Food avoidance and fasting in patients with inflammatory bowel disease: Experience from the Nancy IBD nutrition clinic

Abstract

Background: Patients with inflammatory bowel disease (IBD) consider that their diet is important for controlling symptoms and frequently ask their physician for additional guidance on this matter. The objectives of the present study of patients with IBD were to characterize the prevalence of exclusion diets and fasting and to identify associated risk factors.Methods: Using an anonymous questionnaire, we screened patients attending our IBD nutrition clinic between November 2021 and April 2022 for exclusion diets.The avoidance of a food category completely was defined as total exclusion and avoidance most of the time was defined as partial exclusion. We also asked patients whether they fasted totally, intermittently, or partially.Result: A total of 434 patients with IBD were included. On inclusion, 159 patients (36.6%) totally excluded at least one food category and 271 (62.4%) partially excluded at least one food. Intermittent, total, or partial fasting was reported by 30.8% of the patients. Disease activity (odds ratio (OR) [95% confidence interval] = 1.7 [1.1-2.7], p = 0.0130) and treatment with a small-molecule or an investigational drug ], p = 0.0059) were independently associated with an exclusion diet. A history of stenosis (OR = 2.0 [1.2-3.2], p = 0.0063) and active disease (OR = 1.9 [1.2-3.1], p = 0.0059) were associated with fasting. Conclusion:In this real-world study, approximately two-thirds of our patients with IBD reported the partial or total exclusion of at least one food category and one third reported fasting. A systematic nutritional evaluation might improve clinical management and quality of care for patients with IBD both Crohn's disease and ulcerative colitis.Olivier Bonsack and Bénédicte Caron contributed equally to this manuscript.

Avoiding food avoidance in patients with inflammatory bowel disease

“…Active disease and the use of small molecules or investigational drugs were associated with food avoidance. 1 This study highlights the emerging and highly prevalent phenomenon of food avoidance in patients with IBD. A recent review examining dietary behaviors in patients with IBD indicated a high prevalence of food avoidance (28%–89%), as well as restrictive dietary behavior (41%–93%).…”

“…Active disease and the use of small molecules or investigational drugs were associated with food avoidance. 1 This study…”

“…Active disease and the use of small molecules or investigational drugs were associated with food avoidance. 1 This studyThis is an open access article under the terms of the Creative Commons Attribution License, which permits use, distribution and reproduction in any medium, provided the original work is properly cited.…”

Nutritional status in perianal Crohn’s disease: are we underestimating the impact?

“…The prevalence of nutritional deficiencies is high among CD patients, with estimated prevalence rates of approximately 65–75% ( 12 ). The main reasons for that are related to reduced appetite, self-imposed food avoidance/restriction ( 13 ), disordered eating behavior ( 14 , 15 ), persistent mucosal and systemic inflammation, nutrient malabsorption, increased nutrient requirements, medication side effects, and high gastrointestinal losses through chronic diarrhoea, fistulas, and stomas. It is well established that poor nutritional status is a predictive factor for worse clinical outcomes in CD.…”