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  • Review Article
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Dietary management of adults with IBD — the emerging role of dietary therapy

Nature Reviews Gastroenterology & Hepatology volume 19, pages 652–669 (2022)Cite this article

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Abstract

Historically, dietitians played a minor part in the management of inflammatory bowel disease (IBD), including Crohn’s disease and ulcerative colitis. Patients were commonly referred for consequences of uncontrolled disease, such as malnutrition and bowel obstruction risk. Today, dietitians are fundamental members of the multidisciplinary IBD team, from educating on the role of diet at diagnosis and throughout the lifespan of a patient with IBD to guiding primary induction therapy. This aspect is reflected in published guidelines for IBD management, which previously placed diet as only a minor factor, but now have diet-specific publications. This Review describes a four-step approach in a dietitian’s assessment and management of diet in patients with IBD: (1) identifying and correcting nutritional gaps and dietary imbalances; (2) considering diet to treat active disease with the use of exclusive enteral nutrition (EEN) or emerging diets that could replace EEN; (3) using therapeutic diets to control existing complications of IBD, such as reduced fibre to prevent bowel obstruction in stricturing disease or a fermentable oligosaccharides, disaccharides, monosaccharides and polyols diet to manage co-existing functional gut symptoms; and (4) considering the role of diet in preventing IBD development in high-risk populations.

Key points

  • Specialized dietitian intervention is a key component of inflammatory bowel disease (IBD) management and all patients with symptoms or who have changed their diet should be referred to a dietitian.

  • Nutrition assessment needs to include body composition assessments that are associated with clinical outcomes.

  • Exclusive enteral nutrition (EEN) and the Crohn’s Disease Exclusion Diet could be used to induce IBD remission, with potential for emerging, more-targeted diets to treat disease.

  • Dietary therapy is used to managed complications of IBD, including bowel obstruction risk and co-existing functional gut symptoms.

  • Preoperative nutritional support, with oral nutritional supplements or EEN, improves surgical outcomes and should be optimized if possible.

  • Disordered eating is an emerging issue in IBD and needs clinical consideration and further examination.

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Fig. 1: Roles of diet therapy in management of IBD in a four-step strategy.
Fig. 2: Proposed mechanisms of action for exclusive enteral nutrition treating active Crohn’s disease.

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Acknowledgements

J.A.F. is supported by a Monash University Australian Postgraduate Award and Crohn’s & Colitis Australia PhD Scholarship, S.L.M. is supported by an Alfred Research Trusts Small Project Grant, C.K.Y. is supported by a Crohn’s & Colitis Australia Angela McAvoy Scholarship, E.P.H. is supported by the Crohn’s & Colitis Foundation Litwin IBD Pioneers Program and a National Health & Medical Research Council Investigator Grant. The authors thank M. Justice for help with designing the initial draft of the figures.

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  1. These authors contributed equally: Jessica Fitzpatrick, Sarah Melton.

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  1. Department of Gastroenterology, The Alfred Hospital and Monash University, Melbourne, Victoria, Australia

    Jessica A. Fitzpatrick, Sarah L. Melton, Chu Kion Yao, Peter R. Gibson & Emma P. Halmos

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The authors contributed to researching data, writing, and reviewing/editing the manuscript before submission. J.A.F., S.L.M., P.R.G. and E.P.H. were involved in discussion of content of the article.

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P.R.G. has published a book on food intolerances. The Department of Gastroenterology has published an App, booklets and online educational courses on the Monash University FODMAP Diet, the proceeds of which go to the Department, not to individuals. The other authors declare no competing interests.

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Nature Reviews Gastroenterology & Hepatology thanks Henit Yanai, who co-reviewed with Lihi Godny; Catherine Wall; and the other, anonymous, reviewer(s) for their contribution to the peer review of this work.

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Fitzpatrick, J.A., Melton, S.L., Yao, C.K. et al. Dietary management of adults with IBD — the emerging role of dietary therapy. Nat Rev Gastroenterol Hepatol 19, 652–669 (2022). https://doi.org/10.1038/s41575-022-00619-5

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