Nutritional Therapies and Their Influence on the Intestinal Microbiome in Pediatric Inflammatory Bowel Disease

Abstract

Inflammatory bowel disease (IBD) is a chronic, autoimmune disorder of the gastrointestinal tract with numerous genetic and environmental risk factors. Patients with Crohn’s disease (CD) or ulcerative colitis (UC) often demonstrate marked disruptions of their gut microbiome. The intestinal microbiota is strongly influenced by diet. The association between the increasing incidence of IBD worldwide and increased consumption of a westernized diet suggests host nutrition may influence the progression or treatment of IBD via the microbiome. Several nutritional therapies have been studied for the treatment of CD and UC. While their mechanisms of action are only partially understood, existing studies do suggest that diet-driven changes in microbial composition and function underlie the diverse mechanisms of nutritional therapy. Despite existing therapies for IBD focusing heavily on immune suppression, nutrition is an important treatment option due to its superior safety profile, potentially low cost, and benefits for growth and development. These benefits are increasingly important to patients. In this review, we will describe the clinical efficacy of the different nutritional therapies that have been described for the treatment of CD and UC. We will also describe the effects of each nutritional therapy on the gut microbiome and summarize the strength of the literature with recommendations for the practicing clinician.

Review article: the future of microbiome‐based therapeutics

“…Dietary interventions have been extensively explored for the treatment of IBD, with a large variety diets being investigated for uses in either Crohn's disease (CD) or ulcerative colitis (UC). 47 These diets include, exclusive enteral nutrition (EEN), 48,49 Crohn's disease exclusion diet (CDED), [50][51][52] specific carbohydrate diet, 53 LFD, 54 Mediterranean diet (MD), 55 Crohn's Disease TReatment with EATing diet (CD-TREAT) 56 and partial enteral nutrition. 47 Only two of these diets have proven clinical efficacy in CD treatment and evidence to show their impact on the GI microbiome, EEN 48,49,57 and CDED.…”

“…47 These diets include, exclusive enteral nutrition (EEN), 48,49 Crohn's disease exclusion diet (CDED), [50][51][52] specific carbohydrate diet, 53 LFD, 54 Mediterranean diet (MD), 55 Crohn's Disease TReatment with EATing diet (CD-TREAT) 56 and partial enteral nutrition. 47 Only two of these diets have proven clinical efficacy in CD treatment and evidence to show their impact on the GI microbiome, EEN 48,49,57 and CDED. [50][51][52] Exclusive enteral nutrition involves the replace of all food and beverages with a liquid meal replacement, which can induce remission in 80%-85% of patients with CD.…”

Gut Microbiome in Inflammatory Bowel Disease: Role in Pathogenesis, Dietary Modulation, and Colitis-Associated Colon Cancer

“…Interests in the diet’s ability to alter the gut microbiome as a therapeutic strategy among patients with IBD has grown tremendously in recent years ( Figure 2 ) [ 63 ]. Several nutritional therapies have been explored among pediatric patients with IBD.…”

“…For example, the Crohn’s Disease Exclusion Diet (CDED) is a high protein, low-fat diet that includes foods such as chicken, fish, eggs, rice, potatoes, and various fruits and vegetables. This intervention has been effective for mild to moderate CD in children, as well as for patients whose response to anti-TNF biologic treatments plateaued [ 63 ]. Levine et al found that remission in the CDED groups was associated with changes in microbial diversity, a decrease in Proteobacteria and an increase in Firmicutes , particularly Clostridiales .…”

JNK pathway‐associated phosphatase illustrates low expression and negative correlations with inflammation, disease activity, and T‐helper 17 cells in inflammatory bowel disease children

“… 5 , 6 Although nutritional management, 5‐aminosalicylic acid (5‐ASA), glucocorticoids, immunosuppressive agents, and biologics may be useful in the treatment of IBD in children, there still lacks biomarkers to reflect the risk and characteristics of IBD in children, which could hinder the in‐time management of IBD in children. 4 , 7 , 8 , 9 , 10 …”