[en] BACKGROUND AND AIMS: Recent research has shown that Western-style diets have been associated with an increased risk of inflammatory bowel diseases (IBD). Our aim was to examine the link between an anti-inflammatory diet and the maintenance of IBD remission, as well as to assess the potential therapeutic advantages of this dietary approach in preserving IBD remission. METHODS: The inclusion and exclusion criteria were applied to a total of 189 individuals with IBD, with 21 individuals not meeting the criteria. Therefore, 168 eligible patients were enrolled in the study and allocated to either an anti-inflammatory diet or a regular diet, based on their personal preference. RESULTS: A cohort of 168 IBD adult patients was recruited for the study: 88 patients with ulcerative colitis and 80 with Crohn's disease. The intervention group received an anti-inflammatory diet consisting of the removal of red and processed meat, fried foods, high-lactose foods, fast food, white bread, sugar, and vegetable oils rich in omega-6 for a period of 1 year. The clinical response was maintained in 80 patients (95.2%) in the intervention group and in 72 patients (85.7%) in the control group (p-value=0.036). Although not statistically significant, fecal calprotectin was higher in the control group than in the intervention group at follow-up. CONCLUSIONS: Patients who adhered to an anti-inflammatory diet exhibited a higher rate of maintenance of clinical remission. Furthermore, improvement in inflammation tests was observed in the intervention group, reinforcing the proposition that IBD is a lifestyle-related disease.
Disciplines :
Gastroenterology & hepatology
Author, co-author :
Preda, Carmen Monica; Carol Davila University of Medicine and Pharmacy, Department of Gastroenterology and Hepatology, Fundeni Clinical Institute, Bucharest, Romania. . carmenmonica.preda@gmail.com.
Istratescu, Doina; Carol Davila University of Medicine and Pharmacy, Department of Gastroenterology and Hepatology, Fundeni Clinical Institute, Bucharest, Romania. . doina.proca08@gmail.com.
Nitescu, Maria; Carol Davila University of Medicine and Pharmacy, National Institute for Infectious Diseases Prof. Dr. Matei Bals, Bucharest, Romania. maria.nitescu@umfcd.ro.
Manuc, Teodora; Carol Davila University of Medicine and Pharmacy, Department of Gastroenterology and Hepatology, Fundeni Clinical Institute, Bucharest, Romania. teodora.manuc@gmail.com.
Manuc, Mircea; Carol Davila University of Medicine and Pharmacy, Department of Gastroenterology and Hepatology, Fundeni Clinical Institute, Bucharest, Romania. m_manuc@yahoo.com.
Stroie, Tudor; Carol Davila University of Medicine and Pharmacy, Department of Gastroenterology and Hepatology, Fundeni Clinical Institute, Bucharest, Romania. stroie.tudor@gmail.com.
Tieranu, Cristian; Department of Gastroenterology and Hepatology, Elias Emergency Hospital, Bucharest, Romania. tieranucristian@yahoo.com.
Meianu, Corina Gabriela; Carol Davila University of Medicine and Pharmacy, Department of Gastroenterology and Hepatology, Fundeni Clinical Institute, Bucharest, Romania. corina_meianu@yahoo.com.
Andrei, Adriana; Department of Gastroenterology and Hepatology, Fundeni Clinical Institute, Bucharest, Romania. sandrei741@yahoo.com.
Ciora, Cosmin Alexandru; Department of Gastroenterology and Hepatology, Fundeni Clinical Institute, Bucharest, Romania. cioracsz@yahoo.com.
Louis, Edouard ; Université de Liège - ULiège > Département des sciences cliniques > Hépato-gastroentérologie
Diculescu, Mircea; Carol Davila University of Medicine and Pharmacy, Department of Gastroenterology and Hepatology, Fundeni Clinical Institute, Bucharest, Romania. mmdiculescu@yahoo.com.
Language :
English
Title :
Diet Optimization in Inflammatory Bowel Disease: Impact on Disease Relapse and Inflammatory Markers. A 1-year Prospective Trial.
Lacerda JF, Lagos AC, Carolino E, Silva-Herdade AS, Silva M, Sousa Guerreiro C. Functional Food Components, Intestinal Permeability and Inflammatory Markers in Patients with Inflammatory Bowel Disease. Nutrients 2021;13:642. doi:10.3390/nu13020642
Meyer A, Dong C, Casagrande C, et al. Food Processing and Risk of Crohn’s Disease and Ulcerative Colitis: A European Prospective Cohort Study. Clin Gastroenterol Hepatol 2023;21:1607-1616.e6. doi:10.1016/j. cgh.2022.09.031
Narula N, Chang NH, Mohammad D, et al. Food Processing and Risk of Inflammatory Bowel Disease: A Systematic Review and Meta-Analysis. Clin Gastroenterol Hepatol 2023;21:2483-2495.e1. doi:10.1016/j. cgh.2023.01.012
Day AS, Yao CK, Costello SP, Andrews JM, Bryant RV. Food avoidance, restrictive eating behaviour and association with quality of life in adults with inflammatory bowel disease: A systematic scoping review. Appetite 2021;167:105650. doi:10.1016/j.appet.2021.105650
Cox SR, Clarke H, O’Keeffe M, et al. Nutrient, Fibre, and FODMAP Intakes and Food-related Quality of Life in Patients with Inflammatory Bowel Disease, and Their Relationship with Gastrointestinal Symptoms of Differing Aetiologies. J Crohns Colitis 2021;15:2041-2053. doi:10.1093/ecco-jcc/jjab116
Vidarsdottir JB, Johannsdottir SE, Thorsdottir I, Bjornsson E, Ramel A. A cross-sectional study on nutrient intake and-status in inflammatory bowel disease patients. Nutr J 2016;15:61. doi:10.1186/s12937-016-0178-5
Lambert K, Pappas D, Miglioretto C, et al. Systematic review with meta-analysis: dietary intake in adults with inflammatory bowel disease. Aliment Pharmacol Ther 2021;54:742-754. doi:10.1111/apt.16549
Holt DQ, Strauss BJ, Moore GT. Patients with inflammatory bowel disease and their treating clinicians have different views regarding diet. J Hum Nutr Diet 2017;30:66-72. doi:10.1111/jhn.12400
Czuber-Dochan W, Morgan M, Hughes LD, Lomer MCE, Lindsay JO, Whelan K. Perceptions and psychosocial impact of food, nutrition, eating and drinking in people with inflammatory bowel disease: a qualitative investigation of food-related quality of life. J Hum Nutr Diet 2020;33:115-127. doi:10.1111/jhn.12668
Sigall Boneh R, Westoby C, Oseran I, et al. The Crohn’s Disease Exclusion Diet: A Comprehensive Review of Evidence, Implementation Strategies, Practical Guidance, and Future Directions. Inflamm Bowel Dis 2023. doi:10.1093/ibd/izad255
Konijeti GG, Kim N, Lewis JD, et al. Efficacy of the Autoimmune Protocol Diet for Inflammatory Bowel Disease. Inflamm Bowel Dis 2017;23:2054-2060. doi:10.1097/MIB.0000000000001221
Brotherton CS, Martin CA, Long MD, Kappelman MD, Sandler RS. Avoidance of Fiber Is Associated With Greater Risk of Crohn’s Disease Flare in a 6-Month Period. Clin Gastroenterol Hepatol 2016;14:1130-1136. doi:10.1016/j.cgh.2015.12.029
Ananthakrishnan AN, Khalili H, Konijeti GG, et al. A prospective study of long-term intake of dietary fiber and risk of Crohn’s disease and ulcerative colitis. Gastroenterology 2013;145:970-977. doi:10.1053/j. gastro.2013.07.050
Owczarek D, Rodacki T, Domagała-Rodacka R, Cibor D, Mach T. Diet and nutritional factors in inflammatory bowel diseases. World J Gastroenterol 2016;22:895-905. doi:10.3748/wjg.v22.i3.895
Lewis JD, Abreu MT. Diet as a Trigger or Therapy for Inflammatory Bowel Diseases. Gastroenterology 2017;152:398-414.e6. doi:10.1053/j. gastro.2016.10.019
Keshteli AH, Valcheva R, Nickurak C, et al. Anti-Inflammatory Diet Prevents Subclinical Colonic Inflammation and Alters Metabolomic Profile of Ulcerative Colitis Patients in Clinical Remission. Nutrients 2022;14:3294. doi:10.3390/nu14163294
Olendzki B, Bucci V, Cawley C, et al. Dietary manipulation of the gut microbiome in inflammatory bowel disease patients: Pilot study. Gut Microbes 2022;14:2046244. doi:10.1080/19490976.2022.2046244
Preda CM, Manuc T, Chifulescu A, 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. doi:10.17235/reed.2020.6552/2019
Keshteli AH, Madsen KL, Dieleman LA. Diet in the Pathogenesis and Management of Ulcerative Colitis; A Review of Randomized Controlled Dietary Interventions. Nutrients 2019;11:1498. doi:10.3390/nu11071498
Bodini G, Zanella C, Crespi M, et al. A randomized, 6-wk trial of a low FODMAP diet in patients with inflammatory bowel disease. Nutrition 2019;67-68:110542. doi:10.1016/j.nut.2019.06.023
Nitescu M, Istratescu D, Preda CM, et al. Role of an Exclusion Diet (Reduced Disaccharides, Saturated Fats, Emulsifiers, Red and Ultraprocessed Meats) in Maintaining the Remission of Chronic Inf l ammator y Bowel Diseases in Adults. Medicina (Kaunas) 2023;59:329. doi:10.3390/medicina59020329
Levine A, Wine E, Assa A, et al. Crohn’s Disease Exclusion Diet Plus Partial Enteral Nutrition Induces Sustained Remission in a Randomized Controlled Trial. Gastroenterology 2019;157:440-450.e8. doi:10.1053/j. gastro.2019.04.021450.e8
Takagi S, Utsunomiya K, Kuriyama S, et al. Effectiveness of an ‘half elemental diet’ as maintenance therapy for Crohn’s disease: A randomized-controlled trial. Aliment Pharmacol Ther 2006;24:1333-1340. doi:10.1111/j.1365-2036.2006.03120.x
Verma S, Kirkwood B, Brown S, Giaffer MH. Oral nutritional supplementation is effective in the maintenance of remission in Crohn’s disease. Dig Liver Dis 2000;32:769-774. doi:10.1016/s1590-8658(00)80353-9
Yamamoto T, Nakahigashi M, Saniabadi AR, et al. Impacts of long-term enteral nutrition on clinical and endoscopic disease activities and mucosal cytokines during remission in patients with Crohn’s disease: a prospective study. Inflamm Bowel Dis 2007;13:1493-1501. doi:10.1002/ibd.20238
Yamamoto T, Nakahigashi M, Umegae S, Kitagawa T, Matsumoto K. Impact of long-term enteral nutrition on clinical and endoscopic recurrence after resection for Crohn’s disease: A prospective, non-randomized, parallel, controlled study. Aliment Pharmacol Ther 2007;25:67-72. doi:10.1111/j.1365-2036.2006.03158.x
Yamamoto T, Nakahigashi M, Umegae S, Matsumoto K. Prospective clinical trial: enteral nutrition during maintenance infliximab in Crohn’s disease. J Gastroenterol 2010;45:24-29. doi:10.1007/s00535-009-0136-5
Jones VA, Dickinson RJ, Workman E, Wilson AJ, Freeman AH, Hunter JO. Crohn’s disease: maintenance of remission by diet. Lancet 1985;2:177-180. doi:10.1016/s0140-6736(85)91497-7
Halmos EP, Christophersen CT, Bird AR, Shepherd SJ, Muir JG, Gibson PR. Consistent Prebiotic Effect on Gut Microbiota With Altered FODMAP Intake in Patients with Crohn’s Disease: A Randomised, Controlled Cross-Over Trial of Well-Defined Diets. Clin Transl Gastroenterol 2016;7:e164. doi:10.1038/ctg.2016.22e164
Albenberg L, Brensinger CM, Wu Q, et al. A Diet Low in Red and Processed Meat Does Not Reduce Rate of Crohn’s Disease Fl ares. Gastroenterol ogy 2019; 157: 128-136. e5. doi:10. 1053/j. gastro.2019.03.015
Lorenz-Meyer H, Bauer P, Nicolay C, et al. Omega-3 fatty acids and low carbohydrate diet for maintenance of remission in Crohn’s disease. A randomized controlled multicenter trial. Study Group Members (German Crohn’s Disease Study Group). Scand J Gastroenterol 1996;31:778-785. doi:10.3109/00365529609010352
Ritchie JK, Wadsworth J, Lennard-Jones JE, Rogers E. Controlled multicentre therapeutic trial of an unrefined carbohydrate, fibre rich diet in Crohn’s disease. Br Med J (Clin Res Ed) 1987;295:517-520. doi:10.1136/bmj.295.6597.517
Menees SB, Powell C, Kurlander J, Goel A, Chey WD. 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. doi:10.1038/ajg.2015.6
Turvill J, O’Connell S, Brooks A, et al. Evaluation of a faecal calprotectin care pathway for use in primary care. Prim Health Care Res Dev 2016;17:428-436. doi:10.1017/S1463423616000049
Walker GJ, Moore L, Heerasing N, et al. Faecal calprotectin 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. doi:10.1111/apt.14563
Khaki-Khatibi F, Qujeq D, Kashifard M, Moein S, Maniati M, Vaghari-Tabari M. Calprotectin in inflammatory bowel disease. Clin Chim Acta 2020;510:556-565. doi:10.1016/j.cca.2020.08.025
Louis E, Mary JY, Vernier-Massouille G, et al. Maintenance of remission among patients with Crohn’s disease on antimetabolite therapy after infliximab therapy is stopped. Gastroenterology 2012;142:63-70.e5. doi:10.1053/j.gastro.2011.09.034
De Vos M, Louis EJ, Jahnsen J, 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. doi:10.1097/MIB.0b013e31829b2a37
García-Sánchez V, Iglesias-Flores E, González R, et al. Does fecal calprotectin predict relapse in patients with Crohn’s disease and ulcerative colitis? J Crohns Colitis 2010;4:144-152. doi:10.1016/j. crohns.2009.09.008
Bhattacharyya S, Shumard T, Xie H, et al. A randomized trial of the effects of the no-carrageenan diet on ulcerative colitis disease activity. Nutr Healthy Aging 2017;4:181-192. doi:10.3233/NHA-170023
