A Comprehensive Review of Dietary Approaches in Maintaining Remission of Inflammatory Bowel Diseases in Adults
Abstract
1. Introduction
2. Material and Methods
3. The Importance of Diet in IBD
4. Nutrition Assessment in IBD Patients
5. Dietary Approaches in Maintaining IBD Remission
5.1. Specific Dietary Interventions
5.1.1. The Crohn’s Disease Exclusion Diet (CDED)
5.1.2. Plant-Based Diet
5.1.3. Low-Fat Diet
5.1.4. Low-Meat Diet
5.1.5. IgG-Based Food Exclusion
5.1.6. Anti-Inflammatory Diet
5.1.7. Dietary Exclusion Regimen
5.2. Enteral Nutrition
5.3. Probiotics and Prebiotics
5.4. Complementary and Alternative Medicine
5.5. Vitamin D
6. Conclusions
Funding
Institutional Review Board Statement
Informed Consent Statement
Conflicts of Interest
References
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Factor | Mechanism |
---|---|
Poor dietary intake |
|
Increased nutrient malabsorption |
|
Increased protein loss |
|
Increased metabolism |
|
Micronutrient | Consequences | Recommendations |
---|---|---|
Iron | Anemia, fatigue, weakness, brittle nails | Iron deficiency anemia: supplement with oral iron if mild anemia, inactive IBD and good oral tolerance; supplement with intravenous iron if hemoglobin <10 g/dL, active IBD or oral iron intolerance Iron deficiency without anemia: supplement with oral iron |
Vitamin D | Disturbed calcium homeostasis and bone health | Supplement in case of detecting deficit |
Vitamin B12 | Anemia, fatigue, neurological effects | Supplement in case of detecting deficit and in all patients with ileal resection >20 cm |
Zinc | Impaired healing, disturbed smell and taste, delayed growth in children | Supplement in case of detecting deficit |
Folate | Anemia, fatigue | Supplement in case of detecting deficit |
Calcium | Decreased bone density (risk of bone fracture) | Supplement in case of detecting deficit |
Magnesium | Disturbed bone health, muscular cramps, fatigue | Supplement in case of detecting deficit |
Dietary Pattern | Description of Diet | Evidence of Efficacy |
---|---|---|
Crohn’s Disease Exclusion Diet | Whole foods diet in conjunction with partial enteral nutrition. Eliminates dairy products, processed foods, preservatives, products containing emulsifiers, artificial sweeteners, coffee, alcohol, certain animal fats, and minimizes gluten | RCT in 44 adults with and without PEN showing induction of remission and mucosal healing in some [49] Observational study on 96 patients with and without PEN showing induction of remission and remission maintenance [50] |
Plant-based Diet | Diet that eliminates or minimizes non-plant-based foods; not necessarily entirely vegetarian or vegan. | Observational study showing reduced risk of relapse in 16 patients with Crohn’s disease in clinical remission [51] |
Low-fat Diet | Reduce fat to 10% of total calories Reduce red meat to approximately half a serving daily Include 25 g fibers | Crossover RCT in 17 patients with ulcerative colitis in remission, a low-fat and high-fiber diet improved inflammation and intestinal dysbiosis [52] |
Low-meat Diet | Reduce red and processed meat to one serving per month or less | Prospective RCT in 214 patients with Crohn’s disease in remission showed no difference in relapse between low and high meat intakes [53] |
IgG Exclusion Diet | Restriction of food based on presence of IgG antibodies specific to 14 food antigens, including egg, wheat, milk, corn, rice, soybean, chicken and others | Observational study in 97 UC patients in remission or mild to moderately active disease on open-label IgG exclusion diet or unchanged diet showed lower stool frequency in exclusion group and no endoscopic differences [54] |
Anti-inflammatory Diet | Eliminates processed carbohydrates, increases n-3-polyunsaturated fatty acids, and decreases n-6-polyunsaturated fatty acids. Examples of disallowed foods include cured meats, fruit juices, and many dairy items. | RCT on 28 UC patients in remission revealed comparable relapse rates and levels of fecal calprotectin [55] |
Exclusion Diet | Reduces intake of disaccharides, saturated fats, emulsifiers, red meats, and ultra-processed meats | Case-control study on 139 IBD patients showed higher rates of remission in the exclusion group [56] |
Partial Enteral Nutrition | Replacement of 35–50% of regular food intake with enteral nutrition | Several RCT on CD patients revealed lower rates of relapse in the intervention group [57,58,59,60,61,62] |
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Istratescu, D.; Preda, C.M.; Manuc, T.; Meianu, C.; Stroie, T.; Diculescu, M. A Comprehensive Review of Dietary Approaches in Maintaining Remission of Inflammatory Bowel Diseases in Adults. Medicina 2024, 60, 1068. https://doi.org/10.3390/medicina60071068
Istratescu D, Preda CM, Manuc T, Meianu C, Stroie T, Diculescu M. A Comprehensive Review of Dietary Approaches in Maintaining Remission of Inflammatory Bowel Diseases in Adults. Medicina. 2024; 60(7):1068. https://doi.org/10.3390/medicina60071068
Chicago/Turabian StyleIstratescu, Doina, Carmen Monica Preda, Teodora Manuc, Corina Meianu, Tudor Stroie, and Mircea Diculescu. 2024. "A Comprehensive Review of Dietary Approaches in Maintaining Remission of Inflammatory Bowel Diseases in Adults" Medicina 60, no. 7: 1068. https://doi.org/10.3390/medicina60071068
APA StyleIstratescu, D., Preda, C. M., Manuc, T., Meianu, C., Stroie, T., & Diculescu, M. (2024). A Comprehensive Review of Dietary Approaches in Maintaining Remission of Inflammatory Bowel Diseases in Adults. Medicina, 60(7), 1068. https://doi.org/10.3390/medicina60071068