Dietary Exposures and Interventions in Inflammatory Bowel Disease: Current Evidence and Emerging Concepts

• Published in: Nutrients 2023-01, Vol.15 (3), p.579
• Main Authors: Gubatan, John, Kulkarni, Chiraag V, Talamantes, Sarah Melissa, Temby, Michelle, Fardeen, Touran, Sinha, Sidhartha R
• Format: Article
• Language: English
• Subjects: Artificial sweeteners; Carbohydrates; Chronic illnesses; Clinical outcomes; Clinical trials; Cohort analysis; Confidence intervals; Crohn’s disease; Dairy products; Diet; Diet - adverse effects; Dietary Exposure; Epidemiology; food; Food additives; Food processing; Fruits; Gastrointestinal tract; Heterogeneity; Homeostasis; Humans; Hypotheses; Inflammation; Inflammation - complications; Inflammatory bowel disease; Inflammatory bowel diseases; Inflammatory Bowel Diseases - etiology; Intestine; Meat; Microbiota; Nutrient deficiency; Pathogenesis; Processed foods; Quality of Life; Remission; Review; Signs and symptoms; ulcerative colitis; Vegetables
• ISSN: 2072-6643; 2072-6643
• DOI: 10.3390/nu15030579

Diet is intimately linked to the gastrointestinal (GI) tract and has potent effects on intestinal immune homeostasis. Inflammatory bowel disease (IBD) is characterized by chronic inflammation of the GI tract. The therapeutic implications of diet in patients with IBD have received significant attention in recent years. In this review, we provide a contemporary and comprehensive overview of dietary exposures and interventions in IBD. Epidemiological studies suggest that ultra-processed foods, food additives, and emulsifiers are associated with a higher incidence of IBD. Exclusion and elimination diets are associated with improved symptoms in patients with IBD, but no effects on objective markers of inflammation. Specific dietary interventions (e.g., Mediterranean, specific carbohydrate, high fiber, ketogenic, anti-inflammatory diets) have been shown to reduce symptoms, improve inflammatory biomarkers, and quality of life metrics to varying degrees, but these studies are limited by study design, underpowering, heterogeneity, and confounding. To date, there is no robust evidence that any dietary intervention alone may replace standard therapies in patients with IBD. However, diet may play an adjunct role to induce or maintain clinical remission with standard IBD therapies. The results of novel dietary trials in IBD such as personalized fiber, intermittent fasting, and time-restricted diets are eagerly awaited.