Food avoidance in outpatients with Inflammatory Bowel Disease – Who, what and why

Marsh, Abigail; Kinneally, Jessica; Robertson, Tom; Lord, Anton; Young, Adrienne; –Smith, Graham Radford

doi:10.1016/j.clnesp.2019.03.018

Cited by 33 publications

(50 citation statements)

References 33 publications

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“…The study was not designed to explore the perceived effects of macronutrients; however, from the other responses received, 8% of participants specified foods with a high fat content, and 5% specified takeaways or deep-fried foods. These findings are in agreement with previous and current studies where patients with IBD have identified fast food [ 35 , 48 ], fatty food [ 15 , 17 , 34 , 36 , 37 ], fried and fatty foods [ 14 ], deep-fried and fatty food [ 16 , 39 ], oily food [ 38 ], and fatty meats [ 58 ] in symptom onset or exacerbation. Furthermore, evaluation of dietary intake changes in over 4200 families in Japan over two decades found positive associations between increasing CD incidence and total fat, animal fat, and omega-6 fatty acids [ 59 ].…”

Section: Discussionsupporting

confidence: 93%

“…However, a small proportion of participants remarked that raw fruit and vegetables are problematic. A trend towards cruciferous [ 15 ] and brassica [ 39 ] vegetables has also been described; again, this was not supported by our findings with only two of the most identified vegetables meeting this criterion.…”

Section: Discussioncontrasting

confidence: 89%

“…These findings were higher than anticipated, although this is likely a reflection of the number of dietary elements evaluated and a tendency of some participants to indicate all items within a food group, notably vegetables. Surprisingly, there was no difference in the number of dietary elements identified overall or between participants with CD and UC, a finding that contradicts with observations of greater food avoidance by patients with CD [ 35 , 39 , 40 ].…”

Section: Discussioncontrasting

confidence: 88%

“…Likewise, no difference was seen in the number of dietary elements identified by participants who reported active disease in the previous 12 months and those who reported inactive disease. As active disease is associated with significantly greater food avoidance [ 39 , 40 , 41 ], it was expected that the recall of dietary elements associated with symptoms would be heightened in participants who reported active disease and diminished in patients reporting extended remission.…”

Section: Discussionmentioning

confidence: 99%

“…According to studies on dietary beliefs and behaviours, 56–90% [ 33 , 34 , 35 , 39 , 41 , 48 ] of patients modify their diet following their diagnosis of IBD. The most recent of these studies reported that foods rich in fibre, fruit and vegetables, and grains are the most modified foods [ 41 ], putting patients at risk of inadequate intake of micronutrients such as folate, potassium, magnesium, vitamins A and C, and B vitamins.…”

Section: Discussionmentioning

confidence: 99%

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Inflammatory Bowel Disease: Are Symptoms and Diet Linked?

et al. 2020

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New Zealand (NZ) has one of the world’s highest incidence rates of Inflammatory Bowel Disease (IBD), a group of chronic inflammatory conditions that affect the gastrointestinal tract. Patients with IBD often believe certain foods influence their disease symptoms and consequently may alter their diet considerably. The objective of this study was to determine foods, additives, and cooking methods (dietary elements) that NZ IBD patients identify in the onset, exacerbation, or reduction of their symptoms. A total of 233 participants completed a self-administered questionnaire concerning symptom behaviour in association with 142 dietary elements. Symptom onset and symptom exacerbation were associated with dietary elements by 55% (128) and 70% (164) of all IBD participants, respectively. Fruit and vegetables were most frequently identified, with dairy products, gluten-containing bread, and foods with a high fat content also considered deleterious. Of all IBD participants, 35% (82) associated symptom reduction with dietary elements. The identified foods were typically low in fibre, saturated fatty acids, and easily digestible. No statistically significant differences were seen between the type or number of dietary elements and disease subtype or recent disease activity. The association between diet and symptoms in patients with IBD and the mechanism(s) involved warrant further research and may lead to the development of IBD specific dietary guidelines.

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Section: Discussionsupporting

confidence: 93%

Section: Discussioncontrasting

confidence: 89%

Section: Discussioncontrasting

confidence: 88%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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Inflammatory Bowel Disease: Are Symptoms and Diet Linked?

et al. 2020

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

et al. 2023

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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.

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