The Role of Dietary Fibers in the Management of IBD Symptoms
Abstract
:1. Introduction
2. Fibers Classification and Functions
3. The Effect of Dietary Fibers in IBD
4. Side Effects of Dietary Fibers with a Focus on IBD
5. Gut Microbiota in IBD
6. Mechanism of Action of Dietary Fibers in IBD
7. Conclusions
Author Contributions
Funding
Informed Consent Statement
Data Availability Statement
Conflicts of Interest
References
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Etiopathogenetic Factors | Effects | |
---|---|---|
Genetic factors | NOD2 gene mutation [5,6,7,8,9,10,11] | Alteration of intestinal immune homeostasis and components which maintain the mucus layer |
ATG16L1 gene mutation [5,6,12,13,14,15] | Paneth cell function in autophagy mechanisms is compromised, so protection against infection removing many intracellular microbes is reduced | |
Locus IBD5 alteration [16,17] | Wrong codification of a group of cationic organic transporters, OCTN1 and OCTN2. Reduction in cells and tissues from oxidative and/or inflammatory damage | |
Locus IBD3 alteration [16] | Wrong codification of Major Histocompatibility Complex (MHC) | |
Host-related factors | Microbiota alteration [18,19] | Lower production of anti-inflammatory and immunoregulatory metabolites, in particular butyrate—a lack of which may contribute to increased intestinal inflammation |
Immune response [18,20,21,22] | Hyperactivity of T cells with excessive production of cytokines, among which IL-12, il-23 and IFN-γ promote a TH1 and TH17 lymphocytic phenotype. The inhibition of the effector cytokines, such as TNF-α | |
Environmental factors | Diet [19,23] | Red meat consumption has a pro-inflammatory effect. A high consumption of total fatty acids, polyunsaturated fatty acids (PUFAs), especially omega 6 fatty acids, increases the risk of developing both UC and CD |
Cigarette smoking [16] | Formation of fistulas and intestinal strictures increases the frequency of exacerbations and favors post-surgical relapses in CD. On the contrary, in UC, it seems to have a protective action and it is associated with less frequent flare-ups of the disease |
Symptoms and Signs | CD | UC | ||
---|---|---|---|---|
Presence/Absence | Frequency | Presence/Absence | Frequency | |
Abdominal pain | ✔ | + | ✔ | + |
Diarrhea | ✔ | + | ✔ | + |
Hematochezia | ✔/✗ | +/− | ✔/✗ | + |
Abdominal mass | ✔ | + | ✔ | +/− |
Malnutrition | ✔ | + | ✔/✗ | +/− |
Abdominal distension | ✔/✗ | +/− | ✔/✗ | +/− |
Sub occlusive symptoms | ✔ | + | ✗ | - |
Perianal disease | ✔ | +/− | ✗ | - |
Fistulas | ✔ | +/− | ✗ | - |
Anemia | ✔ | + | ✔/✗ | +/− |
Iron deficiency | ✔ | + | ✔/✗ | +/− |
Low vitamin D | ✔ | + | ✔/✗ | +/− |
Elevated inflammatory markers | ✔ | + | ✔/✗ | +/− |
Number of Patients | Duration | Type and Amount of Fiber | Results | |
---|---|---|---|---|
Davies and Rhodes, 1978 [109] | 39 subjects in UC remission | 6 months | 25 g/day Oat bran | Increased stool but no effects on butyrate production |
Hallert et al., 2003 [110] | 22 subjects in UC remission | 3 months | 60 g/day Oat bran | Increase in butyrate production and a decrease in gastrointestinal symptoms |
Hallert et al., 1991 [111] | 23 subjects in UC remission | 4 months | Plantago ovata peel | 69% of patients showed relief of symptoms for increased SCFAs production |
Fernandez-Bañares et al. in 1999 [112] | 105 subjects in UC remission | 12 months | Arm 1: 10 g twice a day of plantago ovata seeds; Arm 2: mesalamine; Arm 3: plantago ovata seeds + mesalamine | The three arms showed the same results on symptoms |
Mitsuyama et al., 1998 [113] | 10 subjects with active UC | 1 month | 30 g/day GBF | Patients showed improvement in their clinical activity index scores, with a significant decrease in the score |
Wetters et al., [119] | 20 subjects | 3 weeks | 24 g inulin/day | Compared with placebo, inulin increased butyrate concentrations, lowered pH, decreased numbers of Bacteroides fragilis, and diminished concentrations of secondary bile acids in feces |
Number of Patients | Duration | Type and Amount of Fiber | Results | |
---|---|---|---|---|
Lindsay et al. [120]. | 10 subjects with ileocolonic CD | 3 weeks | 15 g/day FOS (70:30% oligofructose:inulin) | Increase in mucosal Bifidobacteria, in IL-10, TLR-2 and TLR-4 |
Jossens et al. [121] | 67 subjects with inactive and mild to moderately active CD | 4 weeks | 10 g oligofructose-enriched inulin (OF-IN) or placebo twice daily | Decrease in Ruminococcus gnavus and an increase in the number of Bifidobacterium longum. In the subgroup of patients with active CD, there was a positive correlation between the increase in the number of Bifidobacterium longum and the improvement in disease activity |
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Di Rosa, C.; Altomare, A.; Imperia, E.; Spiezia, C.; Khazrai, Y.M.; Guarino, M.P.L. The Role of Dietary Fibers in the Management of IBD Symptoms. Nutrients 2022, 14, 4775. https://doi.org/10.3390/nu14224775
Di Rosa C, Altomare A, Imperia E, Spiezia C, Khazrai YM, Guarino MPL. The Role of Dietary Fibers in the Management of IBD Symptoms. Nutrients. 2022; 14(22):4775. https://doi.org/10.3390/nu14224775
Chicago/Turabian StyleDi Rosa, Claudia, Annamaria Altomare, Elena Imperia, Chiara Spiezia, Yeganeh Manon Khazrai, and Michele Pier Luca Guarino. 2022. "The Role of Dietary Fibers in the Management of IBD Symptoms" Nutrients 14, no. 22: 4775. https://doi.org/10.3390/nu14224775