Research Gaps in Diet and Nutrition in Inflammatory Bowel Disease. A Topical Review by D-ECCO Working Group [Dietitians of ECCO]

Abstract

Although the current doctrine of IBD pathogenesis proposes an interaction between environmental factors and gut microbiota in genetically susceptible individuals, dietary exposures have attracted recent interest and are, at least in part, likely to explain the rapid rise in disease incidence and prevalence. The D-ECCO working group along with other ECCO experts with expertise in nutrition, microbiology, physiology, and medicine reviewed the evidence investigating the role of diet and nutritional therapy in the onset, perpetuation, and management of IBD. A narrative topical review is presented where evidence pertinent to the topic is summarised collectively under three main thematic domains: i] the role of diet as an environmental factor in IBD aetiology; ii] the role of diet as induction and maintenance therapy in IBD; and iii] assessment of nutritional status and supportive nutritional therapy in IBD. A summary of research gaps for each of these thematic domains is proposed, which is anticipated to be agenda-setting for future research in the area of diet and nutrition in IBD.

Exclusive enteral nutrition: An optimal care pathway for use in adult patients with active Crohn's disease

“…A normal, unrestricted diet in line with national healthy eating guidelines should be the final goal of therapy when food is reintroduced . Limited data propose three dietary options for food reintroduction: an unrestricted diet, an exclusion/elimination diet, and a low‐fat/fiber exclusion diet; however, it is unclear whether particular dietary components actually influence the success of food reintroduction after EEN therapy …”

“…Four published adult studies have used PEN to induce or maintain remission. The results are conflicting and limited by high dropout rates, different PEN regimens, and lack of control groups . In pediatric and young adult CD cohorts, small studies have reported PEN with an exclusion diet to be effective in remission induction (70%) and maintenance of remission compared to an unrestricted diet (36.4 vs 64% relapse rate, respectively) .…”

“…Pediatric guidelines do not recommend PEN for induction of remission but highlight its potential role as a maintenance therapy in mild disease . Further research is required before a recommendation for PEN in adults with CD can be made …”

A multicentre Study of Nutrition Risk Assessment in Adult Patients with Inflammatory Bowel Disease Attending Outpatient Clinics

“…Patients with active Crohn's disease (CD) are at greatest risk of undernutrition, particularly the newly diagnosed [1,2].…”

Is the emergence of inflammatory bowel disease a prime example of “the third epidemiological transition”?

“…Diet is one of the major determinants of the gut microbiome, and several epidemiological studies have found both positive and negative associations between various dietary constituents and IBD [16]. Among them, higher consumption of soluble fiber (derived from fresh fruits and vegetables), vitamin D, zinc, and potassium had a protective effect against CD.…”