[en] [en] BACKGROUND: Patients with inflammatory bowel disease (IBD) consider that their diet is important for controlling symptoms and frequently ask their physician for additional guidance on this matter. The objectives of the present study of patients with IBD were to characterize the prevalence of exclusion diets and fasting and to identify associated risk factors.
METHODS: Using an anonymous questionnaire, we screened patients attending our IBD nutrition clinic between November 2021 and April 2022 for exclusion diets. The avoidance of a food category completely was defined as total exclusion and avoidance most of the time was defined as partial exclusion. We also asked patients whether they fasted totally, intermittently, or partially.
RESULT: A total of 434 patients with IBD were included. On inclusion, 159 patients (36.6%) totally excluded at least one food category and 271 (62.4%) partially excluded at least one food. Intermittent, total, or partial fasting was reported by 30.8% of the patients. Disease activity (odds ratio (OR) [95% confidence interval] = 1.7 [1.1-2.7], p = 0.0130) and treatment with a small-molecule or an investigational drug (OR = 4.0 [1.5-10.6], p = 0.0059) were independently associated with an exclusion diet. A history of stenosis (OR = 2.0 [1.2-3.2], p = 0.0063) and active disease (OR = 1.9 [1.2-3.1], p = 0.0059) were associated with fasting.
CONCLUSION: In this real-world study, approximately two-thirds of our patients with IBD reported the partial or total exclusion of at least one food category and one third reported fasting. A systematic nutritional evaluation might improve clinical management and quality of care for patients with IBD both Crohn's disease and ulcerative colitis.
Disciplines :
Gastroenterology & hepatology
Author, co-author :
Bonsack, Olivier; Department of Gastroenterology, University of Lorraine, Nancy University Hospital, Nancy, France ; University of Lorraine, INSERM, NGERE, Nancy, France
Caron, Bénédicte; Department of Gastroenterology, University of Lorraine, Nancy University Hospital, Nancy, France ; University of Lorraine, INSERM, NGERE, Nancy, France ; DRCI, Nancy University Hospital, Nancy, France
Baumann, Cedric; Unit of Methodology, Data Management and Statistics, Nancy University Hospital, Nancy, France
Heba, Anne Charlotte; University of Lorraine, INSERM, NGERE, Nancy, France
Vieujean, Sophie ; Centre Hospitalier Universitaire de Liège - CHU > > Service de gastroentérologie, hépatologie, onco. digestive
Arnone, Djesia; University of Lorraine, INSERM, NGERE, Nancy, France
Netter, Patrick; Ingénierie Moléculaire et Ingénierie Articulaire (IMoPA), UMR-7365 CNRS, Faculté de Médecine, University of Lorraine and University Hospital of Nancy, Nancy, France
Danese, Silvio; Gastroenterology and Endoscopy, IRCCS Ospedale San Raffaele and University Vita-Salute San Raffaele, Milano, Italy
Quilliot, Didier; Transversal Nutrition Unit, University of Lorraine, Nancy University Hospital, Nancy, France
Peyrin-Biroulet, Laurent ; Department of Gastroenterology, University of Lorraine, Nancy University Hospital, Nancy, France ; University of Lorraine, INSERM, NGERE, Nancy, France
Language :
English
Title :
Food avoidance and fasting in patients with inflammatory bowel disease: Experience from the Nancy IBD nutrition clinic.
Abraham C, Cho JH. Inflammatory bowel disease. N Engl J Med. 2009;361(21):2066–78. https://doi.org/10.1056/NEJMra0804647
Jowett SL, Seal CJ, Phillips E, Gregory W, Barton JR, Welfare MR. Dietary beliefs of people with ulcerative colitis and their effect on relapse and nutrient intake. Clin Nutr Edinb Scotl. 2004;23(2):161–70. https://doi.org/10.1016/S0261-5614(03)00132-8
Kinsey L, Burden S. A survey of people with inflammatory bowel disease to investigate their views of food and nutritional issues. Eur J Clin Nutr. 2016;70(7):852–4. https://doi.org/10.1038/ejcn.2016.57
Ballegaard M, Bjergstrøm A, Brøndum S, Hylander E, Jensen L, Ladefoged K. Self-reported food intolerance in chronic inflammatory bowel disease. Scand J Gastroenterol. 1997;32(6):569–71. https://doi.org/10.3109/00365529709025101
Melchior C, Algera J, Colomier E, Törnblom H, Simrén M, Störsrud S. Food avoidance and restriction in irritable bowel syndrome: relevance for symptoms, quality of life and nutrient intake. Clin Gastroenterol Hepatol Off Clin Pract J Am Gastroenterol Assoc. 2021;3(21):S1542–3565. https://doi.org/10.1016/j.cgh.2021.07.004
Levine A, Rhodes JM, Lindsay JO, Abreu MT, Kamm MA, Gibson PR, et al. Dietary guidance from the international organization for the study of inflammatory bowel diseases. Clin Gastroenterol Hepatol Off Clin Pract J Am Gastroenterol Assoc. 2020;18(6):1381–92. https://doi.org/10.1016/j.cgh.2020.01.046
Godny L, Reshef L, Pfeffer-Gik T, Goren I, Yanai H, Tulchinsky H, et al. Adherence to the Mediterranean diet is associated with decreased fecal calprotectin in patients with ulcerative colitis after pouch surgery. Eur J Nutr. 2020;59(7):3183–90. https://doi.org/10.1007/s00394-019-02158-3
Yanai H, Levine A, Hirsch A, Boneh RS, Kopylov U, Eran HB, et al. The Crohn’s disease exclusion diet for induction and maintenance of remission in adults with mild-to-moderate Crohn’s disease (CDED-AD): an open-label, pilot, randomised trial. Lancet Gastroenterol Hepatol. 2022;7(1):49–59. https://doi.org/10.1016/S2468-1253(21)00299-5
Greenberg GR, Fleming CR, Jeejeebhoy KN, Rosenberg IH, Sales D, Tremaine WJ. Controlled trial of bowel rest and nutritional support in the management of Crohn’s disease. Gut. 1988;29(10):1309–15. https://doi.org/10.1136/gut.29.10.1309
Tavakkoli H, Haghdani S, Emami MH, Adilipour H, Tavakkoli M, Tavakkoli M. Ramadan fasting and inflammatory bowel disease. Indian J Gastroenterol Off J Indian Soc Gastroenterol. 2008;27(6):239–41.
Kökten T, Hansmannel F, Ndiaye NC, Heba AC, Quilliot D, Dreumont N, et al. Calorie restriction as a new treatment of inflammatory diseases. Adv Nutr Bethesda Md. 2021;12(4):1558–70. https://doi.org/10.1093/advances/nmaa179
Tragnone A, Valpiani D, Miglio F, et al. Dietary habits as risk factors for inflammatory bowel disease. Eur J Gastroenterol Hepatol. 1995;7(1):47–51.
Geerling BJ, Dagnelie PC, Badart-Smook A, Russel MG, Stockbrügger RW, Brummer RJ. Diet as a risk factor for the development of ulcerative colitis. Am J Gastroenterol. 2000;95(4):1008–13. https://doi.org/10.1111/j.1572-0241.2000.01942.x
Li F, Liu X, Wang W, Zhang D. Consumption of vegetables and fruit and the risk of inflammatory bowel disease: a meta-analysis. Eur J Gastroenterol Hepatol. 2015;27(6):623–30. https://doi.org/10.1097/MEG.0000000000000330
Dixon LJ, Kabi A, Nickerson KP, McDonald C. Combinatorial effects of diet and genetics on inflammatory bowel disease pathogenesis. Inflamm Bowel Dis. 2015;21(4):912–22. https://doi.org/10.1097/MIB.0000000000000289
Chan SSM, Luben R, van Schaik F, Oldenburg B, Bueno-de-Mesquita HB, Hallmans G, et al. Carbohydrate intake in the etiology of Crohn’s disease and ulcerative colitis. Inflamm Bowel Dis. 2014;20(11):2013–21. https://doi.org/10.1097/MIB.0000000000000168
Jantchou P, Morois S, Clavel-Chapelon F, Boutron-Ruault MC, Carbonnel F. Animal protein intake and risk of inflammatory bowel disease: the E3N prospective study. Am J Gastroenterol. 2010;105(10):2195–201. https://doi.org/10.1038/ajg.2010.192
de Silva PSA, Olsen A, Christensen J, Schmidt EB, Overvaad K, Tjonneland A, et al. An association between dietary arachidonic acid, measured in adipose tissue, and ulcerative colitis. Gastroenterology. 2010;139(6):1912–17. https://doi.org/10.1053/j.gastro.2010.07.065
Riordan AM, Ruxton CH, Hunter JO. A review of associations between Crohn’s disease and consumption of sugars. Eur J Clin Nutr. 1998;52(4):229–38. https://doi.org/10.1038/sj.ejcn.1600556
Ananthakrishnan AN, Khalili H, Konijeti GG, Higuchi LM, de Silva P, Korzenik JR, et al. A prospective study of long-term intake of dietary fiber and risk of Crohn’s disease and ulcerative colitis. Gastroenterology. 2013;145(5):970–7. https://doi.org/10.1053/j.gastro.2013.07.050
Cohen AB, Lee D, Long MD, Kappelman MD, Martin CF, Sandler RS, et al. Dietary patterns and self-reported associations of diet with symptoms of inflammatory bowel disease. Dig Dis Sci. 2013;58(5):1322–8. https://doi.org/10.1007/s10620-012-2373-3
Laing BB, Lim AG, Ferguson LR. A personalised dietary approach-A way forward to manage nutrient deficiency, effects of the western diet, and food intolerances in inflammatory bowel disease. Nutrients. 2019;11(7):E1532. https://doi.org/10.3390/nu11071532
Zallot C, Quilliot D, Chevaux JB, Peyrin-Biroulet C, Gueant-Rodriguez RM, Freling E, et al. Dietary beliefs and behavior among inflammatory bowel disease patients. Inflamm Bowel Dis. 2013;19(1):66–72. https://doi.org/10.1002/ibd.22965
Bergeron F, Bouin M, D’Aoust L, Lemoyne M, Presse N. Food avoidance in patients with inflammatory bowel disease: what, when and who? Clin Nutr Edinb Scotl. 2018;37(3):884–9. https://doi.org/10.1016/j.clnu.2017.03.010
Marsh A, Kinneally J, Robertson T, Lord A, Young A, Radford-Smith G. Food avoidance in outpatients with inflammatory bowel disease - who, what and why. Clin Nutr ESPEN. 2019;31:10–16. https://doi.org/10.1016/j.clnesp.2019.03.018
Gu P, Feagins LA. Dining with inflammatory bowel disease: a review of the literature on diet in the pathogenesis and management of IBD. Inflamm Bowel Dis. 2020;26(2):181–91. https://doi.org/10.1093/ibd/izz268
Morton H, Pedley KC, Stewart RJC, Coad J. Inflammatory bowel disease: are symptoms and diet linked? Nutrients. 2020;12(10):E2975. https://doi.org/10.3390/nu12102975
Crooks B, McLaughlin J, Matsuoka K, Kobayashi T, Yamazaki H, Limdi JK. The dietary practices and beliefs of people living with inactive ulcerative colitis. Eur J Gastroenterol Hepatol. 2021;33(3):372–9. https://doi.org/10.1097/MEG.0000000000001911
Cox SR, Prince AC, Myers CE, Irving PM, Lindsay JO, Lomer MC, et al. Fermentable carbohydrates [FODMAPs] exacerbate functional gastrointestinal symptoms in patients with inflammatory bowel disease: a randomised, double-blind, placebo-controlled, cross-over, re-challenge trial. J Crohns Colitis. 2017;11(12):1420–9. https://doi.org/10.1093/ecco-jcc/jjx073
Halpin SJ, Ford AC. Prevalence of symptoms meeting criteria for irritable bowel syndrome in inflammatory bowel disease: systematic review and meta-analysis. Am J Gastroenterol. 2012;107(10):1474–82. https://doi.org/10.1038/ajg.2012.260
Limdi JK, Aggarwal D, McLaughlin JT. Dietary practices and beliefs in patients with inflammatory bowel disease. Inflamm Bowel Dis. 2016;22(1):164–70. https://doi.org/10.1097/MIB.0000000000000585
Szilagyi A, Galiatsatos P, Xue X. Systematic review and meta-analysis of lactose digestion, its impact on intolerance and nutritional effects of dairy food restriction in inflammatory bowel diseases. Nutr J. 2016;15(1):67. https://doi.org/10.1186/s12937-016-0183-8
Forbes A, Escher J, Hébuterne X, Klek S, Krznaric Z, Schneider S, et al. ESPEN guideline: clinical nutrition in inflammatory bowel disease. Clin Nutr Edinb Scotl. 2017;36(2):321–47. https://doi.org/10.1016/j.clnu.2016.12.027
