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Dietary and nutritional considerations for inflammatory bowel disease

  • Miranda C. E. Lomer (a1) (a2) (a3)
Abstract

Nutritional assessment and dietary advice are fundamental to inflammatory bowel disease (IBD) patient management and all patients should have access to a dietitian. Newly diagnosed patients often think that their pre-illness diet has contributed to the development of their IBD. However, epidemiological evidence to support diet as a risk factor is lacking. How the diet contributes to the gastrointestinal microbiota is interesting, although the role is not yet clearly defined. Nutritional problems in IBD are common. Malnutrition occurs in up to 85% of patients and weight loss affects up to 80% of patients with Crohn's disease and 18–62% of patients with ulcerative colitis. Nutritional deficiencies are prevalent, particularly in relation to anaemia and osteoporosis. Intestinal strictures can be problematic in Crohn's disease and limiting fibrous foods that may cause a mechanical obstruction in the gastrointestinal tract is helpful. Patients often explore dietary exclusion to alleviate symptoms but such changes may be self-directed or inappropriately advised and can lead to further nutritional deficiencies. Some patients experience concurrent functional symptoms (e.g. abdominal bloating, abdominal pain, flatulence and diarrhoea) that can significantly affect quality of life. Recently, a group of poorly absorbed carbohydrates that occur naturally in the diet called fermentable oligo-, di-, mono-saccharides and polyols have been associated with functional symptoms by intestinal bacterial fermentation leading to rapid gas production, and an osmotic effect increasing fluid delivery to the colon. Emerging evidence indicates that a diet low in fermentable oligo-, di-, mono-saccharides and polyols can alleviate functional symptoms in IBD.

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Corresponding author
Corresponding author: Dr Miranda C. E. Lomer, fax +44 20 7848 4171, email miranda.lomer@kcl.ac.uk
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1. G Van Assche , A Dignass , J Panes (2010) The second European evidence-based consensus on the diagnosis and management of Crohn's disease: Definitions and diagnosis. J Crohns Colitis 4, 7–27.

2. EF Stange , SP Travis , S Vermeire (2008) European evidence-based consensus on the diagnosis and management of ulcerative colitis: Definitions and diagnosis. J Crohns Colitis 2, 123.

3. RJ Xavier & DK Podolsky (2007) Unravelling the pathogenesis of inflammatory bowel disease. Nature 448, 427434.

4. F Scaldaferri & C Fiocchi (2007) Inflammatory bowel disease: Progress and current concepts of etiopathogenesis. J Dig Dis 8, 171178.

5. CA Chapman-Kiddell , PS Davies , L Gillen . (2010) Role of diet in the development of inflammatory bowel disease. Inflamm Bowel Dis 16, 137151.

8. RB Sartor (2008) Microbial influences in inflammatory bowel diseases. Gastroenterology 134, 577594.

9. K Karlinger , T Gyorke , E Mako . (2000) The epidemiology and the pathogenesis of inflammatory bowel disease. Eur J Radiol 35, 154167.

11. GB Porro & E Panza (1985) Smoking, sugar, and inflammatory bowel disease. Br Med J 291, 971972.

12. S Reif , I Klein , F Lubin . (1997) Pre-illness dietary factors in inflammatory bowel disease. Gut 40, 754760.

13. N Sakamoto , S Kono , K Wakai (2005) Dietary risk factors for inflammatory bowel disease: A multicenter case-control study in Japan. Inflamm Bowel Dis 11, 154163.

14. JR Thornton , PM Emmett & KW Heaton (1979) Diet and Crohn's disease: Characteristics of the pre-illness diet. Br Med J 2, 762764.

16. MA Gassull (2001) Dietary fat intake and inflammatory bowel disease. Curr Gastroenterol Rep 3, 358361.

17. A Belluzzi , C Brignola , M Campieri . (1996) Effect of an enteric-coated fish-oil preparation on relapses in Crohn's disease. N Engl J Med 334, 15571560.

18. TM Trebble , MA Stroud , SA Wootton (2005) High-dose fish oil and antioxidants in Crohn's disease and the response of bone turnover: A randomised controlled trial. Br J Nutr 94, 253261.

20.Epidemiological Group of the Research Committee of IBD in Japan (1994) Dietary and other risk factors of ulcerative colitis. A case-control study in Japan. Epidemiology group of the research committee of inflammatory Bowel disease in Japan. J Clin Gastroenterol 19, 166171.

21. AR Hart , R Luben , A Olsen (2008) Diet in the aetiology of ulcerative colitis: A European prospective cohort study. Digestion 77, 5764.

23. SL Jowett , CJ Seal , MS Pearce (2004) Influence of dietary factors on the clinical course of ulcerative colitis: A prospective cohort study. Gut 53, 14791484.

24. P Jantchou , S Morois , F Clavel-Chapelon . (2010) Animal protein intake and risk of inflammatory bowel disease: The E3N prospective study. Am J Gastroenterol 105, 21952201.

25. PG Persson , A Ahlbom & G Hellers (1992) Diet and inflammatory bowel disease: A case-control study. Epidemiology 3, 4752.

26. MC Lomer , RP Thompson & JJ Powell (2002) Fine and ultrafine particles of the diet: Influence on the mucosal immune response and association with Crohn's disease. Proc Nutr Soc 61, 123130.

27. MC Lomer , SL Grainger , R Ede (2005) Lack of efficacy of a reduced microparticle diet in a multi-centred trial of patients with active Crohn's disease. Eur J Gastroenterol Hepatol 17, 377384.

28. E Bannerman , I Davidson , C Conway . (2001) Altered subjective appetite parameters in Crohn's disease patients. Clin Nutr 20, 399405.

29. MA Gassull & E Cabre (2001) Nutrition in inflammatory bowel disease. Curr Opin Clin Nutr Metab Care 4, 561569.

31. MCE Lomer (2009) National UK audits in inflammatory bowel disease (IBD) highlight a deficit of dietitians in gastroenterology: A priority for improvement supported by national IBD standards. J Hum Nutr Diet 22, 287289.

36. MC Lomer , K Kodjabashia , C Hutchinson . (2004) Intake of dietary iron is low in patients with Crohn's disease: A case-control study. Br J Nutr 91, 141148.

37. K Vagianos , S Bector , J McConnell . (2007) Nutrition assessment of patients with inflammatory bowel disease. J Parenter Enteral Nutr 31, 311319.

39. L Valentini , L Schaper , C Buning (2008) Malnutrition and impaired muscle strength in patients with Crohn's disease and ulcerative colitis in remission. Nutrition 24, 694702.

40. DD Mijac , GL Jankovic , J Jorga . (2010) Nutritional status in patients with active inflammatory bowel disease: Prevalence of malnutrition and methods for routine nutritional assessment. Eur J Intern Med 21, 315319.

42. M O'Sullivan & C O'Morain (2006) Nutrition in inflammatory bowel disease. Best Pract Res Clin Gastroenterol 20, 561573.

43. CN Bernstein , JF Blanchard , W Leslie . (2000) The incidence of fracture among patients with inflammatory bowel disease. A population-based cohort study. Ann Intern Med 133, 795799.

44. TP van Staa , C Cooper , LS Brusse . (2003) Inflammatory bowel disease and the risk of fracture. Gastroenterology 125, 15911597.

45. H Tilg , AR Moschen , A Kaser . (2008) Gut, inflammation and osteoporosis: Basic and clinical concepts. Gut 57, 684694.

47. A Dignass , GV Assche , JO Lindsay (2010) The second European evidence-based consensus on the diagnosis and management of Crohn's disease: Current management. J Crohns Colitis 4, 2862.

48. J Compston (2003) Osteoporosis in inflammatory bowel disease. Gut 52, 6364.

49. S Kulnigg & C Gasche (2006) Systematic review: Managing anaemia in Crohn's disease. Aliment Pharmacol Ther 24, 15071523.

50. C Gasche , MC Lomer , I Cavill . (2004) Iron, anaemia, and inflammatory bowel diseases. Gut 53, 11901197.

51. C Gasche , A Berstad , R Befrits (2007) Guidelines on the diagnosis and management of iron deficiency and anemia in inflammatory bowel diseases. Inflamm Bowel Dis 13, 15451553.

53. M Yakut , Y Ustun , G Kabacam . (2010) Serum vitamin B12 and folate status in patients with inflammatory bowel diseases. Eur J Intern Med 21, 320323.

54. RH Driscoll Jr & IH Rosenberg (1978) Total parenteral nutrition in inflammatory bowel disease. Med Clin North Am 62, 185201.

55. MJ Ostro , GR Greenberg & KN Jeejeebhoy (1985) Total parenteral nutrition and complete bowel rest in the management of Crohn's disease. J Parenter Enteral Nutr 9, 280287.

56. AM Griffiths , A Ohlsson , PM Sherman . (1995) Metaanalysis of enteral nutrition as a primary-treatment of active Crohns-disease. Gastroenterology 108, 10561067.

58. T Bamba , T Shimoyama , M Sasaki (2003) Dietary fat attenuates the benefits of an elemental diet in active Crohn's disease: A randomized, controlled trial. Eur J Gastroenterol Hepatol 15, 151157.

59. MA Gassull , F Fernandez-Banares , E Cabre (2002) Fat composition may be a clue to explain the primary therapeutic effect of enteral nutrition in Crohn's disease: Results of a double blind randomised multicentre European trial. Gut 51, 164168.

60. DA Gorard (2003) Enteral nutrition in Crohn's disease: Fat in the formula. Eur J Gastroenterol Hepatol 15, 115118.

61. K Leiper , J Woolner , MM Mullan (2001) A randomised controlled trial of high versus low long chain triglyceride whole protein feed in active Crohn's disease. Gut 49, 790794.

62. MH Giaffer , G North & CD Holdsworth (1990) Controlled trial of polymeric versus elemental diet in treatment of active Crohn's disease. Lancet 335, 816819.

63. JM Fell , M Paintin , F Arnaud-Battandier (2000) Mucosal healing and a fall in mucosal pro-inflammatory cytokine mRNA induced by a specific oral polymeric diet in paediatric Crohn's disease. Aliment Pharmacol Ther 14, 281289.

64. T Yamamoto , M Nakahigashi , S Umegae . (2007) 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 25, 6772.

66. AM Riordan , JO Hunter , RE Cowan (1993) Treatment of active Crohn's disease by exclusion diet: East Anglian multicentre controlled trial. Lancet 342, 11311134.

67. JT Woolner , TJ Parker , GA Kirby . (1998) The development and evaluation of a diet for maintaining remission in Crohn's disease. J Hum Nutr Diet 11, 111.

69. M Ballegaard , A Bjergstrom , S Brondum . (1997) Self-reported food intolerance in chronic inflammatory bowel disease. Scand J Gastroenterol 32, 569571.

70. R Meier & M Gassull (2004) Consensus recommendations on the effects and benefits of fibre in clinical practice. Clin Nutr Suppl 1, 7380.

72. AH Raouf , V Hildrey , J Daniel (1991) Enteral feeding as sole treatment for Crohns-disease – controlled trial of whole protein upsilon-amino acid based feed and a case-study of dietary challenge. Gut 32, 702707.

73. C Hedin , K Whelan & JO Lindsay (2007) Evidence for the use of probiotics and prebiotics in inflammatory bowel disease: A review of clinical trials. Proc Nutr Soc 66, 307315.

74. T Mimura , F Rizzello , U Helwig (2004) Once daily high dose probiotic therapy (VSL#3) for maintaining remission in recurrent or refractory pouchitis. Gut 53, 108114.

75. P Gionchetti , F Rizzello , A Venturi (2000) Oral bacteriotherapy as maintenance treatment in patients with chronic pouchitis: A double-blind, placebo-controlled trial. Gastroenterology 119, 305309.

76. P Gionchetti , F Rizzello , U Helwig (2003) Prophylaxis of pouchitis onset with probiotic therapy: A double-blind, placebo-controlled trial. Gastroenterology 124, 12021209.

77. W Kruis , E Schutz , P Fric . (1997) Double-blind comparison of an oral Escherichia coli preparation and mesalazine in maintaining remission of ulcerative colitis. Aliment Pharmacol Ther 11, 853858.

78. W Kruis , P Fric , J Pokrotnieks (2004) Maintaining remission of ulcerative colitis with the probiotic Escherichia coli Nissle 1917 is as effective as with standard mesalazine. Gut 53, 16171623.

79. BJ Rembacken , AM Snelling , PM Hawkey . (1999) Non-pathogenic Escherichia coli versus mesalazine for the treatment of ulcerative colitis: A randomised trial. Lancet 354, 635639.

82. M Simren , J Axelsson , R Gillberg . (2002) Quality of life in inflammatory bowel disease in remission: The impact of IBS-like symptoms and associated psychological factors. Am J Gastroenterol 97, 389396.

83. SJ Shepherd , FC Parker , JG Muir . (2008) Dietary triggers of abdominal symptoms in patients with irritable bowel syndrome: Randomized placebo-controlled evidence. Clin Gastroenterol Hepatol 6, 765771.

85. DK Ong , SB Mitchell , JS Barrett (2010) Manipulation of dietary short chain carbohydrates alters the pattern of gas production and genesis of symptoms in irritable bowel syndrome. J Gastroenterol Hepatol 25, 13661373.

86. RB Gearry , PM Irving , JS Barrett . (2009) Reduction of dietary poorly absorbed short-chain carbohydrates (FODMAPs) improves abdominal symptoms in patients with inflammatory bowel disease. J Crohns Colitis 3, 8–14.

88. PR Gibson & SJ Shepherd (2010) Evidence-based dietary management of functional gastrointestinal symptoms: The FODMAP approach. J Gastroenterol Hepatol 25, 252258.

89. KL Krok & GR Lichtenstein (2003) Nutrition in Crohn disease. Curr Opin Gastroenterol 19, 148153.

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