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Nutritional Management for Inflammatory Bowel Diseases
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Nutritional Management for Inflammatory Bowel Diseases

A special issue of Nutrients (ISSN 2072-6643). This special issue belongs to the section "Clinical Nutrition".

Deadline for manuscript submissions: closed (10 March 2021) | Viewed by 107486

Special Issue Editor

Dr. Gordon W. Moran

E-Mail Website
Guest Editor
National Institute of Health Research Nottingham Biomedical Research Centre, University of Nottingham, and Nottingham University Hospitals NHS Trust, Nottingham NG7 2UH, UK
Interests: inflammatory bowel disease; sarcopenia; fatigue; imaging; fibrosis

Special Issue Information

Dear Colleagues,

The majority of inflammatory bowel disease patients suffer from nutritional deficiencies, with protein-calorie malnutrition common when in an active phase of the disease and micronutrient deficiencies a recognisable problem in remission. In Crohn’s disease, up to 75% of hospitalized patients are malnourished and as many as 50% are in negative nitrogen balance.

Moreover, the prevalence of reduced muscle mass in adult patients with Crohn’s disease has been estimated to be as high as 61%. Reduced muscle mass has been linked with reduced muscle function, osteopenia, fatigue, and lower quality of life. However, the aetiology of reduced muscle mass remains unclear, and therapies to reverse it remain elusive.

Nutrition is a treatment option in inflammatory bowel disease both in specific cohorts like small-bowel paediatric Crohn’s disease and in the modulation of the microbiome in pouchitis. This Issue will focus on both nutritional deficiencies in inflammatory bowel disease as well as nutrition as a therapy option in this chronic cohort of patients.

Dr. Gordon W. Moran
Guest Editor

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Keywords

  • Malnutrition
  • Inflammatory bowel disease
  • Eating behaviour
  • Gut–brain axis
  • Sarcopenia
  • Osteopenia
  • Vitamin D
  • Microbiome
  • Iron

Published Papers (20 papers)

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Research

Jump to: Review

10 pages, 1372 KiB  
Article
Simple Clinical Screening Underestimates Malnutrition in Surgical Patients with Inflammatory Bowel Disease—An ACS NSQIP Analysis
by Mohamed A. Abd-El-Aziz, Martin Hübner, Nicolas Demartines, David W. Larson and Fabian Grass
Nutrients 2022, 14(5), 932; https://0-doi-org.brum.beds.ac.uk/10.3390/nu14050932 - 22 Feb 2022
Cited by 5 | Viewed by 1877
Abstract
The present large scale study aimed to assess the prevalence and consequences of malnutrition, based on clinical assessment (body mass index and preoperative weight loss) and severe hypoalbuminemia (<3.1 g/L), in a representative US cohort undergoing IBD surgery. The American College of Surgeons [...] Read more.
The present large scale study aimed to assess the prevalence and consequences of malnutrition, based on clinical assessment (body mass index and preoperative weight loss) and severe hypoalbuminemia (<3.1 g/L), in a representative US cohort undergoing IBD surgery. The American College of Surgeons National Quality improvement program (ACS-NSQIP) Public User Files (PUF) between 2005 and 2018 were assessed. A total of 25,431 patients were identified. Of those, 6560 (25.8%) patients had severe hypoalbuminemia, 380 (1.5%) patients met ESPEN 2 criteria (≥10% weight loss over 6 months PLUS BMI < 20 kg/m2 in patients <70 years OR BMI < 22 kg/m2 in patients ≥70 years), and 671 (2.6%) patients met both criteria (severe hypoalbuminemia and ESPEN 2). Patients who presented with malnutrition according to any of the three definitions had higher rates of overall, minor, major, surgical, and medical complications, longer LOS, higher mortality and higher rates of readmission and reoperation. The simple clinical assessment of malnutrition based on BMI and weight loss only, considerably underestimates its true prevalence of up to 50% in surgical IBD patients and calls for dedicated nutritional assessment. Full article
(This article belongs to the Special Issue Nutritional Management for Inflammatory Bowel Diseases)
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10 pages, 259 KiB  
Article
Dietary Patterns and the Risk of Inflammatory Bowel Disease: Findings from a Case-Control Study
by Reema F. Tayyem, Tamara R. Qalqili, Rawan Ajeen and Yaser M. Rayyan
Nutrients 2021, 13(6), 1889; https://0-doi-org.brum.beds.ac.uk/10.3390/nu13061889 - 31 May 2021
Cited by 13 | Viewed by 3831
Abstract
Scientific evidence shows that dietary patterns are associated with the risk of IBD, particularly among unhealthy and Western dietary patterns. However, Western dietary patterns are not exclusive to Western countries, as Jordanians are steadily moving towards a Western lifestyle, which includes an increased [...] Read more.
Scientific evidence shows that dietary patterns are associated with the risk of IBD, particularly among unhealthy and Western dietary patterns. However, Western dietary patterns are not exclusive to Western countries, as Jordanians are steadily moving towards a Western lifestyle, which includes an increased consumption of processed foods. This study aims to investigate the association between dietary patterns and the risk factors for IBD cases among Jordanian adults. This case-control study was conducted between November 2018 and December 2019 in the largest three hospitals in Jordan. Three hundred and thirty-five Jordanian adults aged between 18–68 years were enrolled in this study: one hundred and eighty-five IBD patients who were recently diagnosed with IBD (n = 100 for ulcerative colitis (UC) and n = 85 for Crohn’s disease (CD)) and 150 IBD-free controls. Participants were matched based on age and marital status. In addition, dietary data was collected from all participants using a validated food frequency questionnaire. Factor analysis and principal component analysis were used to determine the dietary patterns. Odds ratios (OR) and their 95% confidence interval (CI) were calculated using a multinomial logistic regression model. Two dietary patterns were identified among the study participants: high-vegetable and high-protein dietary patterns. There was a significantly higher risk of IBD with high-protein intake at the third (OR, CI: 2.196 (1.046–4.610)) and fourth (OR, CI: 4.391 (2.67–8.506)) quartiles in the non-adjusted model as well as the other two adjusted models. In contrast, the high-vegetable dietary pattern shows a significant protective effect on IBD in the third and fourth quartiles in all the models. Thus, a high-vegetable dietary pattern may be protective against the risk of IBD, while a high-protein dietary pattern is associated with an increased risk of IBD among a group of the Jordanian population. Full article
(This article belongs to the Special Issue Nutritional Management for Inflammatory Bowel Diseases)
10 pages, 1039 KiB  
Article
Lactose Intolerance Assessed by Analysis of Genetic Polymorphism, Breath Test and Symptoms in Patients with Inflammatory Bowel Disease
by Olga Maria Nardone, Francesco Manfellotto, Caterina D’Onofrio, Alba Rocco, Giovanni Annona, Francesca Sasso, Pasquale De Luca, Nicola Imperatore, Anna Testa, Roberto de Sire, Elio Biffali and Fabiana Castiglione
Nutrients 2021, 13(4), 1290; https://0-doi-org.brum.beds.ac.uk/10.3390/nu13041290 - 14 Apr 2021
Cited by 13 | Viewed by 4090
Abstract
Many patients with inflammatory bowel disease (IBD) restrict dairy products to control their symptoms. The aim of the study was to investigate the prevalence of lactose intolerance assessed with hydrogen breath test (H-BT) in IBD patients in clinical remission compared to a sex, [...] Read more.
Many patients with inflammatory bowel disease (IBD) restrict dairy products to control their symptoms. The aim of the study was to investigate the prevalence of lactose intolerance assessed with hydrogen breath test (H-BT) in IBD patients in clinical remission compared to a sex, age and BMI matched control population. We further detected the prevalence of three single nucleotide polymorphisms of the lactase (LCT) gene: the lactase non persistence LCT-13910 CC (wildtype) and the intermediate phenotype LCT-22018 CT and LCT-13910 AG; finally, we assess the correlation between genotype and H-BT. A total of 54 IBD patients and 69 control who underwent clinical evaluation, H-BT and genetic test were enrolled. H-BT was positive in 64.8% IBD patients and 62.3% control (p = 0.3). The wild-type genotype was found in 85.2% IBD patients while CT-22018, AG-13910 and CT-22018/AG-13910 polymorphisms were found in 9.3%, 1.8% and 3.7%. In the control group, the wild-type genotype, CT-22018, AG-13910 and CT-22018/AG-13910 polymorphisms were found in 87%, 5.8%, 5.8% and 1.4% of cases, respectively. Therefore, the wild-type and polymorphisms’ prevalence did not differ between IBD population and control group (85.2% vs. 87%, p = 0.1) (14.8% vs. 13%, p = 0.7). The correlation between positive H-BT and genetic analysis showed that the wild-type genotype was associated with higher rate of lactose intolerance in the total population (OR 5.31, 95%CI 1.73–16.29, p = 0.003) and in the IBD (OR 7.61, 95%CI 1.36–42.7, p = 0.02). The prevalence of lactose intolerance in IBD patients did not differ from that of control. Despite suggestive symptoms, about 1/3 of IBD patients are not lactose intolerant, thus not needing “a priori” elimination diet. This may encourage a rationale and balanced dietary management in IBD. Full article
(This article belongs to the Special Issue Nutritional Management for Inflammatory Bowel Diseases)
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10 pages, 909 KiB  
Article
Seven Weeks of High-Dose Vitamin D Treatment Reduces the Need for Infliximab Dose-Escalation and Decreases Inflammatory Markers in Crohn’s Disease during One-Year Follow-Up
by Mia Bendix, Anders Dige, Søren Peter Jørgensen, Jens Frederik Dahlerup, Bo Martin Bibby, Bent Deleuran and Jørgen Agnholt
Nutrients 2021, 13(4), 1083; https://0-doi-org.brum.beds.ac.uk/10.3390/nu13041083 - 26 Mar 2021
Cited by 12 | Viewed by 3774
Abstract
Background: Seven weeks of high-dose vitamin D treatment decreases intestinal IL17A and IFN-γ mRNA expression in active Crohn’s disease (CD). In this follow-up study, we investigated whether seven-week vitamin D treatment affected the infliximab response in the following 45 weeks compared to placebo. [...] Read more.
Background: Seven weeks of high-dose vitamin D treatment decreases intestinal IL17A and IFN-γ mRNA expression in active Crohn’s disease (CD). In this follow-up study, we investigated whether seven-week vitamin D treatment affected the infliximab response in the following 45 weeks compared to placebo. Methods: CD patients (n = 40) were initially randomised into four groups: infliximab + vitamin-D; infliximab + placebo-vitamin-D; placebo-infliximab + vitamin-D; and placebo-infliximab + placebo-vitamin-D. Infliximab (5 mg/kg) or placebo-infliximab was administered at weeks 0, 2 and 6. Vitamin D (5 mg bolus followed by 0.5 mg/day for 7 weeks) or placebo-vitamin D was handed out. After the 7-week vitamin D period, all patients received infliximab during follow-up. Results are reported for Group D+ (infliximab + vitamin-D and placebo-infliximab + vitamin-D) and Group D- (infliximab + placebo-vitamin-D and placebo-infliximab + placebo-vitamin-D). Results: Group D- patients had greater needs for infliximab dose escalation during follow-up compared to group D+ (p = 0.05). Group D+ had lower median calprotectin levels week 15 (p = 0.02) and week 23 (p = 0.04) compared to group D-. Throughout follow-up, group D+ had 2.2 times (95% CI: 1.1–4.3) (p = 0.02) lower median CRP levels compared with group D-. Conclusions: Seven weeks high-dose vitamin D treatment reduces the need for later infliximab dose-escalation and reduces inflammatory markers. EudraCT no. 2013-000971-34. Full article
(This article belongs to the Special Issue Nutritional Management for Inflammatory Bowel Diseases)
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9 pages, 1664 KiB  
Article
The Usefulness of Serum Vitamin D Levels in the Assessment of IBD Activity and Response to Biologics
by Marco Valvano, Marco Magistroni, Antonio Mancusi, Debora D’Ascenzo, Salvatore Longo, Gianpiero Stefanelli, Filippo Vernia, Angelo Viscido, Stefano Necozione and Giovanni Latella
Nutrients 2021, 13(2), 323; https://0-doi-org.brum.beds.ac.uk/10.3390/nu13020323 - 22 Jan 2021
Cited by 16 | Viewed by 3827
Abstract
The main role of vitamin D is calcium homeostasis and bone metabolism, although its activity as an immuno-modulator and its anti-inflammatory effect is well-known. Low blood vitamin D levels are common among patients with inflammatory bowel disease (IBD). Whether low vitamin D levels [...] Read more.
The main role of vitamin D is calcium homeostasis and bone metabolism, although its activity as an immuno-modulator and its anti-inflammatory effect is well-known. Low blood vitamin D levels are common among patients with inflammatory bowel disease (IBD). Whether low vitamin D levels could affect the disease activity or it is an effect of a worse condition of the disease is still unclear. This study aimed to investigate the role of blood vitamin D levels to identify the clinical, endoscopic, and histological activity in a cohort of patients with ulcerative colitis (UC) or Crohn’s disease (CD) on therapy with biological drugs. In this retrospective cohort study, 50 IBD patients (24 UC and 26 CD) that underwent colonoscopy from January 2017 to January 2020 with a concomitant serological evaluation of vitamin D were included. Patients with clinical, endoscopic, and histological activity and those who lost their clinical response to the biological drug had lower vitamin D levels compared to patients in remission or patients that did not change therapeutic regimens. A receiver operating characteristic (ROC) analysis and Youden’s Index were performed to assess the optimal vitamin D levels to identify patients with the active disease. The ROC analysis showed an area under the curve (AUC) of 0.709 (p = 0.005; confidence interval (CI): 0.564–0.829), 0.769 (p < 0.001; CI: 0.628–0.876), and 0.810 (p < 0.001; CI: 0.670–0.910) for the clinical, endoscopic, and histological outcomes, respectively. The optimal vitamin D cut-off was ≤25 ng/mL. The vitamin D level is an additional useful tool in the evaluation of IBD patients with good accuracy to predict their endoscopic and histological activity and clinical response to biologics. Full article
(This article belongs to the Special Issue Nutritional Management for Inflammatory Bowel Diseases)
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12 pages, 265 KiB  
Article
Serum Vitamins D, B9 and B12 in Greek Patients with Inflammatory Bowel Diseases
by Aristea Gioxari, Charalampia Amerikanou, Efstathia Papada, Evangelia Zioga, Andreas D. Georgoulis, George Bamias and Andriana C. Kaliora
Nutrients 2020, 12(12), 3734; https://0-doi-org.brum.beds.ac.uk/10.3390/nu12123734 - 04 Dec 2020
Cited by 8 | Viewed by 2488
Abstract
Deficiencies in vitamin D, folate and cobalamin are common in Inflammatory Bowel Disease (IBD). The aim of the present study was to assess serum levels of these vitamins in IBD adults based on the respective serum cut off values for vitamin deficiencies, and [...] Read more.
Deficiencies in vitamin D, folate and cobalamin are common in Inflammatory Bowel Disease (IBD). The aim of the present study was to assess serum levels of these vitamins in IBD adults based on the respective serum cut off values for vitamin deficiencies, and to explore possible associations with IBD-related biomarkers and nutritional intake. A cross-sectional study was carried out and patients with Crohn’s disease (CD) or ulcerative colitis (UC) from Attica-Greece were enrolled. Medical and dietary history, clinical examination and blood/stool biomarkers were evaluated. In total, 87 patients participated in the study. Serum levels of 25(OH)D, folate and cobalamin were deficient in 36.8%, 18.4% and 5.7% of patients, respectively. Linear regression analysis in the overall patients showed positive associations between (a) serum 25(OH)D with serum iron (beta = 0.083, p = 0.005) and (b) serum cobalamin with total bilirubin (beta = 0.357, p = 0.020) and direct bilirubin (beta = 0.727, p = 0.033), adjusting for age, sex, body mass index (BMI), disease activity and duration, smoking, nutritional intake and season of recruitment. In CD patients (N = 54), a negative linear association between serum folate and fecal lysozyme was evident (beta = −0.009, p = 0.020). No associations were found for UC patients (N = 33). The serum vitamin profile may be a complementary biomarker for the evaluation of disease activity next to serum and stool inflammatory biomarkers. Full article
(This article belongs to the Special Issue Nutritional Management for Inflammatory Bowel Diseases)
14 pages, 2256 KiB  
Article
Decrease in Mucosal IL17A, IFNγ and IL10 Expressions in Active Crohn’s Disease Patients Treated with High-Dose Vitamin D Alone or Combined with Infliximab
by Mia Bendix, Anders Dige, Søren Peter Jørgensen, Jens Frederik Dahlerup, Bo Martin Bibby, Bent Deleuran and Jørgen Agnholt
Nutrients 2020, 12(12), 3699; https://0-doi-org.brum.beds.ac.uk/10.3390/nu12123699 - 30 Nov 2020
Cited by 11 | Viewed by 2574
Abstract
Background: Vitamin D treatment may reduce Crohn’s disease (CD) activity by modulating the mucosal immune function. We investigated if high-dose vitamin D +/− infliximab modulated the mucosal cytokine expression in active CD. Methods: Forty CD patients were randomized into: infliximab + vitamin D; [...] Read more.
Background: Vitamin D treatment may reduce Crohn’s disease (CD) activity by modulating the mucosal immune function. We investigated if high-dose vitamin D +/− infliximab modulated the mucosal cytokine expression in active CD. Methods: Forty CD patients were randomized into: infliximab + vitamin D; infliximab + placebo-vitamin D; placebo-infliximab + vitamin D or placebo-infliximab + placebo-vitamin D. Infliximab (5 mg/kg) and placebo-infliximab were administered at weeks 0, 2 and 6. Oral vitamin D was administered as bolus 200,000 international units (IU) per week 0 followed by 20,000 IU/day for 7 weeks or placebo. Endoscopy with biopsies was performed at weeks 0 and 7 where endoscopic activity was measured and mucosal mRNA cytokine expression was examined. C-reactive protein (CRP), fecal calprotectin and Harvey-Bradshaw Index (HBI) were measured at weeks 0, 2 and 6. Results: High-dose vitamin D treatment alone and combined with infliximab decreased the IL17A, IFNγ and IL10 expression. High-dose vitamin D alone did not significantly decrease the disease activity, CRP or calprotectin. Combined infliximab and vitamin D treatment was not clinically significantly superior to monotherapy with infliximab. Conclusions: High-dose vitamin D as monotherapy and combined with infliximab decreases IL17A, IFNγ and IL-10 expression in mucosa within treatment groups. This did not induce a statistically significant decreased disease activity. EudraCT no.2013-000971-34. Full article
(This article belongs to the Special Issue Nutritional Management for Inflammatory Bowel Diseases)
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18 pages, 6444 KiB  
Article
Probiotic Bacillus Spores Together with Amino Acids and Immunoglobulins Exert Protective Effects on a Rat Model of Ulcerative Colitis
by Adrian Catinean, Maria Adriana Neag, Kiran Krishnan, Dana Maria Muntean, Corina Ioana Bocsan, Raluca Maria Pop, Andrei Otto Mitre, Carmen Stanca Melincovici and Anca Dana Buzoianu
Nutrients 2020, 12(12), 3607; https://0-doi-org.brum.beds.ac.uk/10.3390/nu12123607 - 24 Nov 2020
Cited by 13 | Viewed by 3497
Abstract
In inflammatory bowel disease (IBD), experimental models have proven to be important tools for evaluating potential therapeutic agents and for investigating the mechanisms of pathogenesis. Oxidative stress and the immune response have been associated with acetic acid (AA)-induced ulcerative colitis (UC). Our study [...] Read more.
In inflammatory bowel disease (IBD), experimental models have proven to be important tools for evaluating potential therapeutic agents and for investigating the mechanisms of pathogenesis. Oxidative stress and the immune response have been associated with acetic acid (AA)-induced ulcerative colitis (UC). Our study aimed to evaluate, for the first time, the ability of a spore-based probiotic and an amino acid and immunoglobulin supplement in reducing tissue damage and inflammatory responses in an experimental animal model of UC. Forty-two Wistar rats were divided into six groups, receiving 1% carboxymethylcellulose, 4% AA, MegaSporeBiotic™ (MSB; 1 × 109 colony forming units/day) and MegaMucosa™ (MM; 70 mg/100 g/day). Pretreatment with MSB or MM alone and in combination significantly lowered inflammation and reduced damage to the colonic mucosa. Pretreatment with these agents resulted in levels of proinflammatory cytokines, vascular tight junction proteins, and measures of oxidative stress similar to those reported for methylprednisolone, one of the first-line therapies for moderate to severe activity of UC. The protection was further confirmed by histologic analysis of the colon tissue. In conclusion, pretreatment with probiotic spore-forming Bacillus strains and a supplement of amino acids in combination with immunoglobulins exhibited anti-inflammatory and antioxidant effects in an AA-induced rat model of UC. Full article
(This article belongs to the Special Issue Nutritional Management for Inflammatory Bowel Diseases)
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Review

Jump to: Research

9 pages, 282 KiB  
Review
Current Use of EEN in Pre-Operative Optimisation in Crohn’s Disease
by Sharafaath Shariff, Gordon Moran, Caris Grimes and Rachel Margaret Cooney
Nutrients 2021, 13(12), 4389; https://0-doi-org.brum.beds.ac.uk/10.3390/nu13124389 - 08 Dec 2021
Cited by 3 | Viewed by 2572
Abstract
Despite the increasing array of medications available for the treatment of Crohn’s disease and a focus on mucosal healing, approximately 35% of patients with Crohn’s disease undergo bowel surgery at some stage. The importance of nutritional optimisation before Crohn’s surgery is well-highlighted by [...] Read more.
Despite the increasing array of medications available for the treatment of Crohn’s disease and a focus on mucosal healing, approximately 35% of patients with Crohn’s disease undergo bowel surgery at some stage. The importance of nutritional optimisation before Crohn’s surgery is well-highlighted by surgical, nutritional, and gastroenterological societies with the aim of reducing complications and enhancing recovery. Surgical procedures are frequently undertaken when other treatment options have been unsuccessful, and, thus, patients may have lost weight and/or required steroids, and are therefore at higher risk of post-operative complications. EEN is used extensively in the paediatric population to induce remission, but is not routinely used in the induction of remission of adult Crohn’s disease or in pre-operative optimisation. Large prospective studies regarding the role of pre-operative EEN are lacking. In this review, we evaluate the current literature on the use of EEN in pre-operative settings and its impact on patient outcomes. Full article
(This article belongs to the Special Issue Nutritional Management for Inflammatory Bowel Diseases)
24 pages, 1362 KiB  
Review
Pathogenesis of Musculoskeletal Deficits in Children and Adults with Inflammatory Bowel Disease
by Lewis Steell, Stuart R. Gray, Richard K. Russell, Jonathan MacDonald, John Paul Seenan, Sze Choong Wong and Daniel R. Gaya
Nutrients 2021, 13(8), 2899; https://0-doi-org.brum.beds.ac.uk/10.3390/nu13082899 - 23 Aug 2021
Cited by 11 | Viewed by 3965
Abstract
Musculoskeletal deficits are among the most commonly reported extra-intestinal manifestations and complications of inflammatory bowel disease (IBD), especially in those with Crohn’s disease. The adverse effects of IBD on bone and muscle are multifactorial, including the direct effects of underlying inflammatory disease processes, [...] Read more.
Musculoskeletal deficits are among the most commonly reported extra-intestinal manifestations and complications of inflammatory bowel disease (IBD), especially in those with Crohn’s disease. The adverse effects of IBD on bone and muscle are multifactorial, including the direct effects of underlying inflammatory disease processes, nutritional deficits, and therapeutic effects. These factors also indirectly impact bone and muscle by interfering with regulatory pathways. Resultantly, individuals with IBD are at increased risk of osteoporosis and sarcopenia and associated musculoskeletal morbidity. In paediatric IBD, these factors may contribute to suboptimal bone and muscle accrual. This review evaluates the main pathogenic factors associated with musculoskeletal deficits in children and adults with IBD and summarises the current literature and understanding of the musculoskeletal phenotype in these patients. Full article
(This article belongs to the Special Issue Nutritional Management for Inflammatory Bowel Diseases)
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9 pages, 272 KiB  
Review
The Other Side of Malnutrition in Inflammatory Bowel Disease (IBD): Non-Alcoholic Fatty Liver Disease
by Giulia Gibiino, Alessandro Sartini, Stefano Gitto, Cecilia Binda, Monica Sbrancia, Chiara Coluccio, Vittorio Sambri and Carlo Fabbri
Nutrients 2021, 13(8), 2772; https://0-doi-org.brum.beds.ac.uk/10.3390/nu13082772 - 13 Aug 2021
Cited by 9 | Viewed by 4009
Abstract
Steatohepatitis and hepatobiliary manifestations constitute some of the most common extra-intestinal manifestations of Inflammatory Bowel Disease (IBD). On the other hand, non-alcoholic fatty liver disease (NAFLD) affects around 25% of the world’s population and is attracting ever more attention in liver transplant programs. [...] Read more.
Steatohepatitis and hepatobiliary manifestations constitute some of the most common extra-intestinal manifestations of Inflammatory Bowel Disease (IBD). On the other hand, non-alcoholic fatty liver disease (NAFLD) affects around 25% of the world’s population and is attracting ever more attention in liver transplant programs. To outline the specific pathways linking these two conditions is a pressing task for 21st-century researchers. We are accustomed to expecting the occurrence of fatty liver disease in obese people, but current evidence suggests that there are several different pathways also occurring in underweight patients. Genetic factors, inflammatory signals and microbiota are key players that could help in understanding the entire pathogenesis of NAFLD, with the aim of defining the multiple expressions of malnutrition. In the current review, we summarize the most recent literature regarding the epidemiology, pathogenesis and future directions for the management of NAFLD in patients affected by IBD. Full article
(This article belongs to the Special Issue Nutritional Management for Inflammatory Bowel Diseases)
15 pages, 893 KiB  
Review
The Microbiome as a Therapy in Pouchitis and Ulcerative Colitis
by Jean-Frédéric LeBlanc, Jonathan P. Segal, Lucia Maria de Campos Braz and Ailsa L. Hart
Nutrients 2021, 13(6), 1780; https://0-doi-org.brum.beds.ac.uk/10.3390/nu13061780 - 23 May 2021
Cited by 23 | Viewed by 6346
Abstract
The gut microbiome has been implicated in a range of diseases and there is a rapidly growing understanding of this ecosystem’s importance in inflammatory bowel disease. We are yet to identify a single microbe that causes either ulcerative colitis (UC) or pouchitis, however, [...] Read more.
The gut microbiome has been implicated in a range of diseases and there is a rapidly growing understanding of this ecosystem’s importance in inflammatory bowel disease. We are yet to identify a single microbe that causes either ulcerative colitis (UC) or pouchitis, however, reduced microbiome diversity is increasingly recognised in active UC. Manipulating the gut microbiome through dietary interventions, prebiotic and probiotic compounds and faecal microbiota transplantation may expand the therapeutic landscape in UC. Specific diets, such as the Mediterranean diet or diet rich in omega-3 fatty acids, may reduce intestinal inflammation or potentially reduce the risk of incident UC. This review summarises our knowledge of gut microbiome therapies in UC and pouchitis. Full article
(This article belongs to the Special Issue Nutritional Management for Inflammatory Bowel Diseases)
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15 pages, 1485 KiB  
Review
Optimizing Inpatient Nutrition Care of Adult Patients with Inflammatory Bowel Disease in the 21st Century
by Elaine Chiu, Chris Oleynick, Maitreyi Raman and Barbara Bielawska
Nutrients 2021, 13(5), 1581; https://0-doi-org.brum.beds.ac.uk/10.3390/nu13051581 - 09 May 2021
Cited by 8 | Viewed by 4734
Abstract
Malnutrition is highly prevalent in inflammatory bowel disease (IBD) patients and disproportionately affects those admitted to hospital. Malnutrition is a risk factor for many complications in IBD, including prolonged hospitalization, infection, greater need for surgery, development of venous thromboembolism, post-operative complications, and mortality. [...] Read more.
Malnutrition is highly prevalent in inflammatory bowel disease (IBD) patients and disproportionately affects those admitted to hospital. Malnutrition is a risk factor for many complications in IBD, including prolonged hospitalization, infection, greater need for surgery, development of venous thromboembolism, post-operative complications, and mortality. Early screening for malnutrition and prompt nutrition intervention if indicated has been shown to prevent or mitigate many of these outlined risk factors. There are many causes of malnutrition in IBD including reduced oral food intake, medications, active inflammation, and prior surgical resections. Hospitalization can further compound pre-existing malnutrition through inappropriate diet restrictions, nil per os (NPO) for endoscopy and imaging, or partial bowel obstruction, resulting in “post-hospital syndrome” after discharge and readmission. The aim of this article is to inform clinicians of the prevalence and consequences of malnutrition in IBD, as well as available screening and assessment tools for diagnosis, and to offer an organized approach to the nutritional care of hospitalized adult IBD patients. Full article
(This article belongs to the Special Issue Nutritional Management for Inflammatory Bowel Diseases)
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34 pages, 556 KiB  
Review
Food and Food Groups in Inflammatory Bowel Disease (IBD): The Design of the Groningen Anti-Inflammatory Diet (GrAID)
by Marjo J. E. Campmans-Kuijpers and Gerard Dijkstra
Nutrients 2021, 13(4), 1067; https://0-doi-org.brum.beds.ac.uk/10.3390/nu13041067 - 25 Mar 2021
Cited by 50 | Viewed by 14518
Abstract
Diet plays a pivotal role in the onset and course of inflammatory bowel disease (IBD). Patients are keen to know what to eat to reduce symptoms and flares, but dietary guidelines are lacking. To advice patients, an overview of the current evidence on [...] Read more.
Diet plays a pivotal role in the onset and course of inflammatory bowel disease (IBD). Patients are keen to know what to eat to reduce symptoms and flares, but dietary guidelines are lacking. To advice patients, an overview of the current evidence on food (group) level is needed. This narrative review studies the effects of food (groups) on the onset and course of IBD and if not available the effects in healthy subjects or animal and in vitro IBD models. Based on this evidence the Groningen anti-inflammatory diet (GrAID) was designed and compared on food (group) level to other existing IBD diets. Although on several foods conflicting results were found, this review provides patients a good overview. Based on this evidence, the GrAID consists of lean meat, eggs, fish, plain dairy (such as milk, yoghurt, kefir and hard cheeses), fruit, vegetables, legumes, wheat, coffee, tea and honey. Red meat, other dairy products and sugar should be limited. Canned and processed foods, alcohol and sweetened beverages should be avoided. This comprehensive review focuses on anti-inflammatory properties of foods providing IBD patients with the best evidence on which foods they should eat or avoid to reduce flares. This was used to design the GrAID. Full article
(This article belongs to the Special Issue Nutritional Management for Inflammatory Bowel Diseases)
17 pages, 704 KiB  
Review
The Gut–Brain Axis and Its Role in Controlling Eating Behavior in Intestinal Inflammation
by Gordon William Moran and Gita Thapaliya
Nutrients 2021, 13(3), 981; https://0-doi-org.brum.beds.ac.uk/10.3390/nu13030981 - 18 Mar 2021
Cited by 7 | Viewed by 5055
Abstract
Malnutrition represents a major problem in the clinical management of the inflammatory bowel disease (IBD). Presently, our understanding of the cross-link between eating behavior and intestinal inflammation is still in its infancy. Crohn’s disease patients with active disease exhibit strong hedonic desires for [...] Read more.
Malnutrition represents a major problem in the clinical management of the inflammatory bowel disease (IBD). Presently, our understanding of the cross-link between eating behavior and intestinal inflammation is still in its infancy. Crohn’s disease patients with active disease exhibit strong hedonic desires for food and emotional eating patterns possibly to ameliorate feelings of low mood, anxiety, and depression. Impulsivity traits seen in IBD patients may predispose them to palatable food intake as an immediate reward rather than concerns for future health. The upregulation of enteroendocrine cells (EEC) peptide response to food intake has been described in ileal inflammation, which may lead to alterations in gut–brain signaling with implications for appetite and eating behavior. In summary, a complex interplay of gut peptides, psychological, cognitive factors, disease-related symptoms, and inflammatory burden may ultimately govern eating behavior in intestinal inflammation. Full article
(This article belongs to the Special Issue Nutritional Management for Inflammatory Bowel Diseases)
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16 pages, 339 KiB  
Review
Let Food Be Thy Medicine—Its Role in Crohn’s Disease
by Judith Wellens, Séverine Vermeire and João Sabino
Nutrients 2021, 13(3), 832; https://0-doi-org.brum.beds.ac.uk/10.3390/nu13030832 - 03 Mar 2021
Cited by 6 | Viewed by 8596
Abstract
The food we eat is thought to play a role in both the increasing incidence as well as the course of Crohn’s disease. What to eat and what to avoid is an increasingly important question for both patients and physicians. Restrictive diets are [...] Read more.
The food we eat is thought to play a role in both the increasing incidence as well as the course of Crohn’s disease. What to eat and what to avoid is an increasingly important question for both patients and physicians. Restrictive diets are widely adopted by patients and carry the risk of inducing or worsening malnutrition, without any guarantees on anti-inflammatory potential. Nevertheless, exploration of novel therapies to improve long-term management of the disease is desperately needed and the widespread use of exclusive enteral nutrition in the induction of paediatric Crohn’s disease makes us wonder if a similar approach would be beneficial in adult patients. This narrative review discusses the current clinical evidence on whole food diets in achieving symptomatic and inflammatory control in Crohn’s disease and identifies knowledge gaps with areas for future research. Full article
(This article belongs to the Special Issue Nutritional Management for Inflammatory Bowel Diseases)
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16 pages, 905 KiB  
Review
Sarcopenia in Inflammatory Bowel Disease: A Narrative Overview
by Amritpal Dhaliwal, Jonathan I. Quinlan, Kellie Overthrow, Carolyn Greig, Janet M. Lord, Matthew J. Armstrong and Sheldon C. Cooper
Nutrients 2021, 13(2), 656; https://0-doi-org.brum.beds.ac.uk/10.3390/nu13020656 - 17 Feb 2021
Cited by 45 | Viewed by 8052
Abstract
Malnutrition is a common condition encountered in patients with inflammatory bowel disease (IBD) and is often associated with sarcopenia (the reduction of muscle mass and strength) which is an ever-growing consideration in chronic diseases. Recent data suggest the prevalence of sarcopenia is 52% [...] Read more.
Malnutrition is a common condition encountered in patients with inflammatory bowel disease (IBD) and is often associated with sarcopenia (the reduction of muscle mass and strength) which is an ever-growing consideration in chronic diseases. Recent data suggest the prevalence of sarcopenia is 52% and 37% in Crohn’s disease and ulcerative colitis, respectively, however it is challenging to fully appreciate the prevalence of sarcopenia in IBD. Sarcopenia is an important consideration in the management of IBD, including the impact on quality of life, prognostication, and treatment such as surgical interventions, biologics and immunomodulators. There is evolving research in many chronic inflammatory states, such as chronic liver disease and rheumatoid arthritis, whereby interventions have begun to be developed to counteract sarcopenia. The purpose of this review is to evaluate the current literature regarding the impact of sarcopenia in the management of IBD, from mechanistic drivers through to assessment and management. Full article
(This article belongs to the Special Issue Nutritional Management for Inflammatory Bowel Diseases)
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20 pages, 1695 KiB  
Review
Nutritional Therapy Strategies in Pediatric Crohn’s Disease
by Charlotte M. Verburgt, Mohammed Ghiboub, Marc A. Benninga, Wouter J. de Jonge and Johan E. Van Limbergen
Nutrients 2021, 13(1), 212; https://0-doi-org.brum.beds.ac.uk/10.3390/nu13010212 - 13 Jan 2021
Cited by 25 | Viewed by 11070
Abstract
The increase in incidences of pediatric Crohn’s Disease (CD) worldwide has been strongly linked with dietary shifts towards a Westernized diet, ultimately leading to altered gut microbiota and disturbance in intestinal immunity and the metabolome. Multiple clinical studies in children with CD have [...] Read more.
The increase in incidences of pediatric Crohn’s Disease (CD) worldwide has been strongly linked with dietary shifts towards a Westernized diet, ultimately leading to altered gut microbiota and disturbance in intestinal immunity and the metabolome. Multiple clinical studies in children with CD have demonstrated the high efficacy of nutritional therapy with exclusive enteral nutrition (EEN) to induce remission with an excellent safety profile. However, EEN is poorly tolerated, limiting its compliance and clinical application. This has spiked an interest in the development of alternative and better-tolerated nutritional therapy strategies. Several nutritional therapies have now been designed not only to treat the nutritional deficiencies seen in children with active CD but also to correct dysbiosis and reduce intestinal inflammation. In this review, we report the most recent insights regarding nutritional strategies in children with active CD: EEN, partial enteral nutrition (PEN), Crohn’s disease exclusion diet (CDED), and CD treatment-with-eating diet (CD-TREAT). We describe their setup, efficacy, safety, and (dis)advantages as well as some of their potential mechanisms of action and perspectives. A better understanding of different nutritional therapeutic options and their mechanisms will yield better and safer management strategies for children with CD and may address the barriers and limitations of current strategies in children. Full article
(This article belongs to the Special Issue Nutritional Management for Inflammatory Bowel Diseases)
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26 pages, 776 KiB  
Review
EEN Yesterday and Today … CDED Today and Tomorrow
by Marta Herrador-López, Rafael Martín-Masot and Víctor Manuel Navas-López
Nutrients 2020, 12(12), 3793; https://0-doi-org.brum.beds.ac.uk/10.3390/nu12123793 - 10 Dec 2020
Cited by 19 | Viewed by 5606
Abstract
The treatment of Pediatric Crohn’s Disease (CD) requires attention both to achieve mucosal healing and to optimize growth, while also maintaining proper bone health. Exclusive Enteral Nutrition (EEN) is recommended as first-line treatment in luminal CD. The therapeutic mechanisms of EEN are being [...] Read more.
The treatment of Pediatric Crohn’s Disease (CD) requires attention both to achieve mucosal healing and to optimize growth, while also maintaining proper bone health. Exclusive Enteral Nutrition (EEN) is recommended as first-line treatment in luminal CD. The therapeutic mechanisms of EEN are being discovered by advances in the study of the gut microbiota. Although the total exclusion of a normal diet during the time of EEN continues to be of high importance, new modalities of dietary treatment suggest a successful future for the nutritional management of CD. In this sense, Crohn’s Disease Exclusion Diet (CDED) is a long-term strategy, it apparently acts on the mechanisms that influence the appearance of inflammation (reducing dietary exposure to products negatively affecting the microbiota), but does so using specific available whole foods to achieve this goal, increases the time of clinical remission and promotes healthy lifestyle habits. The development of CDED, which partly minimizes the problems of EEN, has enabled a turnaround in the treatment of pediatric CD. This review highlights the role of enteral nutrition in the treatment of Crohn’s disease with special emphasis on newer dietary modalities such as CDED. Full article
(This article belongs to the Special Issue Nutritional Management for Inflammatory Bowel Diseases)
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14 pages, 597 KiB  
Review
Iron Therapy in Inflammatory Bowel Disease
by Aditi Kumar and Matthew J. Brookes
Nutrients 2020, 12(11), 3478; https://0-doi-org.brum.beds.ac.uk/10.3390/nu12113478 - 12 Nov 2020
Cited by 18 | Viewed by 5500
Abstract
The most common complication seen in inflammatory bowel disease (IBD) patients is iron deficiency anaemia (IDA). Symptoms such as chronic fatigue can be as debilitating to IBD patients as pathological symptoms of abdominal pain and diarrhoea. Recognising and correcting anaemia may be as [...] Read more.
The most common complication seen in inflammatory bowel disease (IBD) patients is iron deficiency anaemia (IDA). Symptoms such as chronic fatigue can be as debilitating to IBD patients as pathological symptoms of abdominal pain and diarrhoea. Recognising and correcting anaemia may be as important as managing IBD symptoms and improving overall quality of life. Thus, iron replacement should be commenced the moment IDA is identified. Although intravenous iron is now considered standard treatment for IBD patients in Europe, oral iron still appears to be the preferred option. Advantages of oral iron include greater availability, lower costs and ease of applicability. However, its multitude of side effects, impact on the microbiome and further exacerbating IBD activity can have consequences on patient compliance. The newer oral iron formulations show promising safety and efficacy data with a good side effect profile. Intravenous iron formulations bypass the gastrointestinal tract absorption thereby leading to less side effects. Multiple studies have shown its superiority compared to oral formulations although its risk for hypersensitivity reactions continue to lead to clinician hesitancy in prescribing this formulation. This article provides an updated review on diagnosis and management of IDA in IBD patients, discussing the newer oral and intravenous formulations. Full article
(This article belongs to the Special Issue Nutritional Management for Inflammatory Bowel Diseases)
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