Assessment of eating habits and nutritional status with subsequent remedial actions might lead to improvement of well-being and symptoms in patients with IBD
Data on diet influencing IBD activity is poor, with the exception of exclusive enteral nutrition inducing remission in Crohn's disease; how food choice can mimic this result is not known
Diet might be helpful in reducing symptoms and lessening the effects of IBD complications
A skilled dietitian is needed to guide diet for therapeutic benefit whilst maintaining adequate nutrition
Studies evaluating diet in IBD development have methodological problems; generally, data support 'healthy diets' including a variety from all food groups, whole-food instead of refined-foods and plant-based instead of animal-derived foods
The current general interest in the use of food choice or diet in maintaining good health and in preventing and treating disease also applies to patients with IBD, who often follow poor or nutritionally challenging dietary plans. Unfortunately, dietary advice plays only a minor part in published guidelines for management of IBD, which sends a message that diet is not of great importance. However, a considerable evidence base supports a focused and serious attention to nutrition and diet in patients with IBD. In this Review, a step-wise approach in the evaluation and management of these patients is proposed. First, dietary intake and eating habits as well as current nutritional state should be documented, and corrective measures instituted. Secondly, dietary strategies as primary or adjunctive therapy for the reduction of inflammation and/or prevention of relapse of IBD should be seriously contemplated. Thirdly, use of diet to improve symptoms or lessen the effects of complications should be considered. Finally, dietary advice regarding disease prevention should be discussed when relevant. An increasing need exists for applying improved methodologies into establishing the value of current and new ways of using food choice as a therapeutic and preventive tool in IBD.
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Jamieson, A. E., Fletcher, P. C. & Schneider, M. A. Seeking control through the determination of diet: a qualitative investigation of women with irritable bowel syndrome and inflammatory bowel disease. Clin. Nurse Spec. 21, 152–160 (2007).
Hou, J. K., Lee, D. & Lewis, J. Diet and inflammatory bowel disease: review of patient-targeted recommendations. Clin. Gastroenterol. Hepatol. 12, 1592–1600 (2014).
Vagianos, K. et al. What are adults with inflammatory bowel disease (IBD) eating? A closer look at the dietary habits of a population-based Canadian IBD cohort. JPEN J. Parenter. Enteral Nutr. http://dx.doi.org/10.1177/0148607114549254.
Walton, M. & Alaunyte, I. Do patients living with ulcerative colitis adhere to healthy eating guidelines? A cross-sectional study. Brit. J. Nutr. 112, 1628–1635 (2014).
Martin, G. S., Tapsell, L. C., Denmeade, S. & Betterham, M. J. Relative validity of a diet history interview in an intervention trial manipulating dietary fat in the management of Type II diabetes mellitus. Prev. Med. 36, 420–428 (2003).
Australian Government National Health and Medical Research Council. Australian dietary guidelines (2013) NHMRC [online], (2013).
Zallot, C. et al. Dietary beliefs and behavior among inflammatory bowel disease patients. Inflamm. Bowel Dis. 19, 66–72 (2013).
Craig, W. J. Nutrition concerns and health effects of vegetarian diets. Nutr. Clin. Pract. 25, 613–620 (2010).
Coin, A. et al. Fat-free and fat mass reference values by dual-energy X-ray absorptiometry (DEXA) in a 20–80 year-old Italian population. Clin. Nutr. 27, 87–94 (2008).
Forbes, A., Goldesgeyme, E. & Paulon, E. Nutrition in inflammatory bowel disease. JPEN J. Parenter. Enteral Nutr. 35, 571–580 (2011).
Bryant, R. V., Trott, M. J., Bartholomeusz, F. D. & Andrews, J. M. Systematic review: body composition in adults with inflammatory bowel disease. Aliment. Pharmacol. Ther. 38, 213–225 (2013).
van Langenberg, D. R. et al. Delving into disability in Crohn's disease: dysregulation of molecular pathways may explain skeletal muscle loss in Crohn's disease. J. Crohns Colitis 8, 626–634 (2014).
van Langenberg, D. R. et al. Objectively measured muscle fatigue in Crohn's disease: correlation with self-reported fatigue and associated factors for clinical application. J. Crohns Colitis 8, 137–146 (2014).
Jiménez-Redondo, S. et al. Influence of nutritional status on health-related quality of life of non-institutionalized older people. J. Nutr. Health Aging 18, 359–364 (2014).
Addolorato, G., Capristo, E., Stefanini, G. F. & Gasbarrini, G. Inflammatory bowel disease: a study of the association between anxiety and depression, physical morbidity, and nutritional status. Scand. J. Gastroenterol. 32, 1013–1021 (1997).
Bernal, I. et al. Predictors of clinical response to systemic steroids in active ulcerative colitis. Dig. Dis. Sci. 51, 1434–1438 (2006).
Valentini, L. et al. Malnutrition and impaired muscle strength in patents with Crohn's disease and ulcerative colitis in remission. Nutrition 24, 694–702 (2008).
Valentini, L. & Schulzke, J. Mundane, yet challenging: the assessment of malnutrition in inflammatory bowel disease. Euro J. Int. Med. 22, 13–15 (2011).
Belli, D. C. et al. Chronic intermittent elemental diet improves growth failure in children with Crohn's disease. Gastroenterology 94, 603–610 (1988).
Royall, D. et al. Total enteral nutrition support improves body composition of patients with active Crohn's disease. JPEN J. Parenter Enteral Nutr. 19, 95–99 (1995).
Rahman, A., Martin, C. & Heyland, D. K. Nutrition therapy for the critically III surgical patient with aortic aneurysmal rupture: defining and improving current practice. JPEN J. Parenter. Enteral Nutr. 39, 104–113 (2015).
Stroud, M., Duncan, H. & Nightingale, J. Guidelines for enteral feeding in adult hospital patients. Gut 52, 1–12 (2003).
Nagahori, M. et al. Prevalence of metabolic syndrome is comparable between inflammatory bowel disease patients and the general population. J. Gastroenterol. 45, 1008–1013 (2010).
Fink, C., Karagiannides, I., Bakirtzi, K. & Pothoulakis, C. Adipose tissue and inflammatory bowel disease pathogenesis. Inflamm. Bowel Dis. 18, 1550–1557 (2012).
Causey, M. W. et al. The impact of obesity on outcomes following major surgery for Crohn's disease: an American College of Surgeons national surgical quality improvement Program assessment. Dis. Colon Rectum 54, 1488–1495 (2011).
Krane, M. K. et al. Does morbid obesity change outcomes after laparoscopic surgery for inflammatory bowel disease? Review of 626 consecutive cases. J. Am. Coll. Surg. 216, 986–996 (2013).
Long, M. D. et al. Prevalence and epidemiology of overweight and obesity in children with inflammatory bowel disease. Inflamm. Bowel Dis. 17, 2162–2168 (2011).
Nic Suibhne, T. et al. High prevalence of overweight and obesity in adults with Crohn's disease: associations with disease and lifestyle factors. J. Crohns Colitis 7, e241–e248 (2013).
Steed, H., Walsh, S. & Reynolds, N. A brief report of the epidemiology of obesity in the inflammatory bowel disease population of Tayside, Scotland. Obes. Facts 2, 370–372 (2009).
Ungar, B. et al. Severe and morbid obesity in Crohn's disease patients: prevalence and disease associations. Digestion 88, 26–32 (2013).
Chan, S. S. et al. Body mass index and the risk for Crohn's disease and ulcerative colitis: data from a European Prospective Cohort Study (The IBD in EPIC Study). Am. J. Gastroenterol. 108, 575–582 (2013).
Via, M. The malnutrition of obesity: micronutrient deficiencies that promote diabetes. ISRN Endocrinol. 2012, 103472 (2012).
Vagianos, K., Bector, S., McConnell, J. & Bernstein, C. N. Nutrition assessment of patients with inflammatory bowel disease. JPEN J. Parenter. Enteral Nutr. 31, 311–319 (2007).
Vavricka, S. R., Rogler, G. Intestinal absorption and vitamin levels: is a new focus needed? Dig. Dis. 30 (Suppl. 3), 73–80 (2012).
Ostro, M. J., Greenberg, G. R. & Jeejeebhoy, K. N. Total parenteral nutrition and complete bowel rest in the management of Crohn's disease. JPEN J. Parenter. Enteral Nutr. 9, 280–287 (1985).
Zachos, M., Tondeur, M. & Griffiths, A. M. Enteral nutritional therapy for induction of remission in Crohn's disease. Cochrane Database of Systematic Reviews, Issue 1. Art. No.: CD000542 http://dx.doi.org/10.1002/14651858.CD000542.pub2.
Hugot, J. P. et al. Crohn's disease: the cold chain hypothesis. Lancet 362, 2012–2015 (2003).
Roberts, C. L., Rushworth, S. L., Richman, E. & Rhodes, J. M. Hypothesis: increased consumption of emulsifiers as an explanation for the rising incidence of Crohn's disease. J. Crohns Colitis 7, 338–341 (2013).
Gibson, P. R. & Shepherd, S. J. Personal view: food for thought—western lifestyle and susceptibility to Crohn's disease. The FODMAP hypothesis. Aliment. Pharmacol. Ther. 21, 1399–1409 (2005).
Roediger, W. E. Review article: nitric oxide from dysbiotic bacterial respiration of nitrate in the pathogenesis and as a target for therapy of ulcerative colitis. Aliment. Pharmacol. Ther. 27, 531–541 (2008).
Lerner, A. Aluminum is a potential environmental factor for Crohn's disease induction: extended hypothesis. Ann. N. Y. Acad. Sci. 1107, 329–345 (2007).
Lomer, M. C., Thompson, R. P. & Powell, J. J. Fine and ultrafine particles of the diet: influence on the mucosal immune response and association with Crohn's disease. Proc. Nutr. Soc. 61, 123–139 (2002).
Sullivan, S. N. Hypothesis revisited: toothpaste and the cause of Crohn's disease. Lancet 3336, 1096–1097 (1990).
Chuah, S. Y. et al. Dietary fats and inflammatory bowel disease in Asians. Ital. J. Gastroenterol. 24, 386–388 (1992).
Guthy, E. Crohn's disease and nutritional lipids. Hypothesis on etiology of regional enteritis [German]. Dtsch Med. Wochenschr. 107, 71–73 (1982).
Garg, M. et al. Review article: vitamin D and inflammatory bowel disease—established concepts and future directions. Aliment. Pharmacol. Ther. 36, 324–344 (2012).
Peyrin-Biroulet, L., Oussalah, A. & Bigard, M. A. Crohn's disease: the hot hypothesis. Med. Hypotheses 73, 94–96 (2009).
Garg, M., Rosella, O., Lubel, J. S. & Gibson, P. R. Association of circulating vitamin D concentrations with intestinal but not systemic inflammation in inflammatory bowel disease. Inflamm. Bowel Dis. 19, 2634–2643 (2013).
Roediger, W. E. Decreased sulphur amino acid intake in ulcerative colitis. Lancet 351, 1555 (1998).
Cohen, S. A. et al. Clinical and mucosal improvement with the specific carbohydrate diet in pediatric Crohn's disease: a prospective pilot study. J. Pediatr. Gastroenterol. Nutr. 59, 516–521 (2014).
Suskind, D. L. et al. Nutritional therapy in pediatric Crohn disease: the specific carbohydrate diet. J. Pediatr. Gastroenterol. Nutr. 58, 87–91 (2014).
Olendzki, B. C. et al. An anti-inflammatory diet as treatment for inflammatory bowel disease: a case series report. Nutr. J. 13, 5 (2014).
Yao, C. K., Gibson, P. R. & Shepherd, S. J. Design of clinical trials evaluating dietary interventions in patients with functional gastrointestinal disorders. Am. J. Gastroenterol. 108, 748–758 (2013).
Dickinson, R. J. et al. Controlled trial of intravenous hyperalimentation and total bowel rest as an adjunct to the routine therapy of acute colitis. Gastroenterology 79, 1199–1204 (1980).
Strisciuglio, C. et al. Does cow's milk protein elimination diet have a role on induction and maintenance of remission in children with ulcerative colitis? Acta Paediatr. 102, e273–e278 (2013).
Wright, R. & Truelove, S. C. A controlled therapeutic trial of various diets in ulcerative colitis. Br. Med. J. 2, 138–141 (1965).
Wedlake, L., Slack, N., Andreyev, H. J. & Whelan, K. Fiber in the treatment and maintenance of inflammatory bowel disease: a systematic review of randomized controlled trials. Inflamm. Bowel Dis. 20, 576–586 (2014).
James, S. L. et al. Abnormal fibre usage in UC in remission. Gut http://dx.doi.org/10.1136/gutjnl-2014-307198.
Turner, D. et al. Maintenance of remission in inflammatory bowel disease using omega-3 fatty acids (fish oil): a systematic review and meta-analyses. Inflamm. Bowel Dis. 17, 336–345 (2011).
Kyaw, M. H., Moshkovska, T. & Mayberry, J. A prospective, randomized, controlled, exploratory study of comprehensive dietary advice in ulcerative colitis: impact on disease activity and quality of life. Eur. J. Gastroenterol. Hepatol. 26, 910–917 (2014).
Day, A. S. et al. Exclusive enteral feeding as primary therapy for Crohn's disease in Australian children and adolescents: a feasible and effective approach. J. Gastroenterol. Hepatol. 21, 1609–1614 (2006).
Dziechciarz, P., Horvath, A., Shamir, R. & Szajewska, H. Meta-analysis: enteral nutrition in active Crohn's disease in children. Aliment. Pharmacol. Ther. 26, 795–806 (2007).
Heuschkel, R. B., Menache, C. C., Megerian, J. T. & Baird, A. E. Enteral nutrition and corticosteroids in the treatment of acute Crohn's disease in children. J. Pediatr. Gastroenterol. Nutr. 31, 8–15 (2000).
Levin, A. D. et al. Vitamin D deficiency in children with inflammatory bowel disease. Dig. Dis. Sci. 56, 830–836 (2011).
Afzal, N. A. et al. Improvement in quality of life of children with acute Crohn's disease does not parallel mucosal healing after treatment with exclusive enteral nutrition. Aliment. Pharmacol. Ther. 20, 167–172 (2004).
Wall, C. L., Day, A. S. & Gearry, R. B. Use of exclusive enteral nutrition in adults with Crohn's disease: a review. World J. Gastroenterol. 19, 7652–7660 (2013).
Gerasimidis, K. et al. Decline in presumptively protective gut bacterial species and metabolites are paradoxically associated with disease improvement in pediatric Crohn's disease during enteral nutrition. Inflamm. Bowel Dis. 20, 861–871 (2014).
Tjellström, B. et al. Effect of exclusive enteral nutrition on gut microflora function in children with Crohn's disease. Scand. J. Gastroenterol. 47, 1454–1459 (2012).
Greenberg, G. R. et al. Controlled trial of bowel rest and nutritional support in the management of Crohn's disease. Gut 29, 1309–1315 (1988).
Jones, V. A. Comparison of total parenteral nutrition and elemental diet in induction of remission of Crohn's disease. Long-term maintenance of remission by personalized food exclusion diets. Dig. Dis. Sci. 32 (12 Suppl.), 100S–107S (1987).
Marion-Letellier, R. et al. Polyunsaturated fatty acids in inflammatory bowel diseases: a reappraisal of effects and therapeutic approaches. Inflamm. Bowel Dis. 19, 650–661 (2013).
Tsujikawa, T. et al. Clinical importance of n-3 fatty acid-rich diet and nutritional education for the maintenance of remission in Crohn's disease. J. Gastroenterol. 35, 99 (2000).
Lomer, M. C. et al. 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, 377–384 (2005).
Patel, P. et al. Clinical evidence for allergy in orofacial granulomatosis and inflammatory bowel disease. Clin. Transl. Allergy 3, 26 (2013).
Campbell, H. et al. Distinguishing orofacial granulomatosis from Crohn's disease: two separate disease entities? Inflamm. Bowel Dis. 17, 2109–2115 (2011).
Campbell, H. et al. Dietary intervention for oral allergy syndrome as a treatment in orofacial granulomatosis: a new approach? J. Oral Pathol. Med. 42, 517–522 (2013).
Campbell, H. E. et al. Development of a low phenolic acid diet for the management of orofacial granulomatosis. J. Hum. Nutr. Diet 26, 527–537 (2013).
Riordan, A. M. et al. Treatment of active Crohn's disease by exclusion diet: East Anglian multicentre controlled trial. Lancet 342, 1131–1134 (1993).
Takagi, S. et al. Effectiveness of an 'half elemental diet' as maintenance therapy for Crohn's disease: A randomized-controlled trial. Aliment. Pharmacol. Ther. 24, 1333–1340 (2006).
Chiba, M. et al. Lifestyle-related disease in Crohn's disease: relapse prevention by a semi-vegetarian diet. World J. Gastroenterol. 16, 2484–2495 (2010).
Nicholson, I., Dalzell, A. M. & El-Matary, W. Vitamin D as a therapy for colitis: a systematic review. J. Crohns Colitis 6, 405–411 (2012).
Jørgensen, S. P. et al. Clinical trial: vitamin D3 treatment in Crohn's disease—a randomized double-blind placebo-controlled study. Aliment. Pharmacol. Ther. 32, 377–383 (2010).
Ludvigsson, J. F. et al. Elemental versus polymeric enteral nutrition in paediatric Crohn's disease: a multicentre randomized controlled trial. Acta Paediatr. 93, 327–335 (2004).
Kansal, S., Wagner, J., Kirkwood, C. D. & Catto-Smith, A. G. Enteral nutrition in Crohn's disease: an underused therapy. Gastroenterol. Res. Pract. 2013, 482108 (2013).
Gorard, D. A. et al. Initial response and subsequent course of Crohn's disease treated with elemental diet or prednisolone. Gut 34, 1198–1202 (1993).
van Bodegraven, A. A. et al. Treatment of bone loss in osteopenic patients with Crohn's disease: a double-blind, randomised trial of oral risedronate 35 mg once weekly or placebo, concomitant with calcium and vitamin D supplementation. Gut 63, 1424–1430 (2014).
Davies, P. S. & Rhodes, J. Maintenance of remission in ulcerative colitis with sulphasalazine or a high-fibre diet: a clinical trial. Br. Med. J. 1, 1524–1525 (1978).
Farrokhyar, F., Marshall, J. K., Easterbrook, B. & Irvine, E. J. Functional gastrointestinal disorders and mood disorders in patients with inactive inflammatory bowel disease: Prevalence and impact on health. Inflamm. Bowel Dis. 12, 38–46 (2006).
Simrén, M. et al. Quality of life in inflammatory bowel disease in remission: the impact of IBS-like symptoms and associated psychological factors. Am. J. Gastroenterol. 97, 389–396 (2002).
de Roest, R. H. et al. The low FODMAP diet improves gastrointestinal symptoms in patients with irritable bowel syndrome: a prospective study. Int. J. Clin. Pract. 67, 895–903 (2013).
Halmos, E. P. et al. A diet low in FODMAPs reduces symptoms of irritable bowel syndrome. Gastroenterology 146, 67–75 (2014).
Staudacher, H. M., Whelan, K., Irving, P. M. & Lomer, M. C. E. Comparison of symptom response following advice for a diet low in fermentable carbohydrates (FODMAPs) versus standard dietary advice in patients with irritable bowel syndrome. J. Hum. Nutr. Diet 24, 487–495 (2011).
Halmos, E. et al. Restriction of dietary FODMAPs reduces gastrointestinal symptoms compared with a typical Australian intake in patients with irritable bowel syndrome: a randomised controlled cross-over trial. J. Gastroenterol. Hepatol. 27 (Suppl. 4) 141 (2012).
Pedersen, N. et al. Low FODMAP diet reduces IBS symptoms and improves quality of life in patients with IBD in a randomized controlled trial. Presented at the 9th Congress of ECCO.
Gearry, R. B. et al. Reduction of dietary poorly absorbed short-chain carbohydrates (FODMAPs) improves abdominal symptoms in patients with inflammatory bowel disease—a pilot study. J. Crohn's Colitis 3, 8–14 (2009).
Barrett, J. S. et al. Dietary poorly absorbed, short-chain carbohydrates increase delivery of water and fermentable substrates to the proximal colon. Aliment. Pharmacol. Ther. 31, 874–882 (2010).
Croagh, C. et al. Pilot study on the effect of reducing dietary FODMAP intake on bowel function in patients without a colon. Inflamm. Bowel Dis. 13, 1522–1528 (2007).
Herfarth, H. H. et al. Prevalence of a gluten-free diet and improvement of clinical symptoms in patients with inflammatory bowel diseases. Inflamm. Bowel Dis. 20, 1194–1197 (2014).
Gibson, P. R., Muir, J. G. & Newnham, E. D. Other dietary confounders. FODMAPs. Dig. Dis. (in press).
Lee, J. et al. British Dietetic Association evidence-based guidelines for the dietary management of Crohn's disease in adults. J. Hum. Nutr. Diet 27, 207–218 (2014).
Levenstein, S., Prantera, C., Luzi, C. & D'Ubaldi, A. Low residue or normal diet in Crohn's disease: a prospective controlled study in Italian patients. Gut 26, 989–993 (1985).
Maconi, G. et al. Prevalence of pancreatic insufficiency in inflammatory bowel diseases. Assessment by fecal elastase-1. Dig. Dis. Sci. 53, 262–270 (2008).
Worcester, E. M. Stones from bowel disease. Endocrinol. Metab. Clin. North Am. 31, 979–999 (2002).
Tiselius, H. G. Epidemiology and medical management of stone disease. Brit. J. Urol. Int. 91, 758–767 (2003).
Goh, K. & Xiao, S. D. Inflammatory bowel disease: a survey of the epidemiology in Asia. J. Dig. Dis. 10, 1–6 (2009).
Prideaux, L. et al. Inflammatory bowel disease in Asia: a systematic review. J. Gastroenterol. Hepatol. 27, 1266–1280 (2012).
Ananthakrishnan, A. N. et al. Higher predicted vitamin D status is associated with reduced risk of Crohn's disease. Gastroenterology 142, 482–489 (2012).
Steed, H., Walsh, S. & Reynolds, N. Crohn's disease incidence in NHS Tayside. Scott Med. J. 55, 22–25 (2010).
Ananthakrishnan, A. N. et al. Long-term intake of dietary fat and risk of ulcerative colitis and Crohn's disease. Gut 63, 776–784 (2014).
Ananthakrishnan, A. N. et al. A prospective study of long-term intake of dietary fiber and risk of Crohn's disease and ulcerative colitis. Gastroenterology 145, 970–977 (2013).
Khalili, H. et al. Early life factors and risk of inflammatory bowel disease in adulthood. Inflamm. Bowel Dis. 19, 542–547 (2013).
Gearry, R. B. et al. Population-based cases control study of inflammatory bowel disease risk factors. J. Gastroenterol. Hepatol. 25, 325–333 (2010).
Barclay, A. R. et al. Systematic review: the role of breastfeeding in the development of pediatric inflammatory bowel disease. J. Pediatr. 155, 421–426 (2009).
Hart, A. R. et al. Diet in the aetiology of ulcerative colitis: a European prospective cohort study. Digestion 77, 57–64 (2008).
Jantchou, P. et al. Animal protein intake and risk of inflammatory bowel disease: the E3N prospective study. Am. J. Gastroenterol. 105, 2195–2201 (2010).
Shoda, R., Matsueda, K., Yamato, S. & Umeda, N. Epidemiologic analysis of Crohn disease in Japan: increased dietary intake of n-6 polyunsaturated fatty acids and animal protein relates to the increased incidence of Crohn disease in Japan. Am. J. Clin. Nutr. 63, 741–745 (1996).
Hou, J. K., Abraham, B. & El-Serag, H. Dietary intake and risk of developing inflammatory bowel disease: a systematic review of the literature. Am. J. Gastroenterol. 106, 563–573 (2011).
Spooren, C. E. et al. Review article: the association of diet with onset and relapse in patients with inflammatory bowel disease. Aliment. Pharmacol. Ther. 38, 1172–1187 (2013).
Klement, E. et al. Breastfeeding and risk of inflammatory bowel disease: a systematic review with meta-analysis. Am. J. Clin. Nutr. 80, 1342–1352 (2004).
Brown, A. C., Rampertab, S. D. & Mullin, G. E. Existing dietary guidelines for Crohn's disease and ulcerative colitis. Expert Rev. Gastroenterol. Hepatol. 5, 411–425 (2011).
Gibson, P. R. Overview of inflammatory bowel disease in Australia in the last 50 years. J. Gastroenterol. Hepatol. 24, S63–S68 (2009).
Eswaran, S., Muir, J. & Chey, W. D. Fiber and functional gastrointestinal disorders. Am. J. Gastroenterol. 108, 718–727 (2013).
Biesiekierski, J. R. et al. No effects of gluten in patients with self-reported non-celiac gluten sensitivity after dietary reduction of fermentable, poorly absorbed, short-chain carbohydrates. Gastroenterolgy 145, 320–328 (2013).
Benjamin, J. et al. Randomised, double-blind, placebo-controlled trial of fructo-oligosaccharides in active Crohn's disease. Gut 60, 923–929 (2011).
Campos, F. G. et al. Pharmacological nutrition in inflammatory bowel diseases. Nutr. Hosp. 18, 57–64 (2003).
Baliga, M. S. et al. Curcumin, an active component of turmeric in the prevention and treatment of ulcerative colitis: preclinical and clinical observations. Food Funct. 3, 1109–1117 (2012).
Pfeffer-Gik, T. & Levine, A. Dietary clues to the pathogenesis of Crohn's disease. Dig. Dis. 32, 389–394 (2014).
Detsky, A. S. et al. What is subjective global assessment of nutritional status? JPEN J. Parenter. Enteral Nutr. 11, 8–13 (1987).
Ferguson, M., Capra, S., Bauer, J. & Banks, M. Development of a valid and reliable malnutrition screening tool for adult acute hospital patients. Nutr. 15, 458–464 (1999).
Guigoz, Y. The Mini Nutritional Assessment (MNA) review of the literature—what does it tell us? J. Nutr. Health Aging 10, 466–485 (2006).
Fuller, N. J. et al. Inter-observer variability in the measurement of body composition. Eur. J. Clin. Nutr. 45, 43–49 (1991).
Kyle, U. G. et al. Bioelectrical impedance analysis—part 1: review of principles and methods. Clin. Nutr. 23, 1226–1243 (2004).
Lee, S. & Kuk, J. L. Changes in fat and skeletal muscle with exercise training in obese adolescents: comparison of whole-body MRI and dual energy X-ray absorptiometry. Obesity (Silver Spring) 21, 2063–2071 (2013).
Bosy-Westphal, A. et al. Accuracy of bioelectrical impedance consumer devices for measurement of body composition in comparison to whole body magnetic resonance imaging and dual X-ray absorptiometry. Obes. Facts 1, 319–324 (2008).
Ishida, S. et al. Serum albumin levels correlate with inflammation rather than nutrition supply in burns patients: a retrospective study. J. Med. Invest. 61, 361–368 (2014).
Ingenbleek, Y. & Young, V. Transthyretin (prealbumin) in health and disease: nutritional implications. Annu. Rev. Nutr. 14, 495–533 (1994).
Theil, E. C. Ferritin: Structure, gene regulation, and cellular function in animals, plants, and microorganisms. Ann. Rev. Biochem. 56, 289–315 (1987).
Battat, R. et al. Vitamin B12 deficiency in inflammatory bowel disease: prevalence, risk factors, evaluation, and management. Inflamm. Bowel Dis. 20, 1120–1128 (2014).
Gibson, R. S., Hess, S. Y., Hotz, C. & Brown, K. H. Indicators of zinc status at the population level: a review of the evidence. Br. J. Nutr. 99 (Suppl. 3), S14–S23 (2008).
Suitor, C. W. & Bailey, L. B. Dietary folate equivalents: interpretation and application. J. Acad. Nutr. Diet 100, 88–94 (2000).
Heaney, R. P. Dairy and bone health. J. Am. Coll. Nutr. 28 (Suppl. 1.) 82S–90S (2009).
Swaminathan, R. Magnesium metabolism and its disorders. Clin. Biochem. Rev. 24, 47–66 (2003).
Leo, S. et al. Ulcerative colitis in remission: it is possible to predict the risk of relapse? Digestion 44, 217–221 (1989).
Jowett, S. L. et al. Influence of dietary factors on the clinical course of ulcerative colitis: a prospective cohort study. Gut 53, 1479–1484 (2004).
Magee, E. A. et al. Associations between diet and disease activity in ulcerative colitis patients using a novel method of data analysis. Nutr. J. 4, 7 (2005).
Tanaka, M. et al. Moderate dietary temperance effectively prevents relapse of Crohn disease: a prospective study of patients in remission. Gastroenterol. Nurs. 30, 202–210 (2007).
Guerreiro, C. S. et al. Fatty acids IL6 and TNFα polymorphisms: an example of nutrigenetics in Crohn's disease. Am. J. Gastroenterol. 104, 2241–2249 (2009).
Bentz, S. et al. Clinical relevance of IgG antibodies against food antigens in Crohn's disease: a double-blind cross-over diet intervention study. Digestion 81, 252–264 (2010).
Brotherton, C. S., Taylor, A. G., Bourguignon, C. & Anderson, J. G. A high-fiber diet may improve bowel function and health-related quality of life in patients with Crohn disease. Gastroenterol. Nurs. 37, 206–216 (2014).
Lomer, M. C. et al. Efficacy and tolerability of a low microparticle diet in a double blind, randomized, pilot study in Crohn's disease. Eur. J. Gastroenterol. Hepatol. 13, 101–106 (2001).
Ritchie, J. K., Wadsworth, J., Lennard-Jones, J. E. & Rogers, E. Controlled multicentre therapeutic trial of an unrefined carbohydrate, fibre rich diet in Crohn's disease. Br. Med. J. (Clin. Res. Ed.) 295, 517–520 (1987).
Wilschanski, M. et al. Supplementary enteral nutrition maintains remission in paediatric Crohn's disease. Gut 38, 543–548 (1996).
Esaki, M. et al. Factors affecting recurrence in patients with Crohn's disease under nutritional therapy. Dis. Colon Rectum 49 (10 Suppl.), S68–S74 (2006).
Verma, S., Holdsworth, C. D. & Giaffer, M. H. Does adjuvant nutritional support diminish steroid dependency in Crohn disease? Scand. J. Gastroenterol. 36, 383–388 (2001).
Yamamoto, T. et al. 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, 67–72 (2007).
Yamamoto, T. et al. Enteral nutrition to suppress postoperative Crohn's disease recurrence: a five-year prospective cohort study. Int. J. Colorectal Dis. 28, 335–340 (2013).
Yamamoto, T., Nakahigashi, M., Umegae, S. & Matsumoto, K. Prospective clinical trial: enteral nutrition during maintenance infliximab in Crohn's disease. J. Gastroenterol. 45, 24–29 (2010).
Hirai, F. et al. Effectiveness of concomitant enteral nutrition therapy and Infliximab for maintenance treatment of Crohn's disease in adults. Dig. Dis. Sci. 58, 1329–1334 (2013).
Tjonneland, A. et al. Linoleic acid, a dietary n-6 polyunsaturated fatty acid, and the aetiology of ulcerative colitis: a nested case-control study within a European prospective cohort study. Gut 58, 1606–1611 (2009).
de Silva, P. S. et al. Dietary arachidonic and oleic acid intake in ulcerative colitis etiology: a prospective cohort study using 7-day food diaries. Eur. J. Gastroenterol. Hepatol. 26, 11–18 (2014).
P.R.G. has published books on food intolerances. E.P.H. declares no competing interests. The Department of Gastroenterology, Monash University, Australia, has published an aApp on the Monash University Low FODMAPs Diet, the proceeds of which partly go to the Department, but not to the individuals working there.
Scorecard with interpretation of the overall findings associated with susceptibility to developing Crohn's disease or ulcerative colitis in retrospective dietary intake studies (develop from data from Spooren et al.S1) (PDF 102 kb)
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Halmos, E., Gibson, P. Dietary management of IBD—insights and advice. Nat Rev Gastroenterol Hepatol 12, 133–146 (2015). https://doi.org/10.1038/nrgastro.2015.11
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