Role of diet and nutrition in inflammatory bowel disease

Dietary behaviour, attitude and food perceptions of patients with ulcerative colitis - An observational study

BACKGROUND

Dietary knowledge, perception and practices may have a role in determining the nutritional status of patients with inflammatory bowel disease (IBD). However, the assessment of these patterns has infrequently been done in developing countries. We aimed to evaluate patients with ulcerative colitis (UC) about their dietary beliefs, practices and changes after the diagnosis.

METHODS

We conducted a cross-sectional survey among patients with UC at a tertiary care centre in North India. Apart from clinical details, we collected information about dietary beliefs, sources of information, dietary practices and changes after the diagnosis of UC. The information was collected using a designed and pretested survey questionnaire.

RESULTS

We included 93 patients with a mean age of 40.6 ± 13.3 years and 49 (52.7%) were men. A majority of patients felt that diet had an important role in the causation of IBD (86%, n = 80) and triggering relapses (86%, n = 80). A total of 94.6% of patients (n = 88) felt that certain foods (especially spicy and fatty food and milk) items increased the symptoms of IBD. Patients felt that some food items (yogurt and buttermilk) improved the symptoms. A total of 96.8% of patients (n = 90) changed their diet in some form (commonly, restriction of milk products and outside food), 64% of patients (n = 60) deprived themselves of their favourite food after diagnosis, 80.6% of patients (n = 75) felt a need for additional dietary advice. Regular milk intake was seen more often by patients in remission than those with active disease in IBD (36/47 (76.6%) vs 7/15(46.6%), p = 0.03).

CONCLUSION

Most patients believe that diet has an important role in the causation, relapses and treatment of UC. Patients also felt the need for more information regarding diet in IBD.

Hepatic Gα13 ablation shifts region-specific colonic inflammatory status by modulating the bile acid synthetic pathway in mice

Inflammatory bowel disease is defined by inflammation and immune dysregulation. This study investigated the effects of Gα13 liver-specific knockout (LKO) on proximal and distal colons of dextran sodium sulfate (DSS)-induced mice in conjunction with a high-fat diet (HFD). HFD improved body weight gain and disease activity index scores. Gα13LKO exerted no improvement. In the proximal colon, HFD augmented the DSS effect on Il6, which was not observed in Gα13LKO mice. In the distal colon, HFD plus DSS oppositely fortified an increase in Tnfa and Cxcl10 mRNA in Gα13LKO but not WT. Il6 levels remained unchanged. Bioinformatic approaches using Gα13LKO livers displayed bile acid and cholesterol metabolism-related gene sets. Cholic acid and chenodeoxycholic acid levels were increased in the liver of mice treated with DSS, which was reversed by Gα13LKO. Notably, mice treated with DSS showed a reduction in hepatic ABCB11, CYP7B1, CYP7A1, and CYP8B1, which was reversed by Gα13LKO. Overall, feeding HFD augments the effect of DSS on Il6 in the proximal colon of WT, but not Gα13LKO mice, and enhances DSS effect on Tnfa and Cxcl10 in the distal colon of Gα13LKO mice, suggesting site-specific changes in the inflammatory cytokines, potentially resulting from changes in BA synthesis and excretion.

Dairy Consumption and Inflammatory Bowel Disease among Arab Adults: A Case-Control Study and Meta-Analysis

BACKGROUND

Inflammatory bowel disease (IBD), which includes ulcerative colitis (UC) and Crohn's disease (CD), is a complex disease with increasing global incidence and prevalence. Although dairy consumption has been linked to various chronic diseases, its relationship with IBD remains uncertain. Additionally, there is a lack of data on this topic from Arab countries. This study aimed to investigate the association between dairy consumption and IBD through a case-control study among Arab populations, followed by a meta-analysis of available studies.

METHOD

First, we used data from 158 UC patients, 244 CD patients, and 395 controls attending a polyclinic in Riyadh, Saudi Arabia. All participants were aged ≥ 18 years. Logistic regression was used to calculate the odds ratios (ORs) and 95% confidence intervals (95% CIs) of UC and CD for individuals who reported the highest versus the lowest frequencies of dairy consumption. Next, we conducted a meta-analysis, combining our results with those from other eligible studies after searching several databases. We used the I2 statistics to examine statistical heterogeneity across studies and the regression test for funnel plot asymmetry to assess publication bias.

RESULTS

The case-control study showed a negative association between frequent dairy consumption and UC (OR (95% CI) = 0.64 (0.41, 1.00)) but not CD (OR (95% CI) = 0.97 (0.65, 1.45)). In the meta-analysis, the highest frequencies of dairy consumption were negatively associated with both UC and CD: ORs (95% CIs) = 0.82 (0.68, 0.98) and 0.72 (0.59, 0.87), respectively. A moderate heterogeneity across studies was noticed in the UC meta-analysis (I2 = 59.58%) and the CD meta-analysis (I2 = 41.16%). No publication bias was detected.

CONCLUSIONS

Frequent dairy consumption could protect against the development of UC and CD, suggesting potential dietary recommendations in the context of IBD prevention.

Early and aggressive treatment for Crohn disease using biologics and immunomodulators

ABSTRACT

Traditionally, medical providers have used the step-up approach to manage patients with Crohn disease, starting with 5-aminosalicylic acid derivatives, progressing to corticosteroids, and eventually to immunomodulators and biologics. However, a new top-down approach focuses on early and aggressive therapy with biologics and immunomodulators to reduce the rate of mucosal and intestinal damage. This article describes early and aggressive biologic and immunomodulator therapies and new therapeutic parameters compared with traditional step-up treatment for patients with Crohn disease.

Factors influencing the quality of life in inflammatory bowel disease: A comprehensive review

Inflammatory bowel disease (IBD) is a group of chronic relapsing disorders, including Crohn's disease (CD) and ulcerative colitis (UC), which affects an increasing number of people worldwide. In the last few decades, the scientific world has witnessed many developments in IBD management by controlling debilitating symptoms and remaining in remission for more protracted periods. Even so, we still have a large population suffering from active IBD. An individual's quality of life (QoL) can be severely affected by IBD, like any other chronic illness. In this article, we have reviewed factors influencing the QoL in IBD patients, including chronic pain, diet, physical activity, and psychological factors like depression, anxiety, and stress symptoms. We also discussed the mechanisms of diet-microbial-immune system interaction, currently available dietary therapies for active CD and UC, and early psycho-social interventions that can reduce the disease burden and improve QoL in IBD patients.

Adherence to the Mediterranean Diet Is Associated with Decreased Fecal Calprotectin Levels in Children with Crohn's Disease in Clinical Remission under Biological Therapy

INTRODUCTION

Adherence to the Mediterranean diet (MD) was shown to be associated with decreased disease activity in adult patients with Crohn's disease (CD). Nevertheless, data on its association with fecal calprotectin (FC), particularly in children, remain limited. This study aimed to assess the association between adherence to the MD and FC as an indicator of mucosal healing in patients who are predominantly in remission while undergoing biological therapy.

METHODS

This was a cross-sectional study among children with CD. Adherence to MD was evaluated using both the KIDMED questionnaire and a food frequency questionnaire (FFQ). Israeli Mediterranean Diet Adherence Screener (I-MEDAS) score was calculated, and FC samples were obtained.

RESULTS

Of 103 eligible patients, 99 were included (mean age 14.3 ± 2.6 years; 38.4% females); 88% were in clinical remission, and 30% presented with elevated FC. The mean KIDMED score was higher among patients who had FC <200 μg/g compared to patients with FC >200 μg/g (5.48 ± 2.58 vs. 4.37 ± 2.47, respectively; p = 0.04). A moderate correlation between the KIDMED score and the I-MEDAS score was observed (r = 0.46; p = 0.001). In a multivariate regression analysis, adherence to MD was associated with decreased calprotectin levels, OR 0.75 [95% CI: 0.6-0.95], p = 0.019. Vegetable consumption was found to be inversely associated with elevated FC (0.9 portion/day [0.3-2.9] in FC >200 μg/g vs. 2.2 portions/day [0.87-3.82] in FC <200 μg/g; p = 0.049).

CONCLUSIONS

In children with CD who are mostly in clinical remission under biological therapy, high adherence to MD is associated with decreased FC levels. Encouraging vegetable consumption, especially during remission, may benefit these patients.

IBD barriers across the continents - East Asia

Inflammatory bowel diseases (IBDs) are chronic illnesses with significant morbidities and impact on patients' quality of life. There has been a rapid increase in the incidence of IBD in East Asia in recent decades. However, there is a huge unmet need in the diagnosis and management of IBD in this region. With the increasing awareness of IBD in East Asia and a persistently high rate of tuberculosis in this region, this poses a significant challenge in the diagnosis and management of IBD. In this review, we will explore the barriers to the diagnosis and management of IBD in the East Asia, hoping to provide an insight on how to improve the healthcare system in the management of this complex disease.

Mathematical Models Including microRNA Levels of Mesenteric Adipose Tissue May Predict Postoperative Relapse in Crohn's Disease Patients

Background and Aims

Recent evidence suggests that the mesenteric adipose tissue (MAT) near the affected intestine may play a role in Crohn's disease (CD) pathophysiology. Modulation of several transcripts has already been identified in the MAT of CD in the literature. Therefore, our aim was to validate the microRNA (miRNA) transcript levels and their target genes in the MAT of active CD patients and correlate them with clinical and epidemiological data.

Methods

Samples from the MAT of surgical specimens from 25 active CD patients were obtained. The control group comprised fifteen patients who underwent surgery for other diseases, except inflammatory bowel diseases. Transcriptional levels of miRNA and their target genes were assessed by quantitative real-time polymerase chain reaction. The correlation between transcripts and clinical characteristics was obtained using multiple linear regression. The mathematical models (M) underwent a statistical filter to ensure robustness and reliability (P value < .05; adjusted R-squared (Rˆ2)> .99; correct predictions of more than 60%).

Results

miRNA-650 and miRNA-29c were upregulated in the MAT of CD compared to the control group (P < .0001 and P = .0032, respectively), besides presenting decreased levels of their target genes. Two were target genes of the miRNA-650: glutamine-fructose-6-phosphate transaminase 2 (P = .012) and aldehyde dehydrogenase 4 family (P = .0035); and 4 were targets of the miRNA-29c: cell death-inducing DFFA-like effector c (P = .001), E2F transcription factor-1 (P = .007), hypoxia-inducible factor 3 subunit alpha (P = .0029), and pyruvate dehydrogenase kinase 4 (P = .0054). We found 2 M with statistical strength and robustness. The performance test identified one model with 100% accuracy for predicting the month of recurrence and determining patients with less risk of early relapse after surgery.

Conclusion

We demonstrate that miRNA-650 and miRNA-29c and some of their target genes, besides clinical and epidemiological variables, may be useful in a model to predict when disease relapse may occur in CD patients who underwent surgery. These findings constitute a potential tool to guide postoperative clinical management.

Autoimmune Thyroid Disorders: The Mediterranean Diet as a Protective Choice

Autoimmune thyroid diseases are on the rise worldwide, and such a rapid increase is mainly driven by environmental factors related to changed lifestyles in "modern" societies. In this context, diet seems to play a crucial role. An unhealthy high-energy diet, rich in animal fat and proteins, salt and refined sugars (the so-called "Western diet") negatively influences the risk of autoimmunity by altering the immune balance and the gut microbiota composition, enhancing oxidative stress and promoting inflammation. In contrast, the Mediterranean diet represents a unique model of healthy eating, characterized by a high intake of food from vegetable sources, a low consumption of saturated fats in favor of unsaturated fats (mainly, olive oil), a moderate consumption of fish (typically, the small oily fishes) and dairy products, as well as a moderate consumption of wine at meals, and a low intake of meat. Thanks to its nutritional components, the Mediterranean Diet positively influences immune system function, gut microbiota composition, and redox homeostasis, exerting anti-oxidants, anti-inflammatory, and immunomodulatory effects. The present review was aimed at exploring the existing knowledge on the correlations between dietary habits and thyroid autoimmunity, to evaluate the role of the Mediterranean diet as a protective model.

Global research trends on diet and nutrition in Crohn’s disease

BACKGROUND

Crohn’s disease represents a challenge for patients concerned with the modified diet regimen as well as practitioners who seek the best nutritional therapy. Crohn’s disease can alter the body’s ability to digest food and to absorb nutrients, resulting in severe vitamin deficiencies, malnutrition and sometimes life-threatening complications. However, a comprehensive bibliometric analysis is lacking to map the current links between nutrition and Crohn’s disease in terms of the number of citations, geographic distribution and growth trends of publications.

AIM

To introduce the current state of research as well as hotspots in the field of nutrition and Crohn’s disease from a bibliometric standpoint.

METHODS

We searched the Scopus database and selected the relevant literature on nutrition and Crohn’s disease that met the inclusion criteria. We analyzed the publication trends and research hotspots by using video object segmentation viewer software.

RESULTS

We included 1237 publications. The number of documents published each year has increased steadily. The United States and the University of Otago, Christchurch, have had the highest productivity, with 208 (16.81%) and 29 (2.34%) documents, respectively. The “role of exclusive enteral nutrition for complicated Crohn’s disease” and “manipulation of the gut microbiota as a key target for Crohn’s disease” were the major research areas in 2016-2021, and they could be extensively investigated in the future. Meanwhile, research on “malnutrition in patients with Crohn’s disease” appeared to be an area that attracted more research attention before 2016.

CONCLUSION

This is the first bibliometric analysis to map the knowledge structure and trends regarding nutrition in Crohn’s disease research over the past two decades. The results provide a comprehensive summary and identification of the frontiers of nutrition and Crohn’s disease-related research, which may be used as a resource by researchers in the field.

GLP-1 Receptor Agonists in Obese Patients with Inflammatory Bowel Disease: from Molecular Mechanisms to Clinical Considerations and Practical Recommendations for Safe and Effective Use

PURPOSE OF REVIEW

To discuss current literature and provide practical recommendations for the safe and effective use of glucagon-like peptide 1 receptor agonists (GLP-1 RA) in people with inflammatory bowel disease (IBD) and type 2 diabetes (T2D) and/or obesity. The molecular mechanisms that justify the potential benefits of GLP-1 RA in IBD and the links between IBD, obesity, and cardiovascular disease are also discussed.

RECENT FINDINGS

Preliminary data suggest that GLP-1 RA can modulate crucial pathways in the pathogenesis of IBD, such as chronic inflammation circuits, intestinal tight junctions, and gut microbiome dysbiosis, setting the stage for human trials to investigate the role of these agents in the treatment of IBD among people with or without diabetes and obesity. However, gastrointestinal side effects related to GLP-1 RA need appropriate clinical management to mitigate risks and maximize the benefits of therapy in people with IBD. GLP-1 RA originally emerged as drugs for the treatment of hyperglycemia and are currently licensed for the management of T2D and/or overweight/obesity. However, their wealth of pleiotropic actions soon raised expectations that they might confer benefits on non-metabolic disorders. Future studies are expected to clarify whether GLP-1 RA deserve an adjunct place in the arsenal of drugs against IBD.

ESPEN guideline on Clinical Nutrition in inflammatory bowel disease

The present guideline is an update and extension of the ESPEN scientific guideline on Clinical Nutrition in Inflammatory Bowel Disease published first in 2017. The guideline has been rearranged according to the ESPEN practical guideline on Clinical Nutrition in Inflammatory Bowel Disease published in 2020. All recommendations have been checked and, if needed, revised based on new literature, before they underwent the ESPEN consensus procedure. Moreover, a new chapter on microbiota modulation as a new option in IBD treatment has been added. The number of recommendations has been increased to 71 recommendations in the guideline update. The guideline is aimed at professionals working in clinical practice, either in hospitals or in outpatient medicine, and treating patients with IBD. General aspects of care in patients with IBD, and specific aspects during active disease and in remission are addressed. All recommendations are equipped with evidence grades, consensus rates, short commentaries and links to cited literature.

Role of an Exclusion Diet (Reduced Disaccharides, Saturated Fats, Emulsifiers, Red and Ultraprocessed Meats) in Maintaining the Remission of Chronic Inflammatory Bowel Diseases in Adults

Background and Objectives: Inflammatory bowel diseases are a main focus in current research, with diet being an emerging therapeutic line due to its links in both onset and progression. A Western-style diet high in processed foods, food additives, red meat, and animal fat has been linked to a higher risk of developing IBD. The aim of this study was to establish an association between an anti-inflammatory exclusion diet and maintenance of remission in IBD. Also, we assessed the efficacy and safety of this diet compared to a non-dietary group and the possible therapeutic effect of this diet in the maintenance of IBD remission. Materials and Methods: A total of 160 patients with IBD were screened for inclusion, but 21 did not met the inclusion criteria. Thus, 139 patients were assigned to either an exclusion diet or a regular diet according to their choice. Results: Clinical remission after six months was maintained in the exclusion diet arm (100%). In the control arm, four patients had clinically active disease (one patient with UC and three with CD), and 90 patients maintained the clinical remission state (95.7%) (p-value = 0.157). Regarding biochemical markers, ESR at baseline was higher in the exclusion diet arm: 29 (5-62) versus in the control arm 16 (4-48) (p-value = 0.019), but six months after, the groups were similar (p-value = 0.440). Conclusions: Patients who followed an exclusion diet maintained clinical remission more frequently. However, the threshold for statistical significance was not achieved. There was also a trend of improvement in inflammation tests in the intervention group.

Nutritional intervention in the management of non-alcoholic fatty liver disease

Lifestyle modification is the primary intervention to control NAFLD progression, but despite evidence-based effectiveness it is difficult to distinguish the benefits of nutrition from physical activity and the optimal diet composition is not established. Macronutrients as saturated fatty acids, sugars and animal proteins are harmful in NAFLD and the Mediterranean Diet reducing sugar, red meat and refined carbohydrates and increasing unsaturated-fatty-acids was reported to be beneficial. However one size cannot fit all since NAFLD is a multifaceted syndrome encompassing many diseases of unknown etiologies, different clinical severity and outcomes. Studies of the intestinal metagenome, provided new insights into the physio-pathological interplay between intestinal microbiota and NAFLD. How much the microbiota heterogeneity can influence response to diet remains unknown. New knowledge indicates that AI guided personalized nutrition based on clinic-pathologic and genetic data combined with pre/post nutritional intervention gut metagenomics/metabolomics will be part of the future management of NAFLD.

Dietary practices, beliefs and behaviours of adults with inflammatory bowel disease: a cross-sectional study

BACKGROUND

It is widely accepted that there is an association between diet and inflammatory bowel disease (IBD). Diet may play a role in disease pathogenesis but also in treatment and management of IBD. There is an increased interest in dietary aspects of people with IBD.

AIMS

To investigate dietary practices, beliefs and behaviours of adults with IBD in Ireland.

METHODS

An online questionnaire was adapted to explore dietary practices, beliefs and behaviours of people with IBD, and to identify any dietary modifications made due to their IBD.

RESULTS

A total of 475 participants (female n = 354, male n = 121) took part in this study, 62% had Crohn's disease and 38% had ulcerative colitis. Dietary restrictions were imposed in the hope of preventing a relapse by 85% of participants. The most reported foods avoided included fatty foods (68%), spicy foods (64%) and raw vegetables or fruit (58%). Low fibre white plain foods (74%) appeared to improve symptoms during a relapse. Participant's appetites were higher during remission (8.36, SD =  ± 1.95), compared to during relapse (3.71, SD =  ± 2.32) (P ≤ 0.001). Almost three-quarters (73%) avoided the same menu as others living in their household and 56% avoided eating out to prevent or for fear of causing a relapse. Additionally, 70% avoided food or drink they liked to try prevent a relapse.

CONCLUSION

These findings provide important insights into the dietary practices, beliefs and behaviours of adults with IBD. Its evident diet plays an important role, and our findings reiterate the importance of patient education and support.

Therapeutic Benefits and Dietary Restrictions of Fiber Intake: A State of the Art Review

Throughout history, malnutrition and deficiency diseases have been a problem for our planet’s population. A balanced diet significantly influences everyone’s health, and fiber intake appears to play a more important role than previously thought. The natural dietary fibers are a category of carbohydrates in the constitution of plants that are not completely digested in the human intestine. High-fiber foods, such as fruits, vegetables and whole grains, have consistently been highly beneficial to health and effectively reduced the risk of disease. Although the mode of action of dietary fiber in the consumer body is not fully understood, nutritionists and health professionals unanimously recognize the therapeutic benefits. This paper presents the fiber consumption in different countries, the metabolism of fiber and the range of health benefits associated with fiber intake. In addition, the influence of fiber intake on the intestinal microbiome, metabolic diseases (obesity and diabetes), neurological aspects, cardiovascular diseases, autoimmune diseases and cancer prevention are discussed. Finally, dietary restrictions and excess fiber are addressed, which can cause episodes of diarrhea and dehydration and increase the likelihood of bloating and flatulence or even bowel obstruction. However, extensive studies are needed regarding the composition and required amount of fiber in relation to the metabolism of saprotrophic microorganisms from the enteral level and the benefits of the various pathologies with which they can be correlated.