The Mediterranean Diet in Paediatric Gastrointestinal Disorders
2. The Mediterranean Diet and Inflammatory Bowel Diseases
3. The Mediterranean Diet and Functional Gastrointestinal Disorders
4. The Mediterranean Diet and Coeliac Disease
5. Future Perspective
Institutional Review Board Statement
Informed Consent Statement
Data Availability Statement
Conflicts of Interest
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|Study||Type of Study||Population||Aim||Results|
|Marlow et al. , 2013||Prospective study||Eight adult patients with active stable Crohn’s disease (six females and two males, aged between 31 and 60 years).||Evaluation of changes in inflammation and in the gut microbiota after administration of a 6-week Mediterranean-inspired diet.||Small reduction of inflammatory biomarkers (non-statistically significant).|
A total of 3551 genes had
significantly (p < 0.05) altered expression as a result of the
Normalising trend of the microbial gut composition.
|Racine et al. , 2016||Prospective study||A total of 366,351 adult patients (20–80 years).|
During the follow-up, 117 patients developed CD, while 256 developed UC.
|Evaluate the connection between adherence to the MD, assessed by an adapted Mediterranean diet score (aMED), and the risk of developing UC and CD.||A diet rich in sugar and soft drinks was positively associated with UC, when diagnosed at least 2 years after diet recording.|
No association between any dietary pattern and CD risk.
|Sureda et al. , 2018||Observational study||A total of 598 healthy patients (364 adolescents and 234 adults).||Evaluate the connection between inflammatory biomarkers and MD adherence (using food-frequency questionnaire (FFQ) and two 24 h diet recalls).||High adherence to the MD was associated with a better inflammatory-biomarker profile.|
|Godny et al. , 2019||Prospective observational study||A total of 153 adult patients with UC, who underwent pouch surgery.||Evaluate the connection between adherence to the MD, using FFQ and inflammatory markers (CRP and faecal calprotectin) and pouchitis-disease-activity index (PDAI).||MD-adherence was higher in patients with inactive disease. |
High MD-adherence was inversely associated with elevated calprotectin and lower risk of developing pouchitis in the years after surgery.
|Papada et al. , 2019||Cross-sectional study||A total of 86 CD adult patients (45 in remission and 41 in relapse).||Evaluate the adherence to MD in patients with CD and assess the role of MD in improving intestinal symptoms and inflammatory markers.||Adherence to MD was greater in patients with inactive disease.|
The MedDiet score correlated positively with the inflammatory bowel disease questionnaire (IBDQ), and negatively with disease activity.
|Khalili et al. , 2020||Prospective study||A total of 83,147 patients.||Evaluate the connection between MD adherence, using semiquantitative food-frequency questionnaire (SFFQ) and IBD risk.||A higher mMED score was linked to a lower risk of developing CD.|
People with poor adherence to an MD had an adjusted population-attributable risk of 12% for later onset CD.
No association was proved between UC and mMED.
|Vrdoljak et al. , 2020||Cross-sectional study||A total of 94 adult patients (44 in the UC group and 50 in the CD group) with IBD diagnosed for at least 1 year.||Investigate nutritional habits and dietary attitudes in IBD patients, in addition to assessing their adherence to the MD.||Only nine participants fulfilled criteria for MD adherence, all of them male.|
A total of 86.2% of subjects considered certain foods as responsible for exacerbating their gastrointestinal symptoms.
A strict correlation between Mediterranean diet serving score (MDSS) and HDL cholesterol levels was observed.
Most of the population (90.4%) considered that proper nutrition plays an important role in their illness and quality of life, and considered that a more controlled and better diet could reduce their IBD symptoms.
|Chicco et al. , 2021||Prospective, Interventional study||A total of 142 patients (18 years old and older) with diagnosis of IBD for at least 6 months in active follow-up.||Impact of short-term dietary intervention based on the adoption of MD on anthropometric parameters, serum lipid profile, liver function and intestinal disease activity.||Improvement of anthropometric measures (BMI and waist circumference reduction), decrease in fat body mass and increase in lean body mass (no statistical significance).|
Significant improvement of liver steatosis and liver function (reduction of alanine aminotransferase and gamma-GT within the reference range).
Improvement of inflammatory biomarkers and of quality of life.
|Taylor et al. , 2018||Single-centre cross-sectional study||A total of 67 patients affected by inactive CD (mean age of 45).||Investigate micro- and macronutrient intake and dietary attitudes in CD patients, including their adherence to the MD, and compare them to a representative of healthy individuals.||Patients with CD had multiple vitamin and micronutrients deficits and lower MD adherence, compared with healthy controls.|
|D’Souza et al. , 2008||Case-control study||A total of 149 cases of children (2.6–20 years) with CD, 251 controls.||Obtain gender-specific dietary patterns and calculate their associated risk for CD.||Dietary pattern rich in vegetables, fruits, dairy products, eggs, olive oil, dark breads, grains, fish and nuts was negatively associated with CD, for both boys and girls.|
|Strisciuglio et al. , 2017||Case-control study||A total of 264 patients (1–18 years); 102 children with CD and 162 children with UC, and 203 healthy controls.||Evaluate the role of environmental factors in IBD development. *||Low adherence to MD was higher for CD and for UC when compared with controls.|
|Strisciuglio et al. , 2020||Single-centre cross-sectional study||A total of 125 children with a diagnosis of IBD in clinical remission and 125 healthy controls.||Assess dietary intake through a 3-day food diary and Mediterranean-diet-quality index for children and adolescents (KIDMED); evaluate their adherence to MD and investigate the relationship between inflammation and dietary behaviours.||IBD patients and healthy controls had an intermediate adherence to MD.|
IBD group had a higher kilocalorie intake.
Significant association between adherence to MD and a lower level of FC in IBD patients.
In comparing CD and UC, a higher intake of protein, iron and vitamin D in CD patients emerged.
|El Amrousy et al. , 2022||Prospective randomised study||A total of 100 patients (12–18 years) with mild-moderately active CD or UC.|
Group I (26 patients with active CD and 24 patients with active UC) received Mediterranean Diet for 12 weeks.
Group II (28 patients with active CD and 22 patients with active UC) followed its regular diet.
|Evaluation of clinical remission, clinical scores (PCDAI and PUCAI) and inflammatory biomarkers (CRP, calprotectin, TNF-alfa, IL17, IL12, IL13).||Most of the patients reached clinical remission after a 12-week diet.|
Clinical scores (PCDAI and PUCAI) and inflammatory markers were significantly improved in patients in Group I (all cytokines were decreased, except IL10).
|Study||Type of Study||Population||Aim||Results|
|Zito et al. , 2016||Case-control study||A total of 1134 people (598 males and 536 females, 17–83 years).||Assess the connection between MD adherence and onset of functional gastrointestinal disorders (IBS and functional dyspepsia).||MD adherence is inversely associated with the prevalence of gastrointestinal symptoms.|
|Elmaliklis et al. , 2019||Retrospective case-control study||A total of 289 adults (127 males and 162 females); 142 patients had GI disorders (UC, CD, IBS or gastroesophageal reflux disease) and 147 healthy controls.||Investigate the connection between functional food consumption and MD adherence in gastrointestinal-disorders development.||The MD index was higher in controls.|
In the 2–3 years before diagnosis, patients consumed less functional food (for example, probiotics, prebiotics, vegetables), than controls.
|Paduano et al. , 2019||Prospective interventional study||A total of 42 patients (18–45 years old) diagnosed with IBS, in accordance with the Rome IV criteria.||Compare the efficacy of three diets (low-FODMAP, gluten-free diet and balanced diet) in IBS treatment.||The low-FODMAP diet proved to be effective in normalising stool solidity.|
All three diets were effective in reducing disease severity, abdominal bloating and the duration of abdominal pain.
The low-FODMAP and the gluten-free diet improved the quality of life of the patients both physically and mentally, while the balanced diet led only to a psychological improvement.
|Altomare et al. , 2021||Cross-sectional study||A total of 28 IBS patients (median age 55 years old) and|
21 controls (median age 56 years old).
|Evaluate the association between MD adherence, using MDSS, and macronutrients intake with microbiota composition and clinical symptoms, in IBS patients.||IBS patients had a lower MD-adherence than controls, in addition to an inadequate diet. |
These patients complained about more severe symptoms (abdominal pain and flatulence).
IBS patients with an inadequate diet had an altered microbiome composition.
|Agakidis et al. , 2019||Prospective cohort study||A total of 1116 children and adolescents (6–18 years old).||Assess the link between MD adherence, using KIDMED score, and FGID development, using Rome III criteria.||FGIDs were inversely associated with MD-adherence, and positively associated with age.|
|Strisciuglio et al. , 2022||Multicentre cross-sectional study||A total of 4422 people (4–18 years), divided into: Group A: 1972 children aged 4 to 9 years;|
Group B: 2450 adolescents aged 10 to 18.
|Investigate the connection between FGIDs prevalence in Mediterranean area and FODMAP intake and MD adherence.||No association was found between FGIDs and FODMAP intake.|
A statistically significant association was found between FGIDs and the KIDMED score. A statistically significant association was found between MD adherence and FC and PDS.
|Al-Biltagi et al. , 2022||Prospective, randomised cross-sectional controlled study||A total of 100 people with IBS (12–18 years old).|
Group 1 (50 patients): Mediterranean diet administration with good adherence; Group 2 (50 patients): regular diet.
|Assess the tolerance and security of the MD in children and adolescents with IBS.|
Evaluate the MD efficacy as treatment.
|MD was well tolerated; no adverse reactions to, or effects of, the diet were reported.|
IBS symptoms severity-score questionnaire, IBS quality-of -life questionnaire were significantly improved in the group who received the MD.
|Study||Type of Study||Population||Aim||Results|
|Morreale et al. , 2018||Cross-sectional study||A total of 122 adult coeliac patients who followed a GFD, and 102 healthy adults.||Evaluation of MD adherence.||Coeliac patients had a low adherence to the MD.|
The nutritional status of coeliac patients was poorer than the control group.
Coeliac patients ate higher amounts of potatoes and red meat, while the fruit intake was higher in the control group.
|Larretxi et al. , 2018||Prospective study||A total of 83 paediatric coeliac patients (3–18 years old).||Assessment of the nutritional adequacy of the GFD.||A total of 47% of the boys and 25% of the girls followed an MD.|
Coeliac patients who followed a GFD had micronutrient deficiencies, as well as an unbalanced intake of macronutrients (fat and carbohydrate).
|Lionetti et al. , 2020||Prospective case-control study||A total of 120 coeliac children (4–16 years old) on a GFD for more than 2 years, and 100 healthy children as controls.||Assessment of the nutritional status of the patients, as well as their dietary habits and their adherence to the MD.||Coeliac patients’ nutritional status is not dissimilar from the healthy control group; however, their diet is unbalanced (rich in fats and poor in fibres).|
The KIDMED index is 6.5 in coeliac patients, versus 6.8 in healthy controls.
|Nestares et al. , 2021||Prospective cross-sectional study||A total of 59 children with coeliac disease (7–18 years old), and 40 healthy controls.||Evaluation of the influence of MD-adherence and physical activity on bone health in paediatric coeliac patients.||Adherence to the MD, along with effective physical activity, were associated with a higher Z-score and lean mass in instrumental analysis.|
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Cenni, S.; Sesenna, V.; Boiardi, G.; Casertano, M.; Di Nardo, G.; Esposito, S.; Strisciuglio, C. The Mediterranean Diet in Paediatric Gastrointestinal Disorders. Nutrients 2023, 15, 79. https://doi.org/10.3390/nu15010079
Cenni S, Sesenna V, Boiardi G, Casertano M, Di Nardo G, Esposito S, Strisciuglio C. The Mediterranean Diet in Paediatric Gastrointestinal Disorders. Nutrients. 2023; 15(1):79. https://doi.org/10.3390/nu15010079Chicago/Turabian Style
Cenni, Sabrina, Veronica Sesenna, Giulia Boiardi, Marianna Casertano, Giovanni Di Nardo, Susanna Esposito, and Caterina Strisciuglio. 2023. "The Mediterranean Diet in Paediatric Gastrointestinal Disorders" Nutrients 15, no. 1: 79. https://doi.org/10.3390/nu15010079