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.
Nitescu, Maria; Istratescu, Doina; Preda, Carmen Monicaet al.
[en] 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.
Disciplines :
Gastroenterology & hepatology
Author, co-author :
Nitescu, Maria; University of Medicine and Pharmacy "Carol Davila", 050474 Bucharest, Romania. ; National Institute for Infectious Diseases "Prof. Dr. Matei Bals", 021105
Istratescu, Doina; Department of Gastroenterology, Clinic Fundeni Institute, 022328 Bucharest,
Preda, Carmen Monica; University of Medicine and Pharmacy "Carol Davila", 050474 Bucharest, Romania. ; Department of Gastroenterology, Clinic Fundeni Institute, 022328 Bucharest,
Manuc, Teodora Ecaterina; University of Medicine and Pharmacy "Carol Davila", 050474 Bucharest, Romania. ; Department of Gastroenterology, Clinic Fundeni Institute, 022328 Bucharest,
Louis, Edouard ; Centre Hospitalier Universitaire de Liège - CHU > > Service de gastroentérologie, hépatologie, onco. digestive
Manuc, Mircea; University of Medicine and Pharmacy "Carol Davila", 050474 Bucharest, Romania. ; Department of Gastroenterology, Clinic Fundeni Institute, 022328 Bucharest,
Stroie, Tudor; University of Medicine and Pharmacy "Carol Davila", 050474 Bucharest, Romania. ; Department of Gastroenterology, Clinic Fundeni Institute, 022328 Bucharest,
Catrinoiu, Mihai; University of Medicine and Pharmacy "Carol Davila", 050474 Bucharest, Romania.
Tieranu, Cristian George ; Gastroenterology & Hepatology Department, Elias Emergency Hospital, 011461
Badea, Larisa Emanuela; Department of Gastroenterology, Clinic Fundeni Institute, 022328 Bucharest,
Tugui, Letitia; Department of Gastroenterology, Clinic Fundeni Institute, 022328 Bucharest,
Andrei, Adriana; Department of Gastroenterology, Clinic Fundeni Institute, 022328 Bucharest,
Diculescu, Mihai Mircea; University of Medicine and Pharmacy "Carol Davila", 050474 Bucharest, Romania. ; Department of Gastroenterology, Clinic Fundeni Institute, 022328 Bucharest,
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.
Reddavide R. Rotolo O. Caruso M.G. Stasi E. Notarnicola M. Miraglia C. Nouvenne A. Meschi T. De’ Angelis G.L. Di Mario F. et al. The role of diet in the prevention and treatment of Inflammatory Bowel Diseases Acta Biomed. 2018 89 60 75 30561397
Saez-Gonzalez E. Mateos B. Lopez-Munoz P. Iborra M. Moret I. Nos P. Beltran B. Bases for the Adequate Development of Nutritional Recommendations for Patients with Inflammatory Bowel Disease Nutrients 2019 11 1062 10.3390/nu11051062 31083616
Sugihara K. Morhardt T.L. Kamada N. The Role of Dietary Nutrients in Inflammatory Bowel Disease Front. Immunol. 2018 9 3183 10.3389/fimmu.2018.03183 30697218
Wark G. Samocha-Bonet D. Ghaly S. Danta M. The Role of Diet in the Pathogenesis and Management of Inflammatory Bowel Disease: A Review Nutrients 2020 13 135 10.3390/nu13010135 33396537
Gu P. Feagins L.A. Dining With Inflammatory Bowel Disease: A Review of the Literature on Diet in the Pathogenesis and Management of IBD Inflamm. Bowel Dis. 2020 26 181 191 10.1093/ibd/izz268
Hsieh M.S. Hsu W.H. Wang J.W. Wang Y.K. Hu H.M. Chang W.K. Chen C.Y. Wu D.C. Kuo F.C. Su W.W. Nutritional and dietary strategy in the clinical care of inflammatory bowel disease J. Formos. Med. Assoc. 2020 119 1742 1749 10.1016/j.jfma.2019.09.005
Jiang Y. Jarr K. Layton C. Gardner C.D. Ashouri J.F. Abreu M.T. Sinha S.R. Therapeutic Implications of Diet in Inflammatory Bowel Disease and Related Immune-Mediated Inflammatory Diseases Nutrients 2021 13 890 10.3390/nu13030890
Lee D. Albenberg L. Compher C. Baldassano R. Piccoli D. Lewis J.D. Wu G.D. Diet in the pathogenesis and treatment of inflammatory bowel diseases Gastroenterology 2015 148 1087 1106 10.1053/j.gastro.2015.01.007
Mentella M.C. Scaldaferri F. Pizzoferrato M. Gasbarrini A. Miggiano G.A.D. Nutrition, IBD and Gut Microbiota: A Review Nutrients 2020 12 944 10.3390/nu12040944
Morton H. Pedley K.C. Stewart R.J.C. Coad J. Inflammatory Bowel Disease: Are Symptoms and Diet Linked? Nutrients 2020 12 2975 10.3390/nu12102975
Owczarek D. Rodacki T. Domagala-Rodacka R. Cibor D. Mach T. Diet and nutritional factors in inflammatory bowel diseases World J. Gastroenterol. 2016 22 895 905 10.3748/wjg.v22.i3.895
Preda C.M. Manuc T. Chifulescu A. Istratescu D. Louis E. Baicus C. Sandra I. Diculescu M.M. Reenaers C. Van Kemseke C. et al. Diet as an environmental trigger in inflammatory bowel disease: A retrospective comparative study in two European cohorts Rev. Esp. Enferm. Dig. 2020 112 440 447 10.17235/reed.2020.6552/2019
Preda C.M. Manuc T. Istratescu D. Louis E. Baicus C. Sandra I. Diculescu M. Reenaers C. Van Kemseke C. Nitescu M. et al. Environmental Factors in Romanian and Belgian Patients with Inflammatory Bowel Disease—A Retrospective Comparative Study Maedica 2019 14 233 239
Cusimano F.A. Damas O.M. Diet as a treatment for inflammatory bowel disease: Is it ready for prime time? Curr. Opin. Gastroenterol. 2022 38 358 372 10.1097/MOG.0000000000000850
De Castro M.M. Pascoal L.B. Steigleder K.M. Siqueira B.P. Corona L.P. Ayrizono M.L.S. Milanski M. Leal R.F. Role of diet and nutrition in inflammatory bowel disease World J. Exp. Med. 2021 11 1 16 10.5493/wjem.v11.i1.1
El Amrousy D. Elashry H. Salamah A. Maher S. Abd-Elsalam S.M. Hasan S. Adherence to the Mediterranean Diet Improved Clinical Scores and Inflammatory Markers in Children with Active Inflammatory Bowel Disease: A Randomized Trial J. Inflamm. Res. 2022 15 2075 2086 10.2147/JIR.S349502
Fiorindi C. Dinu M. Gavazzi E. Scaringi S. Ficari F. Nannoni A. Sofi F. Giudici F. Adherence to mediterranean diet in patients with inflammatory bowel disease Clin. Nutr. ESPEN 2021 46 416 423 10.1016/j.clnesp.2021.09.726
Keshteli A.H. Madsen K.L. Dieleman L.A. Diet in the Pathogenesis and Management of Ulcerative Colitis; A Review of Randomized Controlled Dietary Interventions Nutrients 2019 11 1498 10.3390/nu11071498
Preda C. Istrătescu D. Etiology of Ulcerative Colitis Ulcerative Colitis—Etiology, Diagnosis, Diet, Special Populations, and the Role of Interventional Endoscopy Pal P. IntechOpen London, UK 2022 Available online: https://www.intechopen.com/online-first/83372 (accessed on 30 October 2022) 10.5772/intechopen.106842
Altajar S. Moss A. Inflammatory Bowel Disease Environmental Risk Factors: Diet and Gut Microbiota Curr. Gastroenterol. Rep. 2020 22 57 10.1007/s11894-020-00794-y
Bodini G. Zanella C. Crespi M. Lo Pumo S. Demarzo M.G. Savarino E. Savarino V. Giannini E.G. A randomized, 6-wk trial of a low FODMAP diet in patients with inflammatory bowel disease Nutrition 2019 67–68 110542 10.1016/j.nut.2019.06.023
Dabek-Drobny A. Kaczmarczyk O. Wozniakiewicz M. Pasko P. Dobrowolska-Iwanek J. Wozniakiewicz A. Piatek-Guziewicz A. Zagrodzki P. Zwolinska-Wcislo M. Association between Fecal Short-Chain Fatty Acid Levels, Diet, and Body Mass Index in Patients with Inflammatory Bowel Disease Biology 2022 11 108 10.3390/biology11010108 35053106
Dolovich C. Shafer L.A. Vagianos K. Witges K. Targownik L.E. Bernstein C.N. The complex relationship between diet, symptoms, and intestinal inflammation in persons with inflammatory bowel disease: The Manitoba Living with IBD Study JPEN J. Parenter. Enter. Nutr. 2022 46 867 877 10.1002/jpen.2257 34435688
Ji Y. Yang Y. Sun S. Dai Z. Ren F. Wu Z. Insights into diet-associated oxidative pathomechanisms in inflammatory bowel disease and protective effects of functional amino acids Nutr. Rev. 2022 81 95 113 10.1093/nutrit/nuac039 35703919
Lee J.E. Kim K.S. Koh H. Lee D.W. Kang N.J. Diet-Induced Host-Microbe Interactions: Personalized Diet Strategies for Improving Inflammatory Bowel Disease Curr. Dev. Nutr. 2022 6 nzac110 10.1093/cdn/nzac110 36060223
Baradaran Ghavami S. Asadzadeh Aghdaei H. Sorrentino D. Shahrokh S. Farmani M. Ashrafian F. Dore M.P. Keshavarz Azizi Raftar S. Mobin Khoramjoo S. Zali M.R. Probiotic-Induced Tolerogenic Dendritic Cells: A Novel Therapy for Inflammatory Bowel Disease? Int. J. Mol. Sci. 2021 22 8274 10.3390/ijms22158274
De Graaf M.C.G. Spooren C. Hendrix E.M.B. Hesselink M.A.M. Feskens E.J.M. Smolinska A. Keszthelyi D. Pierik M.J. Mujagic Z. Jonkers D. Diet Quality and Dietary Inflammatory Index in Dutch Inflammatory Bowel Disease and Irritable Bowel Syndrome Patients Nutrients 2022 14 1945 10.3390/nu14091945
Grammatikopoulou M.G. Goulis D.G. Gkiouras K. Nigdelis M.P. Papageorgiou S.T. Papamitsou T. Forbes A. Bogdanos D.P. Low FODMAP Diet for Functional Gastrointestinal Symptoms in Quiescent Inflammatory Bowel Disease: A Systematic Review of Randomized Controlled Trials Nutrients 2020 12 3648 10.3390/nu12123648
Bischoff S.C. Escher J. Hebuterne X. Klek S. Krznaric Z. Schneider S. Shamir R. Stardelova K. Wierdsma N. Wiskin A.E. et al. ESPEN practical guideline: Clinical Nutrition in inflammatory bowel disease Clin. Nutr. 2020 39 632 653 10.1016/j.clnu.2019.11.002
Racine A. Carbonnel F. Chan S.S. Hart A.R. Bueno-de-Mesquita H.B. Oldenburg B. Van Schaik F.D. Tjønneland A. Olsen A. Dahm C.C. et al. Dietary Patterns and Risk of Inflammatory Bowel Disease in Europe: Results from the EPIC Study Inflamm. Bowel Dis. 2016 22 345 354 10.1097/MIB.0000000000000638
Cox S.R. Prince A.C. Myers C.E. Irving P.M. Lindsay J.O. Lomer M.C. Whelan K. 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 1420 1429 10.1093/ecco-jcc/jjx073
Pedersen N. Ankersen D.V. Felding M. Wachmann H. Végh Z. Molzen L. Burisch J. Andersen J.R. Munkholm P. Low-FODMAP diet reduces irritable bowel symptoms in patients with inflammatory bowel disease World J. Gastroenterol. 2017 23 3356 3366 10.3748/wjg.v23.i18.3356
Reif S. Klein I. Lubin F. Farbstein M. Hallak A. Gilat T. Pre-illness dietary factors in inflammatory bowel disease Gut 1997 40 754 760 10.1136/gut.40.6.754
Jowett S.L. Seal C.J. Pearce M.S. Phillips E. Gregory W. Barton J.R. Welfare M.R. Influence of dietary factors on the clinical course of ulcerative colitis: A prospective cohort study Gut 2004 53 1479 1484 10.1136/gut.2003.024828
Albenberg L. Brensinger C.M. Wu Q. Gilroy E. Kappelman M.D. Sandler R.S. Lewis J.D. A Diet Low in Red and Processed Meat Does Not Reduce Rate of Crohn’s Disease Flares Gastroenterology 2019 157 128 136.e5 10.1053/j.gastro.2019.03.015
Chiba M. Abe T. Tsuda H. Sugawara T. Tsuda S. Tozawa H. Fujiwara K. Imai H. Lifestyle-related disease in Crohn’s disease: Relapse prevention by a semi-vegetarian diet World J. Gastroenterol. 2010 16 2484 2495 10.3748/wjg.v16.i20.2484
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 67 10.1186/s12937-016-0183-8
Truelove S.C. Wright R. The controlled therapeutic trial in gastroenterology Am. J. Dig. Dis. 1964 9 1 30 10.1007/BF02232676
Strisciuglio C. Giannetti E. Martinelli M. Sciorio E. Staiano A. Miele E. Does cow’s milk protein elimination diet have a role on induction and maintenance of remission in children with ulcerative colitis? Acta Paediatr. 2013 102 e273 e278 10.1111/apa.12215
Eadala P. Matthews S.B. Waud J.P. Green J.T. Campbell A.K. Association of lactose sensitivity with inflammatory bowel disease—Demonstrated by analysis of genetic polymorphism, breath gases and symptoms Aliment Pharmacol. Ther. 2011 34 735 746 10.1111/j.1365-2036.2011.04799.x
Mishkin S. Dairy sensitivity, lactose malabsorption, and elimination diets in inflammatory bowel disease Am. J. Clin. Nutr. 1997 65 564 567 10.1093/ajcn/65.2.564
Ananthakrishnan A.N. Khalili H. Konijeti G.G. Higuchi L.M. De Silva P. Korzenik J.R. Fuchs C.S. Willett W.C. Richter J.M. Chan A.T. A prospective study of long-term intake of dietary fiber and risk of Crohn’s disease and ulcerative colitis Gastroenterology 2013 145 970 977 10.1053/j.gastro.2013.07.050 23912083
Amre D.K. D’Souza S. Morgan K. Seidman G. Lambrette P. Grimard G. Israel D. Mack D. Ghadirian P. Deslandres C. et al. Imbalances in dietary consumption of fatty acids, vegetables, and fruits are associated with risk for Crohn’s disease in children Am. J. Gastroenterol. 2007 102 2016 2025 10.1111/j.1572-0241.2007.01411.x 17617201
Sakamoto N. Kono S. Wakai K. Fukuda Y. Satomi M. Shimoyama T. Inaba Y. Miyake Y. Sasaki S. Okamoto K. et al. Dietary risk factors for inflammatory bowel disease: A multicenter case-control study in Japan Inflamm. Bowel Dis. 2005 11 154 163 10.1097/00054725-200502000-00009 15677909
John S. Luben R. Shrestha S.S. Welch A. Khaw K.T. Hart A.R. Dietary n-3 polyunsaturated fatty acids and the aetiology of ulcerative colitis: A UK prospective cohort study Eur. J. Gastroenterol. Hepatol. 2010 22 602 606 10.1097/MEG.0b013e3283352d05 20216220
De Silva P.S. Luben R. Shrestha S.S. Khaw K.T. Hart A.R. Dietary arachidonic and oleic acid intake in ulcerative colitis etiology: A prospective cohort study using 7-day food diaries Eur. J. Gastroenterol. Hepatol. 2014 26 11 18 10.1097/MEG.0b013e328365c372
Cariello M. Contursi A. Gadaleta R.M. Piccinin E. De Santis S. Piglionica M. Spaziante A.F. Sabbà C. Villani G. Moschetta A. Extra-Virgin Olive Oil from Apulian Cultivars and Intestinal Inflammation Nutrients 2020 12 1084 10.3390/nu12041084
Morvaridi M. Jafarirad S. Seyedian S.S. Alavinejad P. Cheraghian B. The effects of extra virgin olive oil and canola oil on inflammatory markers and gastrointestinal symptoms in patients with ulcerative colitis Eur. J. Clin. Nutr. 2020 74 891 899 10.1038/s41430-019-0549-z
Menees S.B. Powell C. Kurlander J. Goel A. Chey W.D. A meta-analysis of the utility of C-reactive protein, erythrocyte sedimentation rate, fecal calprotectin, and fecal lactoferrin to exclude inflammatory bowel disease in adults with IBS Am. J. Gastroenterol. 2015 110 444 454 10.1038/ajg.2015.6
Walker G.J. Moore L. Heerasing N. Hendy P. Perry M.H. McDonald T.J. Debenham T. Bethune R. Bewshea C. Hyde C. et al. Faecalcalprotectin effectively excludes inflammatory bowel disease in 789 symptomatic young adults with/without alarm symptoms: A prospective UK primary care cohort study Aliment Pharmacol. Ther. 2018 47 1103 1116 10.1111/apt.14563
Turvill J. O’Connell S. Brooks A. Bradley-Wood K. Laing J. Thiagarajan S. Hammond D. Turnock D. Jones A. Sood R. et al. Evaluation of a faecalcalprotectin care pathway for use in primary care Prim. Health Care Res. Dev. 2016 17 428 436 10.1017/S1463423616000049
Louis E. Fecal calprotectin: Towards a standardized use for inflammatory bowel disease management in routine practice J. Crohns Colitis 2015 9 1 3 10.1093/ecco-jcc/jju012
Louis E. Mary J.Y. Vernier-Massouille G. Grimaud J.C. Bouhnik Y. Laharie D. Dupas J.L. Pillant H. Picon L. Veyrac M. et al. Maintenance of remission among patients with Crohn’s disease on antimetabolite therapy after infliximab therapy is stopped Gastroenterology 2012 142 63 10.1053/j.gastro.2011.09.034
Costa F. Mumolo M.G. Ceccarelli L. Bellini M. Romano M.R. Sterpi C. Ricchiuti A. Marchi S. Bottai M. Calprotectin is a stronger predictive marker of relapse in ulcerative colitis than in Crohn’s disease Gut 2005 54 364 368 10.1136/gut.2004.043406
García-Sánchez V. Iglesias-Flores E. González R. Gisbert J.P. Gallardo-Valverde J.M. González-Galilea A. Naranjo-Rodríguez A. De Dios-Vega J.F. Muntané J. Gómez-Camacho F. Does fecal calprotectin predict relapse in patients with Crohn’s disease and ulcerative colitis? J. Crohns Colitis 2010 4 144 152 10.1016/j.crohns.2009.09.008
De Vos M. Louis E.J. Jahnsen J. Vandervoort J.G. Noman M. Dewit O. D’haens G.R. Franchimont D. Baert F.J. Torp R.A. et al. Consecutive fecal calprotectin measurements to predict relapse in patients with ulcerative colitis receiving infliximab maintenance therapy Inflamm. Bowel Dis. 2013 19 2111 2117 10.1097/MIB.0b013e31829b2a37
De Vries J.H.M. Dijkhuizen M. Tap P. Witteman B.J.M. Patient’s Dietary Beliefs and Behaviours in Inflammatory Bowel Disease Dig. Dis. 2019 37 131 139 10.1159/000494022
Zallot C. Quilliot D. Chevaux J.B. Peyrin-Biroulet C. Guéant-Rodriguez R.M. Freling E. Collet-Fenetrier B. Williet N. Ziegler O. Bigard M.A. et al. Dietary beliefs and behavior among inflammatory bowel disease patients Inflamm. Bowel Dis. 2013 19 66 72 10.1002/ibd.22965