Nutrient, Fibre, and FODMAP Intakes and Food-related Quality of Life in Patients with Inflammatory Bowel Disease, and Their Relationship with Gastrointestinal Symptoms of Differing Aetiologies

When dietary modification turns problematic in patients with esophageal conditions

BACKGROUND

Patients with chronic illness affecting the esophagus often modify their eating habits to manage symptoms. Although this begins as a protective strategy, anxiety around eating can become problematic, and lead to poor outcomes. We administered a survey to examine the factors associated with problematic eating behaviors in patients who have reflux and difficulty swallowing (esophageal dysphagia).

METHODS

In total, 277 adult patients aged above 18 diagnosed with achalasia, eosinophilic esophagitis, and gastroesophageal reflux completed an online survey: (1) demographic and disease information; (2) reflux and dysphagia severity (3) eating behaviors, as measured by a study-specific, modified version of the Eating Disorder Questionnaire (EDE-Q) for patients with esophageal conditions; and (4) Food related quality of life (FRQOL). Descriptive statistics, one-way ANOVA, and Pearson's correlations evaluated the sample data and a hierarchical linear regression evaluated predictors of problematic eating behaviors.

KEY RESULTS

Problematic eating behaviors were associated with reflux severity, dysphagia severity, symptom anxiety, and hypervigilance, and negatively associated with FRQOL. While reflux and dysphagia severity predicted greater problematic eating, symptom anxiety explained more of these behaviors. Although hypervigilance and anxiety also predicted poorer FRQOL, problematic eating was the largest predictor.

CONCLUSION & INFERENCES

Problematic eating behaviors are associated with increased symptom severity and symptom anxiety, and diminished FRQoL. Symptom anxiety, rather than symptom severity, appears to be a driving factor in problematic eating behaviors. Interventions aimed at diminishing symptom anxiety may be useful in reducing problematic eating behaviors in patients with gastrointestinal symptoms.

Knowledge Levels About Inflammatory Bowel Disease Vary Between Healthcare Professional Groups

BACKGROUND

Inflammatory Bowel Disease (IBD) is one of the most serious chronic diseases affecting the global population. Clinical team members involved in the care of individuals with IBD should have sufficient knowledge about IBD.

AIMS

The study aim was to assess IBD knowledge among four health care professional groups in New Zealand: nurses, medical students, dietitians, and pharmacists.

METHODS

All four groups completed surveys on demographics, work experience, and contact with patients with IBD. All completed a validated IBD knowledge assessment questionnaire (IBD-KID2), and percentage scores with standard deviation (SD) for each group calculated and compared.

RESULTS

Participants included 200 nurses, 196 medical students, 45 dietitians, and 28 pharmacists. Mean IBD-KID2 percentage scores were nurses 69.7% (SD 14.7), medical students 77.6% (SD 14.5), dietitians 87.4% (SD 8.3), and pharmacists 83.4% (SD 10.1). Nurses scored lower than other HCP (P < 0.001). Independent variables were associated (P < 0.05) with higher scores for nurses having first degree relative with IBD, access to IBD guidelines, worked with children with IBD; medical students in their clinical years of study; and dietitians with IBD-specific education. Specific items scored poorly: growth, food triggers, heritability of IBD, and nutrient absorption.

CONCLUSIONS

Knowledge gaps exist among HCP that may be addressed with targeted education. Improvements in the knowledge of those caring for people with IBD may optimize patient outcomes.

Role of micronutrients in inflammatory bowel disease

Inflammatory bowel disease (IBD) is an autoimmune intestinal disease that includes ulcerative colitis, Crohn's disease, and indeterminate colitis. Patients with IBD are often at risk for malnutrition, including micronutrient deficiencies, due to dietary restrictions and poor intestinal absorption. Micronutrients, including vitamins and minerals, play an important role in the human body's metabolism and maintenance of tissue functions. This article reviews the role of micronutrients in IBD. Micronutrients can affect the occurrence and progression of IBD by regulating immunity, intestinal flora, oxidative stress, intestinal barrier function, and other aspects. Monitoring and timely supplementation of micronutrients are important to delay progression and improve clinical symptoms in IBD patients.

Benefits of Fiber-Enriched Foods on Satiety and Parameters of Human Well-Being in Adults with and without Cardiometabolic Risk

Consumption of fiber-rich foods is linked to beneficial effects on chronic diseases and gut health, while implications towards improving satiety and parameters of well-being remain unclear. A randomized placebo-controlled intervention study was conducted to compare the effects of fiber-enriched foods to their non-enriched counterparts in adults over a 12-week period on selected clinical parameters-satiety, quality of life, body sensation, and life satisfaction-subjective health status, and importance of diet for well-being. Quality of life (QOL) differed significantly between intervention and control groups at baseline, throughout, and at the end of the study. No effects on satiety, satisfaction with life, or the importance of diet for well-being could be shown between groups. With higher fiber intake, body sensation ratings increased. A higher BMI was significantly associated with lower-body sensation, subjective health status and quality of life. Fiber-enriched foods do not seem to affect feeling of satiety or parameters of well-being. Larger samples and additional methods are necessary to fully explore the effect of increased fiber intake on patient-related outcomes in more detail.

Higher Fiber Intake is Associated with Reduced Risk of Related Surgery among Individuals with Inflammatory Bowel Disease in a Prospective Cohort Study

BACKGROUND

Evidence for the effects of dietary fiber on adverse outcomes in individuals with inflammatory bowel disease (IBD) is insufficient and controversial.

OBJECTIVES

We aimed to prospectively explore the association between dietary fiber intake and the risk of IBD-related surgery.

METHODS

We identified 5580 individuals with diagnosed IBD [Crohn disease (CD, n = 1908) and ulcerative colitis (UC, n = 3672)] at baseline in the UK Biobank via electronic medical records and self-reported information. Dietary fiber intake was estimated by a partial fiber score derived from a valid food frequency questionnaire. IBD-related surgery (enterotomy, perianal surgery, and others) was ascertained via inpatient data. Cox proportional model was applied to estimate hazard ratios with 95% confidence intervals (CIs) of dietary fiber in quartiles for the risk of IBD-related surgery.

RESULTS

During a mean follow-up period of 11.2 y, we documented 624 IBD-related surgery among 5580 individuals with IBD (mean age, 57.3; 52.8% females). Compared with individuals in the lowest quartiles, those with second to fourth quartiles of fiber intake were associated with 23% (95% CI: 5%, 38%, P = 0.015), 29% (95% CI: 11%, 43%, P = 0.003), and 28% (95% CI: 10%, 43%, P = 0.005) reduced risk (P-trend = 0.002) of IBD-related surgery. Similar associations were observed in CD (P-trend = 0.005) but not UC (P-trend = 0.131). We observed inverse associations of fiber in vegetables and fruits (P-trend = 0.017 and 0.007) but positive associations of fiber in bread (P-trend = 0.046) with the risk of IBD-related surgery.

CONCLUSIONS

Higher intake of fiber is associated with reduced IBD-related surgery risk in patients with IBD with CD but not UC.

Dietary Behaviors and Beliefs in Patients with Inflammatory Bowel Disease

INTRODUCTION

Due to a lack of clear dietary guidelines, patients with inflammatory bowel disease (IBD) self-impose dietary restrictions based on their own nutritional experiences. The aim of this study was to investigate dietary perceptions and behavior in IBD patients.

MATERIALS AND METHODS

A total of 82 patients (48 with Crohn's disease and 34 with ulcerative colitis) participated in this prospective, questionnaire-based study. Based on a literature review, the questionnaire was developed to investigate dietary beliefs, behaviors and food exclusions during IBD relapses and remission.

RESULTS

The majority of patients (85.4%) believed that diet can be a trigger factor for IBD relapses, and 32.9% believed that diet initiates the disease. The majority of patients (81.7%) believed that they should eliminate some products from their diets. The most often-pointed-out products were spicy and fatty foods, raw fruits and vegetables, alcohol, leguminous foods, cruciferous vegetables, dairy products and milk. Most patients (75%) modified their diets after diagnosis, and 81.7% imposed food restrictions to prevent IBD relapses.

CONCLUSIONS

The majority of patients avoided certain foods during relapses as well as to maintain remission of IBD, basing this on their own beliefs, inconsistently with current scientific knowledge. Patient education should be a key determinant in IBD control.

Analysis of the Nutritional Value of Diets and Food Choices in Polish Female Ulcerative Colitis Individuals Compared with a Pair-Matched Control Sample

Ulcerative colitis patients often attribute their symptoms to specific dietary products. Therefore, even though there are no specific dietary recommendations, these patients commonly have dietary restrictions, often with no consultation from their physician or dietitian, as they believe that they may be beneficial for them. The aim of the study was to analyze the nutritional value of diets and food choices in Polish female ulcerative colitis individuals, in comparison with a pair-matched control sample. The study was conducted on a group of 44 Polish female ulcerative colitis individuals being in remission and 44 individuals within a pair-matched control sample, matched by their age and concurrent diseases, excluding those resulting from ulcerative colitis. The analysis of the diet was based on the self-reported data, including 3-day dietary records (to assess the intake of nutrients and food products), as well as the simple open-ended question about food products excluded from their diet. It was stated that Polish female ulcerative colitis individuals were characterized by a lower energy value of diet (p = 0.0043), accompanied by the higher proportion of total protein (p = 0.0128) than the pair-matched control sample. As a result of a lower energy value for ulcerative colitis individuals, the intake of numerous nutrients was also lower (p < 0.05); however, after recalculation per 1000 kcal, ulcerative colitis individuals were characterized by higher total protein (p = 0.0121), starch (p = 0.0009), and vitamin B₆ intake (p = 0.0319), as well as lower alcohol intake (p = 0.0464). Similarly, as a result of a lower energy value for ulcerative colitis individuals, the intake of numerous foods was also lower (p < 0.05); however, after recalculation per 1000 kcal, ulcerative colitis individuals were characterized by higher meat (p = 0.0058) and potatoes intake (p = 0.0052), as well as lower legumes (p = 0.0301), chocolate sweets (p = 0.0165), and alcoholic beverages intake (p = 0.0062). For chocolate sweets (p = 0.0134) and alcoholic beverages (p = 0.0091), ulcerative colitis individuals were characterized by a higher frequency of declaration of dietary exclusion. At the same time, ulcerative colitis individuals were characterized by a lower frequency of meeting the recommended intake for magnesium (p = 0.0005), iron (p = 0.0189), vitamin E (p = 0.0389), and vitamin B₁ (p = 0.0032). It was concluded that even in remission, there is a risk of inadequate consumption, not meeting the recommended intake, and nutritional deficiencies in the population of female ulcerative colitis patients.

Development and validation of an inflammatory bowel disease nutrition self-screening tool (IBD-NST) for digital use

Background and aim

The identification of, and timely intervention for, patients with impaired nutritional status may reduce inflammatory bowel disease (IBD) complications. This study aimed to develop and validate an IBD-specific nutrition self-screening tool (IBD-NST) that identifies patients at nutrition risk.

Methods

An expert IBD panel was consulted to support development of an IBD-NST. The tool was assessed in different cohorts of patients attending IBD outpatient clinics for face, content and convergent validity and repeat reliability. The tool was compared with (i) the malnutrition universal screening tool to assess face validity and (ii) subjective global assessment (SGA), hand-grip strength (HGS) and mid-arm muscle circumference to assess convergent validity. Tool content was informed by agreement between assessment tools, sensitivity analysis and chi-squared tests. The IBD-NST was completed electronically twice, 1 week apart to assess repeat reliability using observed agreement and kappa statistic. Statistical significance assumed at p < 0.05.

Results

In total, 282 IBD patients (175 with Crohn's disease) were recruited to validate the IBD-NST. The final validated IBD-NST includes body mass index (BMI), weight loss and IBD-specific nutrition-focussed questions which were acceptable to patients. It identified patients at risk of malnutrition, moderately or severely malnourished patients and patients at nutritional risk. The IBD-NST identified 54/179 (30%) patients at moderate or high nutrition risk and had excellent repeat reliability in 85 patients [r = 0.77 (95% CI 0.669 to 0.746)].

Conclusion

The IBD-NST is a self-screening tool, validated for use as either a paper or e-health version, that identifies patients at nutrition risk who are likely to benefit from dietetic assessment and intervention. Furthermore, patients with IBD symptoms who are concerned about their dietary intake can potentially access dietetic care more easily therefore encouraging greater self-management of IBD-related symptoms. The routine use of the IBD-NST as a self-screening tool would enable patient-led care in the outpatient setting and may facilitate timely access to dietetic care.

British Dietetic Association consensus guidelines on the nutritional assessment and dietary management of patients with inflammatory bowel disease

BACKGROUND

Despite increased awareness of diet and nutrition being integral to the management of patients with inflammatory bowel disease (IBD), there are gaps in the knowledge of IBD healthcare providers regarding nutrition. Furthermore, high quality evidence on nutritional assessment and dietary management of IBD is limited. A Delphi consensus from a panel of experts allows for best-practice guidelines to be developed, especially where high quality evidence is limited. The aim was to develop guidelines for the nutritional assessment and dietary management of IBD using an eDelphi online consensus agreement platform.

METHODS

Seventeen research topics related to IBD and nutrition were systematically reviewed. Searches in Cochrane, Embase®, Medline® and Scopus® electronic databases were performed. GRADE was used to develop recommendations. Experts from the IBD community (healthcare professionals and patients with IBD) were invited to vote anonymously on the recommendations in a custom-built online platform. Three rounds of voting were carried out with updated iterations of the recommendations and evaluative text based on feedback from the previous round.

RESULTS

From 23,824 non-duplicated papers, 167 were critically appraised. Fifty-five participants completed three rounds of voting and 14 GRADE statements and 42 practice statements achieved 80% consensus. Comprehensive guidance related to nutrition assessment, nutrition screening and dietary management is provided.

CONCLUSIONS

Guidelines on the nutritional assessment and dietary management of IBD have been developed using evidence-based consensus to improve equality of care. The statements and practice statements developed demonstrate the level of agreement and the quality and strength of the guidelines.

Folate and Vitamin B12 Deficiency Exacerbate Inflammation during Mycobacterium avium paratuberculosis (MAP) Infection

Folate and vitamin B₁₂ deficiency is highly prevalent among Crohn's disease (CD) patients. Furthermore, CD pathology can be mediated by Mycobacterium avium subsp. paratuberculosis (MAP) infection. However, the direct effect of folate (B₉) and cobalamin (B₁₂) deficiency during MAP infection remains uncharacterized. This study investigates how folate and B₁₂ deficiency impedes macrophage apoptosis and exacerbates the inflammation in macrophages infected with MAP isolated from CD patients. Accordingly, we measured folate and B₁₂ in ex vivo plasma samples collected from CD patients with or without MAP infection (N = 35 per group). We also measured the expression of the pro-inflammatory cytokines IL-1β and TNF-α, cellular apoptosis and viability markers, and bacterial viability in MAP-infected macrophages cultured in folate and B₁₂ deficient media. We determined that MAP-positive CD patients have significantly lower plasma folate and B₁₂ in comparison to MAP-negative CD patients [414.48 ± 94.60 pg/mL vs. 512.86 ± 129.12 pg/mL, respectively]. We further show that pro-inflammatory cytokines IL-1β and TNF-α are significantly upregulated during folate and vitamin B₁₂ deprivation following MAP infection by several folds, while supplementation significantly reduces their expression by several folds. Additionally, depletion of folate, B₁₂, and folate/B₁₂ following MAP infection, led to decreased macrophage apoptosis from 1.83 ± 0.40-fold to 1.04 ± 0.08, 0.64 ± 0.12, and 0.45 ± 0.07 in folate-low, B₁₂-low, and folate/B₁₂-low cells, respectively. By contrast, folate and folate/B₁₂ supplementation resulted in 3.38 ± 0.70 and 2.58 ± 0.14-fold increases in infected macrophages. Interestingly, changes in overall macrophage viability were only observed in folate-high, folate/B₁₂-high, and folate/B₁₂-low media, with 0.80 ± 0.05, 0.82 ± 0.02, and 0.91 ± 0.04-fold changes, respectively. Incubation of Caco-2 intestinal epithelial monolayers with supernatant from infected macrophages revealed that folate/B₁₂ deficiency led to increased LDH release independent of oxidative stress. Overall, our results indicate that folate and B₁₂ are key vitamins affecting cell survival and inflammation during MAP infection.

Genetic Aspects of Micronutrients Important for Inflammatory Bowel Disease

Inflammatory bowel disease (IBD), Crohn’s disease (CD) and ulcerative colitis (UC) are complex diseases whose etiology is associated with genetic and environmental risk factors, among which are diet and gut microbiota. To date, IBD is an incurable disease and the main goal of its treatment is to reduce symptoms, prevent complications, and improve nutritional status and the quality of life. Patients with IBD usually suffer from nutritional deficiency with imbalances of specific micronutrient levels that contribute to the further deterioration of the disease. Therefore, along with medications usually used for IBD treatment, therapeutic strategies also include the supplementation of micronutrients such as vitamin D, folic acid, iron, and zinc. Micronutrient supplementation tailored according to individual needs could help patients to maintain overall health, avoid the triggering of symptoms, and support remission. The identification of individuals’ genotypes associated with the absorption, transport and metabolism of micronutrients can modify future clinical practice in IBD and enable individualized treatment. This review discusses the personalized approach with respect to genetics related to micronutrients commonly used in inflammatory bowel disease treatment.

Improving Food-Related Quality of Life in Inflammatory Bowel Disease through a Novel Web Resource: A Feasibility Randomised Controlled Trial

Food-related quality of life (FR-QoL) is impaired in inflammatory bowel disease (IBD) and education and support on food-related issues in IBD is needed. This feasibility trial aimed to investigate the effectiveness and acceptability of a web resource in enhancing FR-QoL in newly diagnosed IBD. Patients diagnosed with Crohn's disease or ulcerative colitis in the preceding 12 months, with an impaired FR-QoL, were recruited and randomised to either receive access to the web resource (covering IBD-specific diet concerns) or no access (control group) for 12 weeks, while receiving usual clinical care. FR-QoL, health-related quality of life, psychological outcomes, and clinical disease activity were assessed. Web resource usage was assessed, and patients' experiences of the web resource were investigated in semi-structured interviews. Of 81 patients screened, 50 participants were randomised, 30 to the web resource and 20 to control. FR-QoL increased more in the web resource (+11.7 SD 18.2) than control group (+1.4 SD 20.4) (p = 0.067), while IBD distress reduced in the web resource (-6.8 SD 26.6) and increased in the control group (+8.3 SD 25.5) (p = 0.052), albeit not statistically significantly. End of trial Crohn's disease clinical activity (PRO-2) was significantly lower in the web resource than control group (p = 0.046). Participants most frequently accessed web resource content discussing dietary management of gut symptoms and in semi-structured interviews, reported the website to contain relevant information. This feasibility study demonstrates potential effectiveness of the web resource on improving FR-QoL and psychological outcomes in IBD. An adequately powered effectiveness RCT is feasible to conduct and is now warranted. NCT03884686.

Impact of fibre and red/processed meat intake on treatment outcomes among patients with chronic inflammatory diseases initiating biological therapy: A prospective cohort study

Background

Biologic disease-modifying drugs have revolutionised the treatment of a number of chronic inflammatory diseases (CID). However, up to 60% of the patients do not have a sufficient response to treatment and there is a need for optimization of treatment strategies.

Objective

To investigate if the treatment outcome of biological therapy is associated with the habitual dietary intake of fibre and red/processed meat in patients with a CID.

Methods

In this multicentre prospective cohort study, we consecutively enrolled 233 adult patients with a diagnosis of Crohn's Disease, Ulcerative Colitis, Rheumatoid Arthritis (RA), Axial Spondyloarthritis, Psoriatic Arthritis and Psoriasis, for whom biologic therapy was planned, over a 3 year period. Patients with completed baseline food frequency questionnaires were stratified into a high fibre/low red and processed meat exposed group (HFLM) and an unexposed group (low fibre/high red and processed meat intake = LFHM). The primary outcome was the proportion of patients with a clinical response to biologic therapy after 14-16 weeks of treatment.

Results

Of the 193 patients included in our primary analysis, 114 (59%) had a clinical response to biologic therapy. In the HFLM group (N = 64), 41 (64%) patients responded to treatment compared to 73 (56%) in the LFHM group (N = 129), but the difference was not statistically significant (OR: 1.48, 0.72-3.05). For RA patients however, HFLM diet was associated with a more likely clinical response (82% vs. 35%; OR: 9.84, 1.35-71.56).

Conclusion

Habitual HFLM intake did not affect the clinical response to biological treatment across CIDs. HFLM diet in RA patients might be associated with better odds for responding to biological treatment, but this would need confirmation in a randomised trial.

Trial registration

(clinicaltrials.gov), identifier [NCT03173144].

A Randomized Dietary Intervention to Increase Colonic and Peripheral Blood Short-Chain Fatty Acids Modulates the Blood B- and T-cell Compartments in Healthy Humans

BACKGROUND

Short-chain fatty acids (SCFA) have immune-modulating effects in animal models of disease. However, there is limited evidence that this may occur in humans.

OBJECTIVES

This study aimed to determine the effects of increased exposure to SCFA via dietary manipulation on colonic fermentation and adaptive immune cells.

METHODS

Twenty healthy, young adults (18-45 years of age) underwent a blinded, randomized, cross-over dietary intervention, consuming a high-SCFA producing diet and matched low-SCFA diet for 21 days with 21-day wash-out in between. SCFA were provided through resistant starch, inulin and apple cider vinegar. Blood and 3-day total fecal output were collected at baseline and at the end of each diet. Gas chromatography was used to measure fecal and plasma SCFA. Flow cytometry was used for peripheral blood immuno-phenotyping.

RESULTS

High-SCFA diet was associated with significantly (paired samples Wilcoxon test) higher median [IQR] fecal SCFA concentrations (86.6 [59.0] vs 75.4 [56.2] µmol/g, P = 0.02) and significantly lower median fecal ammonia concentrations (26.2 [14.7] vs 33.4 [18.5] µmol/g, P = 0.04) than the low-SCFA diet. Plasma propionate (9.87 [12.3] vs 4.72 [7.6] µmol/L, P = 0.049) and butyrate (2.85 [1.35] vs 2.02 [1.29] µmol/L, P = 0.03) were significantly higher after high-SCFA diet than after low-SCFA diet. Blood total B cells (184 [112] vs 199 [143] cells/µL, P = 0.04), naive B cells (83 [66] vs 95 [89] cells/µL, P = 0.02), Th1 cells (22 [19] vs 29 [16] cells/µL, P = 0.03) and mucosal-associated invariant T (MAIT) cells (62 [83] vs 69 [114] cells/µL, P = 0.02) were significantly lower after high-SCFA diet than low-SCFA diet.

CONCLUSION

Increasing colonic and peripheral blood SCFA has discrete effects on circulating immune cells in healthy humans following 3-week intervention. Further studies, e.g., in patients with inflammatory disease, are necessary to determine if these changes have immunomodulatory effects, whether these are therapeutically beneficial, and whether prolonged intake might be required. Clinical trial registry: Australian New Zealand Clinical trials registry: ACTRN12618001054202. <https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=375342&isReview=true>.

Low FODMAP diet in irritable bowel syndrome: a review of recent clinical trials and meta-analyses

PURPOSE OF REVIEW

The low fermentable oligosaccharides, disaccharides, monosaccharides and polyol (FODMAP) diet is widely used in the dietary management of irritable bowel syndrome (IBS). The aim of this review is to summarize recent evidence regarding the use of the low FODMAP diet in IBS and other gastrointestinal disorders from recent clinical trials and meta-analyses.

RECENT FINDINGS

Several recent systematic reviews and meta-analyses support the use of low FODMAP restriction for global symptoms in IBS in the short term. Uncontrolled follow-up studies show that at least 50% of individuals experience symptom relief following restriction, reintroduction and personalization in the long term. Although evidence from comparative trials in IBS suggests potential benefit of less burdensome approaches (e.g. standard IBS diet and low lactose diet) many studies are insufficiently powered. One established mechanism is colonic gas production that may induce pain signalling measurable in the brain, however altered gastrointestinal epithelial integrity and shifts in microbiome composition and function may also be involved.

SUMMARY

Quality trials of the low FODMAP diet are emerging and have been transformational in supporting the widespread application to IBS management in some areas (e.g. short-term effectiveness), whereas other areas still require considerable improvements in research evidence (e.g. long-term effectiveness, mechanisms and educational delivery).

Research progress on the relationship between intestinal microecology and intestinal bowel disease

Intestinal microecology is the main component of human microecology. Intestinal microecology consists of intestinal microbiota, intestinal epithelial cells, and intestinal mucosal immune system. These components are interdependent and establish a complex interaction network that restricts each other. According to the impact on the human body, there are three categories of symbiotic bacteria, opportunistic pathogens, and pathogenic bacteria. The intestinal microecology participates in digestion and absorption, and material metabolism, and inhibits the growth of pathogenic microorganisms. It also acts as the body's natural immune barrier, regulates the innate immunity of the intestine, controls the mucosal barrier function, and also participates in the intestinal epithelial cells' physiological activities such as hyperplasia or apoptosis. When the steady‐state balance of the intestinal microecology is disturbed, the existing core intestinal microbiota network changes and leads to obesity, diabetes, and many other diseases, especially irritable bowel syndrome, inflammatory bowel disease (IBD), and colorectal malignancy. Intestinal diseases, including tumors, are particularly closely related to intestinal microecology. This article systematically discusses the research progress on the relationship between IBD and intestinal microecology from the pathogenesis, treatment methods of IBD, and the changes in intestinal microbiota.

Food-related quality of life in inflammatory bowel disease: measuring the validity and reliability of the Turkish version of FR-QOL-29

Purpose

Food-related quality of life is considerably impaired in patients with inflammatory bowel disease (IBD) and should be widely measured in research and clinical practice. This study aims to translate the FR-QoL-29 instrument to the Turkish language and evaluate its validity and reliability in Turkish patients with IBD.

Methods

The FR-QoL-29 was forwards and backwards translated into Turkish and the validity and reliability of the FR-QoL-29-Turkish measured at two tertiary hospitals in Ankara, Turkey. Participants completed four questionnaires regarding: sociodemographic; clinical (disease type and activity), and nutritional characteristics (MUST) together with FR-QoL-29-Turkish. In addition, 30 patients repeated the questionnaires after two weeks. collected. Pearson correlation coefficients and Cronbach α were used to assess reliability and validity (p < 0.05).

Results

A total of 180 participants with IBD (78 Crohn’s disease, 102 ulcerative colitis), with a mean age of 45.9 ± 12.5 years, were included. Bartlett's sphericity test was statistically significant (p < 0.001), meeting the prerequisite for factor analysis, and the adequacy of the sample size for factor analysis was confirmed by a high Kaiser–Meyer–Olkin (KMO = 0.92). Validity was confirmed by factor loadings ranging from 0.310 to 0.858. Item-total score correlations ranged from 0.258 to 0.837 and Cronbach’s α coefficient was 0.96 for the whole questionnaire indicating high internal consistency.

Conclusions

FR-QoL-29-Turkish is a valid and reliable measure of food-related quality of life in IBD patients with Turkish language. The FR-QoL-29-Turkish gives a comprehensive overview of the main aspects of food quality of life and can be used as a useful tool in both research and clinical practice.

Should high-fiber diets be recommended for patients with inflammatory bowel disease?

PURPOSE OF REVIEW

Dietary fiber intake in IBD patients has oftentimes generated conflicting data and clinical recommendations. This review aims to unify apparently conflicting lines of evidence regarding dietary fiber intake in IBD patients by highlighting new information from natural history studies and prospective clinical trials.

RECENT FINDINGS

IBD patients have lower dietary fiber intake than the general population as well as national guideline recommendations. Patients report short-term benefits from fiber avoidance. Low fiber and low FODMAP diets are associated with lower fecal microbiota abundance and essential nutrient intake. There is emerging evidence suggesting that IBD patients may be able to increase dietary fiber intake with short-term benefit and good tolerability, particularly when fiber is introduced during clinical remission. Current societal recommendations do not favor withholding dietary fiber during long-term IBD management. The long-term impact of increased dietary fiber on IBD clinical outcomes remains unanswered.

SUMMARY

Dietary fiber intake is not necessarily contraindicated in IBD patients.