidence: 99%

Dysbiosis in metabolic genes of the gut microbiomes of patients with an ileo-anal pouch resembles that observed in Crohn’s Disease

Dubinsky

Reshef

Rabinowitz

et al. 2020

Preprint

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Background: Crohn's disease (CD), ulcerative colitis (UC) and pouchitis are multifactorial and chronic inflammatory diseases of the gastrointestinal tract, termed together as inflammatory bowel diseases (IBD). Pouchitis develops in former patients with UC after total proctocolectomy and ileal pouch-anal anastomosis ("pouch surgery") and is characterized by inflammation of the previously normal small intestine comprising the pouch. It has been extensively shown that broad taxonomic and functional alterations ("dysbiosis") occur in the gut microbiome of patients with IBD. However, the extent to which microbial dysbiosis in pouchitis resembles that of CD or UC has not been investigated in-depth, and the pathogenesis of pouchitis largely remains unknown. Results: In this study we collected 250 fecal metagenomes from 75 patients with a pouch, including both non-inflamed (normal pouch) and inflamed (pouchitis) phenotypes, and compared them to publicly available metagenomes of patients with CD (n=88), and UC (n=76), as well as healthy controls (n=56). Patients with pouchitis presented the highest level of dysbiosis compared to other IBD phenotypes based on species, metabolic pathways and enzyme profiles, and their level of dysbiosis was correlated with intestinal inflammation. In patients with pouchitis, the microbiome mucin degradation potential was lower, but was accompanied by an enrichment of Ruminococcus gnavus strains encoding specific mucin-degrading glycoside hydrolases, which might be pro-inflammatory. Butyrate and secondary bile acids producers were decreased in all IBD phenotypes and were especially low in pouchitis. Butyrate synthesis genes were positively correlated with total dietary fiber intake. Patients with pouchitis harbored more facultative anaerobic bacteria encoding enzymes involved in oxidative stress response, suggesting high oxidative stress during pouch inflammation. Finally, we have developed enzymes-based classifiers that can distinguish between patients with a normal pouch and pouchitis with an area under the curve of 0.91. Conclusions: We propose that the non-inflamed pouch is already dysbiotic (function- and species-wise) and microbially is more similar to CD than to UC. Our study reveals microbial functions that underlie the pathogenesis of pouchitis and suggests bacterial groups and functions that could be targeted for nutritional intervention to attenuate or prevent small intestinal inflammation present in pouchitis and CD.

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“…This correlation could be explained by the modification in gut microbiota induced by the assumption of a higher quantity of antioxidants [177]. Accordingly, an adherence to the Mediterranean diet is associated with decreased fecal calprotectin levels after pouch surgery [178].…”

Section: Hospitalization For Surgerymentioning

confidence: 98%

Inflammatory Bowel Diseases: Is There a Role for Nutritional Suggestions?

et al. 2021

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Nutrition has an important impact on inflammatory bowel diseases (IBD). In particular, several studies have addressed its role in their pathogenesis, showing how the incidence of IBD significantly increased in recent years. Meanwhile, nutrition should be considered a component of the treatment of the disease, both as a therapy itself, and especially in the perspective of correcting the various nutritional deficiencies shown by these patients. In this perspective, nutritional suggestions are very important even in the most severe forms of IBD, requiring hospitalization or surgical treatment. Although current knowledge about nutrition in IBD is increasing over time, nutritional suggestions are often underestimated by clinicians. This narrative review is an update summary of current knowledge on nutritional suggestions in IBD, in order to address the impact of nutrition on pathogenesis, micro- and macro-nutrients deficiencies (especially in the case of sarcopenia and obesity), as well as in hospitalized patients.

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Adherence to the Mediterranean diet is associated with decreased fecal calprotectin in patients with ulcerative colitis after pouch surgery

Cited by 52 publications

References 64 publications

Review article: the impact of diet on ileoanal pouch function and on the pathogenesis of pouchitis

Review article: the impact of diet on ileoanal pouch function and on the pathogenesis of pouchitis

Dysbiosis in metabolic genes of the gut microbiomes of patients with an ileo-anal pouch resembles that observed in Crohn’s Disease

Inflammatory Bowel Diseases: Is There a Role for Nutritional Suggestions?

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