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Advances in Nutritional Management of Pediatric Inflammatory Bowel Disease

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

Deadline for manuscript submissions: closed (30 September 2020) | Viewed by 80154

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Special Issue Editor

Prof. Dr. Wael El-Matary

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Guest Editor

1. Health Sciences Center, AE 408-671 William Avenue, Winnipeg, MB R3E 0Z2, Canada
2. Department of Pediatrics, University of Manitoba, Winnipeg, MB R3A 1S1, Canada
3. IBD Clinical and Research Center, University of Manitoba, Winnipeg, MB R3A 1S1, Canada
4. Children’s Hospital Research Institute of Manitoba, University of Manitoba, Winnipeg, MB R3A 1S1, Canada
Interests: celiac; colitis; Crohn; inflammatory bowel disease (IBD); nutritional therapy of IBD
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Dear Colleagues,

Over the last few decades, several “diets” have been suggested to be effective in managing inflammatory bowel disease (IBD) with several landmark papers, especially in the last few years, which have been pivotal in changing our understanding and management of IBD from a nutrition perspective.

This Special Issue on “Advances in Nutritional Management of Pediatric Inflammatory Bowel Disease” aims to provide an overview of the role and importance of nutritional status and available diet therapy in pediatric IBD, the pros and cons of each option, including potential associated costs of treatment and subsequent effect on quality of life, mechanisms of action including proposed modifications of intestinal microbiome, and what the landscape of nutritional interventions in children with IBD over the next few decades will look like.

You are very welcome to share with our readers your research ideas and interesting results that will bring us closer to answering one of the most important questions that we all hear from our patients with IBD: “What can or can’t I eat?”

Prof. Wael El-Matary
Guest Editor

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Keywords

Colitis
Crohn
Diet
Enteral
Inflammatory bowel disease
IBD
Nutrition

Published Papers (11 papers)

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Editorial

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4 pages, 211 KiB

Open AccessEditorial

Advances in Nutritional Management of Pediatric Inflammatory Bowel Disease

by Wael El-Matary

Nutrients 2021, 13(2), 324; https://0-doi-org.brum.beds.ac.uk/10.3390/nu13020324 - 23 Jan 2021

Cited by 1 | Viewed by 1882

Abstract

Crohn’s disease (CD) and ulcerative colitis (UC) are chronic lifelong non-curable inflammatory bowel diseases (IBD) of uncertain etiology with immune dysfunction likely related to the interaction between the environment and the intestinal microbiome in genetically susceptible individuals [...] Full article

(This article belongs to the Special Issue Advances in Nutritional Management of Pediatric Inflammatory Bowel Disease)

Research

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14 pages, 288 KiB

Open AccessArticle

Micronutrient Deficiencies and Anemia in Children with Inflammatory Bowel Disease

by Julie Rempel, Kanika Grover and Wael El-Matary

Nutrients 2021, 13(1), 236; https://0-doi-org.brum.beds.ac.uk/10.3390/nu13010236 - 15 Jan 2021

Cited by 24 | Viewed by 4579

Abstract

Children with inflammatory bowel disease (IBD) are at risk of developing nutrition deficiencies, particularly because of reduced intake, restrictive diets, malabsorption, and excessive nutrient loss. The aim of this study was to determine the prevalence and predictors of anemia and micronutrient deficiencies at diagnosis and one year follow up in children and adolescents with inflammatory bowel disease (IBD). Children and young adults diagnosed with IBD before the age of 17 years between 2012 and 2018 were included. Laboratory measurements including serum levels of iron, ferritin, zinc, vitamin D, vitamin A, vitamin E, selenium, copper, vitamin B12, and red blood cell (RBC) folate at diagnosis and one-year follow-up were documented as part of the Manitoba Longitudinal Pediatric Inflammatory Bowel Disease (MALPID) Cohort. A total of 165 patients with IBD were included, 87 (53%) with Crohn’s disease (CD) and 78 (47%) with ulcerative colitis (UC). The prevalence of deficiencies in our cohort at diagnosis and one year follow-up, respectively, were iron (56% and 27%), ferritin (39% and 27%), zinc (10% and 6%), vitamin D (22% and 13%), vitamin A (25% and 25%), vitamin E (5% and 4%), selenium (10 and 7%), copper (17% and 27%), vitamin B12 (2% and 5%), and Red blood cell (RBC) folate (1% and 17%). Anemia was present in 57% and 25% at diagnosis and follow up respectively. In CD patients, age of diagnosis (15y–younger than 18y) was a predictor of moderate to severe anemia and albumin levels (<33 g/L) were protective against anemia. Many children with IBD suffer from anemia and micronutrient deficiencies at diagnosis and some fail to recover after one year despite being in clinical remission. Full article

(This article belongs to the Special Issue Advances in Nutritional Management of Pediatric Inflammatory Bowel Disease)

22 pages, 2191 KiB

Open AccessArticle

The Specific Carbohydrate Diet and Diet Modification as Induction Therapy for Pediatric Crohn’s Disease: A Randomized Diet Controlled Trial

by David L. Suskind, Dale Lee, Young-Mo Kim, Ghassan Wahbeh, Namita Singh, Kimberly Braly, Mason Nuding, Carrie D. Nicora, Samuel O. Purvine, Mary S. Lipton, Janet K. Jansson and William C. Nelson

Nutrients 2020, 12(12), 3749; https://0-doi-org.brum.beds.ac.uk/10.3390/nu12123749 - 06 Dec 2020

Cited by 57 | Viewed by 10839

Abstract

Background: Crohn’s disease (CD) is a chronic inflammatory intestinal disorder associated with intestinal dysbiosis. Diet modulates the intestinal microbiome and therefore has a therapeutic potential. The aim of this study is to determine the potential efficacy of three versions of the specific carbohydrate diet (SCD) in active Crohn’s Disease. Methods: 18 patients with mild/moderate CD (PCDAI 15–45) aged 7 to 18 years were enrolled. Patients were randomized to either SCD, modified SCD(MSCD) or whole foods (WF) diet. Patients were evaluated at baseline, 2, 4, 8 and 12 weeks. PCDAI, inflammatory labs and multi-omics evaluations were assessed. Results: Mean age was 14.3 ± 2.9 years. At week 12, all participants (n = 10) who completed the study achieved clinical remission. The C-reactive protein decreased from 1.3 ± 0.7 at enrollment to 0.9 ± 0.5 at 12 weeks in the SCD group. In the MSCD group, the CRP decreased from 1.6 ± 1.1 at enrollment to 0.7 ± 0.1 at 12 weeks. In the WF group, the CRP decreased from 3.9 ± 4.3 at enrollment to 1.6 ± 1.3 at 12 weeks. In addition, the microbiome composition shifted in all patients across the study period. While the nature of the changes was largely patient specific, the predicted metabolic mode of the organisms increasing and decreasing in activity was consistent across patients. Conclusions: This study emphasizes the impact of diet in CD. Each diet had a positive effect on symptoms and inflammatory burden; the more exclusionary diets were associated with a better resolution of inflammation. Full article

(This article belongs to the Special Issue Advances in Nutritional Management of Pediatric Inflammatory Bowel Disease)

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14 pages, 676 KiB

Open AccessArticle

Effectiveness of Mediterranean Diet’s Adherence in Children with Inflammatory Bowel Diseases

by Caterina Strisciuglio, Sabrina Cenni, Maria Rosaria Serra, Pasquale Dolce, Massimo Martinelli, Annamaria Staiano and Erasmo Miele

Nutrients 2020, 12(10), 3206; https://0-doi-org.brum.beds.ac.uk/10.3390/nu12103206 - 20 Oct 2020

Cited by 29 | Viewed by 3829

Abstract

Background: Nutritional support is very important in the treatment of Paediatric Inflammatory Bowel Disease (IBD). The role of the Mediterranean Diet (MD) has been understudied in children with IBD. The aims of this study were to assess the dietary intakes of IBD children in comparison with healthy controls (HCs), their adherence to MD; and the relationship between inflammation and dietary behaviors. Methods: Paediatric IBD patients in clinical remission and HCs were enrolled. The nutritional status and adherence to the Mediterranean Diet was evaluated through a 3-day food diary and the Mediterranean Diet Quality Index for Children and Adolescents (KIDMED). Results: The analysis of food diaries showed a significantly higher kilocalorie intake in IBD patients compared to HCs (p = 0.012), an increase in carbohydrates (p = 0.015) and in protein intake (p = 0.024). Both IBD and HCs have an intermediate adherence to MD. The comparison between Crohn’s disease (CD) and Ulcerative colitis (UC) patients showed significant difference in protein intake in CD patients (p = 0.047), as well as for vitamin D (p = 0.044) and iron intake (p = 0.023). Interestingly; in IBD patients we found a significant association between adherence to MD and a low level of fecal calprotectin (p = 0.027). Conclusion: Children with IBD in remission have a sub-optimal food intake compared to HCs. MD seems to correlate to decreased intestinal inflammation. Full article

(This article belongs to the Special Issue Advances in Nutritional Management of Pediatric Inflammatory Bowel Disease)

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20 pages, 7374 KiB

Open AccessArticle

Effect of Exclusive Enteral Nutrition and Corticosteroid Induction Therapy on the Gut Microbiota of Pediatric Patients with Inflammatory Bowel Disease

by Lara Hart, Yasamin Farbod, Jake C. Szamosi, Mai Yamamoto, Philip Britz-McKibbin, Camilla Halgren, Mary Zachos and Nikhil Pai

Nutrients 2020, 12(6), 1691; https://0-doi-org.brum.beds.ac.uk/10.3390/nu12061691 - 05 Jun 2020

Cited by 19 | Viewed by 3786

Abstract

Introduction: Exclusive enteral nutrition (EEN) and corticosteroids (CS) are effective induction therapies for pediatric Crohn’s Disease (CD). CS are also therapy for ulcerative colitis (UC). Host–microbe interactions may be able to explain the effectiveness of these treatments. This is the first prospective study to longitudinally characterize compositional changes in the bacterial community structure of pediatric UC and CD patients receiving EEN or CS induction therapy. Methods: Patients with diagnoses of CD or UC were recruited from McMaster Children’s Hospital (Hamilton, Canada). Fecal samples were collected from participants aged 5–18 years old undergoing 8 weeks of induction therapy with EEN or CS. Fecal samples were submitted for 16S rRNA sequencing. The Shannon diversity index and the relative abundance of specific bacterial taxa were compared using a linear mixed model. Results: The clustering of microbiota was the highest between patients who achieved remission compared to patients still showing active disease (p = 0.029); this effect was independent of the diagnosis or treatment type. All patients showed a significant increase in Shannon diversity over the 8 weeks of treatment. By week 2, a significant difference was seen in Shannon diversity between patients who would go on to achieve remission and those who would not. Conclusion: The gut microbiota of pediatric UC and CD patients was most influenced by patients’ success or failure to achieve remission and was largely independent of the choice of treatment or disease type. Significant differences in Shannon diversity indices occurred as early as week 2 between patients who went on to achieve remission and those who continued to have active disease. Full article

(This article belongs to the Special Issue Advances in Nutritional Management of Pediatric Inflammatory Bowel Disease)

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12 pages, 744 KiB

Open AccessArticle

Predictors of Response to Exclusive Enteral Nutrition in Newly Diagnosed Crohn´s Disease in Children: PRESENCE Study from SEGHNP

by Melinda Moriczi, Gemma Pujol-Muncunill, Rafael Martín-Masot, Santiago Jiménez Treviño, Oscar Segarra Cantón, Carlos Ochoa Sangrador, Luis Peña Quintana, Daniel González Santana, Alejandro Rodríguez Martínez, Antonio Rosell Camps, Honorio Armas, Josefa Barrio, Rafael González de Caldas, Mónica Rodríguez Salas, Elena Balmaseda Serrano, Ester Donat Aliaga, Andrés Bodas Pinedo, Esther Vaquero Sosa, Raquel Vecino López, Alfonso Solar Boga, Ana Moreno Álvarez, César Sánchez Sánchez, Mar Tolín Hernani, Carolina Gutiérrez Junquera, Nazareth Martinón Torres, María Rosaura Leis Trabazo, Francisco Javier Eizaguirre, Mónica García Peris, Enrique Medina Benítez, Beatriz Fernández Caamaño, Ana María Vegas Álvarez, Laura Crespo Valderrábano, Carmen Alonso Vicente, Javier Rubio Santiago, Rafael Galera-Martínez, Ruth García-Romero, Ignacio Ros Arnal, Santiago Fernández Cebrián, Helena Lorenzo Garrido, Javier Francisco Viada Bris, Marta Velasco Rodríguez-Belvis, Juan Manuel Bartolomé Porro, Miriam Blanco Rodríguez, Patricia Barros García, Gonzalo Botija, Francisco José Chicano Marín, Enrique La Orden Izquierdo, Elena Crehuá-Gaudiza, Víctor Manuel Navas-López and Javier Martín-de-Carpi Show full author list Hide full author list

Nutrients 2020, 12(4), 1012; https://0-doi-org.brum.beds.ac.uk/10.3390/nu12041012 - 07 Apr 2020

Cited by 17 | Viewed by 4798

Abstract

Exclusive enteral nutrition (EEN) has been shown to be more effective than corticosteroids in achieving mucosal healing in children with Crohn´s disease (CD) without the adverse effects of these drugs. The aims of this study were to determine the efficacy of EEN in terms of inducing clinical remission in children newly diagnosed with CD, to describe the predictive factors of response to EEN and the need for treatment with biological agents during the first 12 months of the disease. We conducted an observational retrospective multicentre study that included paediatric patients newly diagnosed with CD between 2014–2016 who underwent EEN. Two hundred and twenty-two patients (140 males) from 35 paediatric centres were included, with a mean age at diagnosis of 11.6 ± 2.5 years. The median EEN duration was 8 weeks (IQR 6.6–8.5), and 184 of the patients (83%) achieved clinical remission (weighted paediatric Crohn’s Disease activity index [wPCDAI] < 12.5). Faecal calprotectin (FC) levels (μg/g) decreased significantly after EEN (830 [IQR 500–1800] to 256 [IQR 120–585] p < 0.0001). Patients with wPCDAI ≤ 57.5, FC < 500 μg/g, CRP >15 mg/L and ileal involvement tended to respond better to EEN. EEN administered for 6–8 weeks is effective for inducing clinical remission. Due to the high response rate in our series, EEN should be used as the first-line therapy in luminal paediatric Crohn’s disease regardless of the location of disease and disease activity. Full article

(This article belongs to the Special Issue Advances in Nutritional Management of Pediatric Inflammatory Bowel Disease)

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Review

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22 pages, 1118 KiB

Open AccessReview

Fiber and Prebiotic Interventions in Pediatric Inflammatory Bowel Disease: What Role Does the Gut Microbiome Play?

by Genelle R. Healey, Larissa S. Celiberto, Soo Min Lee and Kevan Jacobson

Nutrients 2020, 12(10), 3204; https://0-doi-org.brum.beds.ac.uk/10.3390/nu12103204 - 20 Oct 2020

Cited by 16 | Viewed by 5498

Abstract

The etiology of inflammatory bowel disease (IBD) is complex but is thought to be linked to an intricate interaction between the host’s immune system, resident gut microbiome and environment, i.e., diet. One dietary component that has a major impact on IBD risk and disease management is fiber. Fiber intakes in pediatric IBD patients are suboptimal and often lower than in children without IBD. Fiber also has a significant impact on beneficially shaping gut microbiota composition and functional capacity. The impact is likely to be particularly important in IBD patients, where various studies have demonstrated that an imbalance in the gut microbiome, referred to as dysbiosis, occurs. Microbiome-targeted therapeutics, such as fiber and prebiotics, have the potential to restore the balance in the gut microbiome and enhance host gut health and clinical outcomes. Indeed, studies in adult IBD patients demonstrate that fiber and prebiotics positively alter the microbiome and improve disease course. To date, no studies have been conducted to evaluate the therapeutic potential of fiber and prebiotics in pediatric IBD patients. Consequently, pediatric IBD specific studies that focus on the benefits of fiber and prebiotics on gut microbiome composition and functional capacity and disease outcomes are required. Full article

(This article belongs to the Special Issue Advances in Nutritional Management of Pediatric Inflammatory Bowel Disease)

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21 pages, 2900 KiB

Open AccessReview

Nutritional Therapy to Modulate Tryptophan Metabolism and Aryl Hydrocarbon-Receptor Signaling Activation in Human Diseases

by Mohammed Ghiboub, Charlotte M. Verburgt, Bruno Sovran, Marc A. Benninga, Wouter J. de Jonge and Johan E. Van Limbergen

Nutrients 2020, 12(9), 2846; https://0-doi-org.brum.beds.ac.uk/10.3390/nu12092846 - 17 Sep 2020

Cited by 37 | Viewed by 8004

Abstract

The aryl hydrocarbon receptor (AhR) is a nuclear protein which, upon association with certain endogenous and exogenous ligands, translocates into the nucleus, binds DNA and regulates gene expression. Tryptophan (Trp) metabolites are one of the most important endogenous AhR ligands. The intestinal microbiota is a critical player in human intestinal homeostasis. Many of its effects are mediated by an assembly of metabolites, including Trp metabolites. In the intestine, Trp is metabolized by three main routes, leading to kynurenine, serotonin, and indole derivative synthesis under the direct or indirect involvement of the microbiota. Disturbance in Trp metabolism and/or AhR activation is strongly associated with multiple gastrointestinal, neurological and metabolic disorders, suggesting Trp metabolites/AhR signaling modulation as an interesting therapeutic perspective. In this review, we describe the most recent advances concerning Trp metabolism and AhR signaling in human health and disease, with a focus on nutrition as a potential therapy to modulate Trp metabolites acting on AhR. A better understanding of the complex balance between these pathways in human health and disease will yield therapeutic opportunities. Full article

(This article belongs to the Special Issue Advances in Nutritional Management of Pediatric Inflammatory Bowel Disease)

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20 pages, 762 KiB

Open AccessReview

Dietary Strategies for Maintenance of Clinical Remission in Inflammatory Bowel Diseases: Are We There Yet?

by Konstantinos Gkikas, Konstantinos Gerasimidis, Simon Milling, Umer Z. Ijaz, Richard Hansen and Richard K. Russell

Nutrients 2020, 12(7), 2018; https://0-doi-org.brum.beds.ac.uk/10.3390/nu12072018 - 07 Jul 2020

Cited by 27 | Viewed by 7929

Abstract

The etiopathogenesis of Inflammatory bowel disease (IBD) is a result of a complex interaction between host immune response, the gut microbiome and environmental factors, such as diet. Although scientific advances, with the use of biological medications, have revolutionized IBD treatment, the challenge for maintaining clinical remission and delaying clinical relapse is still present. As exclusive enteral nutrition has become a well-established treatment for the induction of remission in pediatric Crohn’s disease, the scientific interest regarding diet in IBD is now focused on the development of follow-on dietary strategies, which aim to suppress colonic inflammation and delay a disease flare. The objective of this review is to present an extensive overview of the dietary strategies, which have been used in the literature to maintain clinical remission in both Crohn’s disease and Ulcerative colitis, and the evidence surrounding the association of dietary components with clinical relapse. We also aim to provide study-related recommendations to be encompassed in future research studies aiming to investigate the role of diet during remission periods in IBD. Full article

(This article belongs to the Special Issue Advances in Nutritional Management of Pediatric Inflammatory Bowel Disease)

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20 pages, 381 KiB

Open AccessReview

Nutrition, IBD and Gut Microbiota: A Review

by Maria Chiara Mentella, Franco Scaldaferri, Marco Pizzoferrato, Antonio Gasbarrini and Giacinto Abele Donato Miggiano

Nutrients 2020, 12(4), 944; https://0-doi-org.brum.beds.ac.uk/10.3390/nu12040944 - 29 Mar 2020

Cited by 158 | Viewed by 21042

Abstract

Inflammatory bowel disease (IBD) is a chronic relapsing–remitting systemic disease of the gastrointestinal tract, characterized by an inflammatory process that requires lifelong treatment. The underlying causes of IBD are still unclear, as this heterogeneous disorder results from a complex interplay between genetic variability, the host immune system and environmental factors. The current knowledge recognizes diet as a risk factor for the development of IBD and attributes a substantial pathogenic role to the intestinal dysbiosis inducing an aberrant mucosal immune response in genetically predisposed individuals. This review focused on the clinical evidence available that considers the impact of some nutrients on IBD onset and the role of different diets in the management of IBD and their effects on the gut microbiota composition. The effects of the Specific Carbohydrate Diet, low fermentable oligosaccharides, disaccharides, monosaccharides and polyols (FODMAP) diet, gluten free diet, anti-inflammatory diet and Mediterranean diet are investigated with regard to their impact on microbiota and on the evolution of the disease. At present, no clear indications toward a specific diet are available but the assessment of dysbiosis prior to the recommendation of a specific diet should become a standard clinical approach in order to achieve a personalized therapy. Full article

(This article belongs to the Special Issue Advances in Nutritional Management of Pediatric Inflammatory Bowel Disease)

Other

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8 pages, 430 KiB

Open AccessConcept Paper

A Case-Based Approach to New Directions in Dietary Therapy of Crohn’s Disease: Food for Thought

by Arie Levine, Wael El-Matary and Johan Van Limbergen

Nutrients 2020, 12(3), 880; https://0-doi-org.brum.beds.ac.uk/10.3390/nu12030880 - 24 Mar 2020

Cited by 19 | Viewed by 6986

Abstract

Recent evidence has demonstrated that Crohn’s disease may have its roots in dysbiosis of the microbiome and other environmental factors. One of the strongest risk factors linked to immune activation appears to be diet. Exclusion diets have been shown to ameliorate inflammation and induce remission in 70–80% of treatment-naïve children at disease onset, and to induce remission in patients that lose response or are refractory to currently recommended medical therapy. Recent studies have also linked dietary modulation of the microbiome with clinical remission, while reintroduction of the previous habitual diet led to reactivation of inflammation and reversion of the dysbiotic state. While dietary therapy has usually been used as a first line therapy as a bridge to immunomodulators, newer insights suggest that new treatment paradigms involving dietary therapy may allow different treatment strategies. This case-based narrative review will discuss the Crohn’s disease exclusion diet (CDED) as monotherapy, combination therapy with drugs, as a rescue therapy in refractory patients and for de-escalation from medical therapy. Full article

(This article belongs to the Special Issue Advances in Nutritional Management of Pediatric Inflammatory Bowel Disease)

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