The Bidirectional Link between Nutritional Factors and Inflammatory Bowel Diseases: Dietary Deficits, Habits, and Recommended Interventions—A Narrative Review
Abstract
:1. Introduction
1.1. Diets: The Good and the Bad
1.2. FAO Survey on the “Nutrition Transition”
2. Materials and Methods
3. Results
3.1. Food-Related Pathogenetic Molecular Mechanisms of IBD
3.1.1. Dietary Risk Factors
3.1.2. Protective Dietary Factors
3.2. Malnutrition in IBD
3.2.1. Disease-Related Causes of Malnutrition
3.2.2. Food Habits-Related Causes of Malnutrition
3.3. Nutritional Interventions
Low FODMAPS Diet | ||||||
Authors | Study Design | Dietary Intervention | Patient Number | Clinical Activity | Days of Treatment | Results |
Cox et al., 2017 [129]. | Randomized, double blind, placebo controlled, crossover. | LFD + 4 reintroduction challenge of fructans or galacto-oligosaccharides or sorbitol or placebo, each challenge preceded by 4 days of wash out. | 12 CD 17 UC | Remission. All patients also met criteria for FGS. | 3 days challenge. | Fructane reintroduction induced a worsening of FGS. |
Bodini et al., 201. [130]. | Randomized. | LFD vs. Free diet | 35 CD 20 UC | Remission/mild disease. All patients also met criteria for FGS. | 6 weeks | Decrease in HBI index and calprotectin but not in Mayo score in LFD group. |
Pedersen et al., 2017 [132]. | Randomized. | LFD vs. Free diet | 61 UC 28 CD | Remission/mild disease. All patients also met criteria for FGS. | 6 weeks | Decrease in IBS-SSS score in LFD, decrease in SCCAI in UC LFD Group, no change in HBI score. |
Cox et al., 2020 [131]. | Randomized. | LFD vs. Free diet | 26 UC 26 CD | Remission. All patients also met criteria for FGS. | 4 weeks | Decrease in IBS-SSS score in UC patients but not in CD patients. |
Melgaard et al., 2022 [133]. | Randomized, blinded placebo controlled. | LFD + reintroduction challenge | 16 UC | Remission. All patients also met criteria for FGS. | 8 weeks LFD + 2 weeks Low FODMAPs or Placebo | No effect on IBS-SSS score. |
Enteral Nutrition | ||||||
Authors | Study design | Dietary Intervention | Patient number | Clinical activity | Days of treatment | Results |
Guo et al., 2013 [134]. | Pilot study. | EEN | 13 CD | Active. | 4 weeks | Clinical remission in 86% of patients. |
Pigneur et al., 2019 [135]. | Randomized. | EEN vs. steroids | 19 CD, pediatrics | Active. | 8 weeks | Same efficacy in inducing remission, 89% of mucosal healing in EEN arm, 17% of mucosal healing steroids arm. |
Brückner et al., 2020 [136]. | Open label | PEN vs. free Diet | 41 CD, pediatrics. | Remission/mild. | 12 months | Growth improvement. |
Moriczi et al., 2020 [137]. | Retrospective. | EEN | 235 CD, pediatrics. | Active. | 8 weeks | 83% clinical remission. |
Specific Carbohydrate Diet (SCD) | ||||||
Authors | Study design | Dietary Intervention | Patient number | Clinical activity | Days of treatment | Results |
Lewis et al., 2021 [116]. | Randomized. | SCD vs. MD | 194 CD | Mild/ moderate. | 6 weeks | Clinical Remission: 46.5% SCD, 43.5% MD. |
Suskind et al., 2020 [113]. | Randomized. | SCD vs. Modified SCD vs. WFD | 18 CD, pediatrics. | Mild/ moderate. | 12 weeks | Clinical remission in all arms. |
Braly et al., 2017 [111]. | Prospective, open label, non-controlled. | SCD | 9 CD/UC, pediatrics. | Mild/ moderate. | 12 weeks | Clinical remission. |
Suskind et al., 2014 [114]. | Retrospective. | SCD | 7 CD, pediatrics. | Active. | 3 months | Clinical remission. |
Obih et al., 2016 [115]. | Retrospective. | SCD | 20 CD 6 UC pediatrics | Active. | 6 months | Clinical remission in CD patients, decrease in PUCAI in UC patients. |
Cohen et al., 2014 [112]. | Prospective, non controlled. | SCD | 10 CD, pediatrics | Active. | 12 weeks | Decrease in HBI and PCDAI. |
Mediterranean Diet/Mediterranean-like | ||||||
Authors | Study Design | Dietary Intervention | Patient number | Clinical activity | Days of treatment | Results |
Chicco et al., 2021 [117]. | Prospective, non controlled. | MD | 84 UC, 58 CD | Mild/moderate and remission. | 6 months | Remission in patients with active disease. |
Brotherton et al., 2014 [118]. | Randomized, controlled, single blind. | HF vs. Exclusion Diet | 7 CD | Active. | 4 weeks | Decrease in HBI score in HF group. |
Albenberg et al., 2019 [120]. | Randomized. | HM vs. LM | 214 CD | Remission. | 49 weeks | Relapse in 62% HM group, 42% LM group. |
Fritsch et al., 2021 [119]. | Randomized, crossover. | LFHF vs. iSAD | 17 UC | Remission/mild. | 4 weeks | LFHF decreased markers of inflammation. |
Exclusion Diets | ||||||
Authors | Study Design | Dietary Intervention | Patient number | Clinical activity | Days of treatment | Results |
Guasekeera et al., 2016 [121]. | Randomized, controlled. | IgG4-guided diet vs. sham diet | 98 CD | Active. | 4 weeks | Improvement of CDAI in the IgG4-guided diet. |
Szczubełek et al., 2021 [122]. | Prospective, non-controlled. | CDED | 32 CD | Active. | 12 weeks | Clinical remission in 82.1% of cases. |
Yanai et al., 2022 [123]. | Randomized, open label. | CDED + PEN vs. CDED | 44 CD | Mild/ moderate. | 24 weeks | Clinical remission in 68% of patients undergoing CDED+ PEN, and in 57% of patients undergoing CDED. |
Levine et al., 2019 [125]. | Randomized. | PEN+CDED vs. EEN followed by PEN | 78 CD, pediatric. | Mild/ moderate. | 12 weeks | Remission: 75,6% in CDED +PEN arm, 45.1% EEN+ PEN arm. |
Sigall et al., 2021 [124]. | Randomized. | EEN vs. PEN + CDED | 73 CD, pediatric. | Mild/ Moderate. | 6 weeks | Remission: 61.5% in CDED+PEN arm, 64.7% in EEN arm (at week 3). |
4. Conclusions
Author Contributions
Funding
Data Availability Statement
Acknowledgments
Conflicts of Interest
Abbreviations
References
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Micronutrient Deficiency Prevalence (%) | ||||
---|---|---|---|---|
UC | CD | Causes of Deficiencies * | Main Effects | |
Folic acid | 35 | 54–67 | GI resections; use of sulfasalazine, methotrexate, cholestyramine; achlorhydria; small intestinal bacterial overgrowth (SIBO). | Cause and worsen anemia, hyperhomocysteinemia (causes thromboembolic events), risk of carcinogenesis. |
Vitamin B12 | 5 | 48 | Terminal ileitis, resection if the terminal ileum > 20 cm, small intestinal bacterial overgrowth (SIBO). | Exacerbate anemia, hyperhomocysteinemia (causes thromboembolic events). |
Vitamin C | 16 | 24 | Malabsorption, polymorphisms in genes encoding vitamin C transporters. TNF-α also downregulates transcription of transporters necessary for vitamin C uptake. | Impaired uptake and utilization of iron, wound healing deficit, bleeding. |
Vitamin A ** | 26–93 | 11–50 | Terminal ileum disease or ileal resection (malabsorption). | Associated with severity of the disease, wound healing deficit. |
Vitamin D ** | 40 | 70 | Terminal ileum disease or ileal resection (malabsorption), small intestinal bacterial overgrowth (SIBO) | Calcium deficiency, bone mineral density loss, compromised mucosal barrier functions, associated with disease activity, risk of carcinogenesis. |
Vitamin E ** | 5 | 5 | Terminal ileum disease or ileal resection (malabsorption). | Lipid peroxidation, reduced wound healing. |
Vitamin K ** | 44 | 54 | Terminal ileum disease or ileal resection (malabsorption). | Bone mineral density loss, bleeding. |
Iron | 81 | 39 | Disease in/resection of the proximal small bowel (limited intestinal absorption), rectal bleeding, achlorhydria, small intestinal bacterial overgrowth (SIBO). | Anemia, fatigue, abnormal growth and inadequate cognitive development in children and adolescents. |
Potassium | NA | 6–20 | Colectomy/pouch, prednisone, diarrhoea, vomiting, mucosal inflammation (increased secretion). | Muscle weakness/cramps, cardiac arrhythmia. |
Calcium | 10 | 13 | Disease in/resection of the proximal small bowel (limited intestinal absorption), corticosteroid therapy, disturbed metabolism of vitamin D. | Bone mineral density loss, osteoporosis, risk of carcinogenesis. |
Magnesium | NA | 14–88 | Chronic or severe acute diarrhoea, short gut (reduced intestinal absorption), disturbed metabolism of vitamin D. | Bone mineral density loss. |
Zinc | 38-45 | 40-50 | Diarrhoea, ostomies, high-exit fistulas, chronic malabsorption state due to intestinal inflammation. | Oxidative cellular damage, wound healing deficit, dysfunctional epithelial barrier, altered mucosal immunity, increased pro-inflammatory cytokines. |
Selenium | NA | 35–40 | Impaired intestinal absorption (duodenum, caecum). | Inflammation, risk of carcinogenesis. |
Low Fermentable Oligosaccharides, Disaccharides, Monosaccharides, and Polyols (FODMAP) Diet | |
Allowed foods | Eggs and meat. Certain cheeses such as brie, camembert, cheddar and feta. Almond milk, rice, quinoa and oats. Vegetables such as eggplant, potatoes, tomatoes, cucumbers and zucchini. Fruits such as grapes, oranges, strawberries, blueberries and pineapple. |
Restricted foods | Dairy-based products, wheat-based, beans and lentils. Vegetables, such as artichokes, asparagus, onions and garlic. Fruits such as apples, cherries, pears and peaches. |
Other Details | This diet consists of three steps: (1) elimination of all FODMAPs for 4–6 weeks, (2) gradual reintroduction aimed to individuate foods related to symptomatology, (3) personalization of diet. |
Enteral Nutrition | |
Allowed foods | Elemental formulas (amino acids), semi-elemental formulas (oligopeptides), or polymeric formulas (whole proteins). |
Restricted foods | All other foods. |
Other Details | Enteral nutrition can be administered both by nasogastric tube or ingested. Enteral nutrition can be “exclusive” when formulas completely substitute meals, or “partial” when it is administered together with meals. Partial enteral mutrition is often prescribed in association to Crohn’s disease exclusion diet. |
Specific Carbohydrate Diet (SCD) | |
Allowed foods | Additive-free meats, poultry, fish and shellfish. Additive-free and sugar-free oils, white vinegar, cider and mustard. Additive-free and sugar-free coffee, tea and fruit juice. All-natural, sugar-free peanut butter. Cheeses such as sharp cheddar, colby, swiss and dry curd cottage cheese. Fresh, frozen, raw or cooked vegetables, including string beans. Fresh fruits or frozen, cooked or dried fruits without added sugar. Eggs. Homemade yogurt that ferments for at least 24 h. Honey. Legumes such as dried navy beans, lentils, peas, split peas and lima beans. Also, unroasted cashews and unroasted peanuts in the shell. Nuts, peanuts and nut flours. |
Restricted foods | Grains such as barley, corn, oats, quinoa, rice and wheat. Grain products such as bread, cereal and pasta. Candy, chocolates and other products made with sugar, high fructose corn syrup, or fructo-oligosaccharides (FOS). Canned or processed meats. Canned vegetables with additives. Certain legumes such as soybeans, chickpeas and bean sprouts. Dairy products high in lactose such as mild cheddar, store-bought yogurt, milk, cream, ice cream and sour cream. Powdered spices such as curry, garlic and onion. Seaweed. Starches such as potatoes, sweet potatoes and turnips. Sugars including molasses, corn syrup, maple syrup, fructose, sucrose and other processed sugars. |
Mediterranean Diet | |
Allowed foods | Vegetables, fruits, cereals, nuts, legumes, unsaturated fat such as olive oil. Medium intake of fish, dairy products, wine. |
Restricted foods | Saturated fat, meat, processed foods, processed meat and sweets |
Crohn’s Disease Exclusion Diets | |
Allowed foods | Phase I Mandatory daily foods: fresh chicken breast 150–200 g, 2 eggs, 2 bananas, 1 fresh apple, 2 potatoes (potatoes must be cooked and refrigerated before use). Allowed daily foods: fresh strawberries, fresh melon (1 slice), rice flour, white rice and rice noodles (unlimited), 2 tomatoes (additional allowed for cooking), 2 cucumbers (2 medium size), 2 avocado halves, 1 arrot, spinach 1 cup uncooked leaves, lettuce (3 leaves), onion, fresh green herbs (e.g., basil, parsley, coriander, rosemary, thyme, mint, dill), 1 glass freshly squeezed orange juice from fresh oranges (not from cartons or bottles), water, sparkling water, salt, pepper, paprika, cinnamon, cumin, turmeric, 3 tablespoons of honey, 4 teaspoons of sugar, fresh ginger and garlic cloves, lemons and limes. Foods allowed only once a week: fresh lean fish (not deep fried, dietitian guidance required). Phase II Mandatory daily foods: fresh chicken breast 150–200 g, 2 eggs, 2 bananas, 1 fresh apple, 2 potatoes (potatoes must be cooked and refrigerated before use). Allowed daily foods: fresh strawberries, fresh melon (1 slice), Rice flour, White rice and rice noodles (unlimited), 2 Tomatoes (additional allowed for cooking), 2 Cucumbers (2 medium size), 2 Avocado halves, 1 Carrot, 1 cup uncooked spinach leaves, lettuce (3 leaves), onion, fresh green herbs (e.g., basil, parsley, coriander, rosemary, thyme, mint, dill), 1 glass freshly squeezed orange juice from fresh oranges (not from cartons or bottles), water, sparkling water, salt, pepper, paprika, cinnamon, cumin, turmeric. 3 tablespoons of honey, 4 teaspoons of sugar, fresh ginger and garlic cloves, one slice whole grain bread daily, quinoa, 3 tablespoons of cooked lentils or peas, 6 almonds or walnut halves (unprocessed), baking soda. Foods allowed only once a week: fresh lean fish (not deep fried, dietitian guidance required), 200 gr Sirloin or fillet steak (maximum), 1 slice whole grain bread (maximum), 1 can of tuna (in olive or canola oil) drained, ½ cup of oatmeal or cut oats. Additional daily foods from week 7: broccoli, cauliflower 2 florets daily, 4 fresh mushrooms (not canned), ½ red bell pepper, 1 zucchini or slice squash, 1 pear or kiwi or ripe nectarine. Additional daily foods from week 10: most vegetables (restricted amounts with dietitian guidance), most fruits (restricted amounts with dietitian guidance), quinoa, 3–4 tablespoons of cooked lentils or peas. |
Restricted foods | Dairy, animal fat, wheat, emulsifiers, artificial sweeteners, other cuts or parts of chicken, other sources animal or soy protein, carrageenan, maltodextrins (and sucralose), sulfite containing foods, xanthan gum, packaged/canned/frozen precooked foods, doughs, baked goods, frozen, canned fruits and vegetables, oral iron supplements, soy or gluten-free products, ready to use sauces, syrups, spreads dressings, margarine, butter, vinegar, soy sauce, ketchup, mayonnaise, alcoholic beverages, soft drinks, juices, deep-fried or oily foods. |
Other Details | Each phase has a duration of 6 weeks. CDED is often associated with polymeric formulas which, during phase 1, represent 50% of the caloric intake. Fruit and vegetables are progressively reintroduced during phase II. |
IgG 4-guided diet | |
Allowed foods | Foods not associated with IgG4 reactivity. |
Restricted foods | Foods associated with IgG4 reactivity. |
Other Details | IgG4-guided exclusion diet is a personalized approach excluding and replacing in each patient 4 food types with the highest IgG4 titration. Screening is performed on 16 food types: milk, peanuts, soya, shrimp, egg, tomato, pork, beef, cod fish, potato, wheat, yeast, cheddar cheese, chicken, lamb and rice. |
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Saracino, I.M.; Spisni, E.; Imbesi, V.; Ricci, C.; Dussias, N.K.; Alvisi, P.; Gionchetti, P.; Rizzello, F.; Valerii, M.C. The Bidirectional Link between Nutritional Factors and Inflammatory Bowel Diseases: Dietary Deficits, Habits, and Recommended Interventions—A Narrative Review. Foods 2023, 12, 1987. https://doi.org/10.3390/foods12101987
Saracino IM, Spisni E, Imbesi V, Ricci C, Dussias NK, Alvisi P, Gionchetti P, Rizzello F, Valerii MC. The Bidirectional Link between Nutritional Factors and Inflammatory Bowel Diseases: Dietary Deficits, Habits, and Recommended Interventions—A Narrative Review. Foods. 2023; 12(10):1987. https://doi.org/10.3390/foods12101987
Chicago/Turabian StyleSaracino, Ilaria Maria, Enzo Spisni, Veronica Imbesi, Chiara Ricci, Nikolas Konstantine Dussias, Patrizia Alvisi, Paolo Gionchetti, Fernando Rizzello, and Maria Chiara Valerii. 2023. "The Bidirectional Link between Nutritional Factors and Inflammatory Bowel Diseases: Dietary Deficits, Habits, and Recommended Interventions—A Narrative Review" Foods 12, no. 10: 1987. https://doi.org/10.3390/foods12101987