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Dietary adherence to the Mediterranean diet pattern in a randomized clinical trial of patients with quiescent ulcerative colitis (MED)

NTforIBD Comment: Newsletter March 2023

Summary Excerpt: Patients with UC can adhere to and tolerate the Mediterranean Diet Pattern (MDP) and achieve improved diet quality with reduced bowel symptoms compared to Canadian Habitual Diet (CHD). Increased adherence to the MDP can be achieved through appropriate support such as nutrition education and counseling by a Registered Dietitian. Overall, this data supports that the MDP can be recommended as a remission diet to UC patients to help support disease management alongside front-line therapy drugs.

Dietary adherence to the Mediterranean diet pattern in a randomized clinical trial of patients with quiescent ulcerative colitis. Frontiers in Nutrition, 9.
Haskey, N et al.

Lessons from an audit of exclusive enteral nutrition in adult inpatients and outpatients with active Crohn’s disease: a single-centre experience (EEN)

NTforIBD Comment: Newsletter March 2023

Summary Excerpt: Positive outcomes occur in 70% of adult patients with Crohn’s disease tolerating EEN and 81% in those who are able to completely adhere to EEN, without compromise of nutritional status. Similar success occurs when initiated as an inpatient or outpatient. Failure to tolerate EEN is the major hurdle to its use.

Lessons from an audit of exclusive enteral nutrition in adult inpatients and outpatients with active Crohn’s disease: a single-centre experienceFrontline Gastroenterology 2023;14:6-12.
Melton SL, et al

Date Title Diets Authors Summary Excerpt Citation
Oct 2020 Effectiveness of Mediterranean Diet's Adherence in children with Inflammatory Bowel Diseases MED Strisciuglio C et al Children with IBD in remission have a sub-optimal food intake compared to HCs. MD seems to correlate to decreased intestinal inflammation. Nutrients . 2020 Oct 20;12(10):3206. doi: 10.3390/nu12103206.
Dec 2020 The Specific Carbohydrate Diet and Diet Modification as Induction Therapy for Pediatric Crohn's Disease: A Randomized Diet Controlled Trial SCD, mSCD Suskind DL et al 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. Nutrients . 2020 Dec 6;12(12):E3749. doi: 10.3390/nu12123749
Jan 2021 Multidimensional Impact of Mediterranean Diet on IBD Patients MED Chicco F et al A significant reduction of malnutrition-related parameters and liver steatosis was observed in both CD and UC patients after short-term dietary intervention based on the adoption of Md, and this was associated with a spontaneous improvement of disease activity and inflammatory markers. https://pubmed.ncbi.nlm.nih.gov/32440680/
Jan 2021 Randomised Clinical Trial: Exclusive Enteral Nutrition Versus Standard of Care for Acute Severe Ulcerative Colitis EEN Sahu P et al Patients on EEN had a shorter hospital stay [median (range) 10 (8-17) vs 13 (8-24) days; P = 0.04], higher day 7 albumin level (34 ± 4 vs 29 ± 3 g/L, P < 0.01), greater reduction in serum C-reactive protein and faecal calprotectin levels (both P = 0.04) and a lower composite outcome of colectomy/hospitalisation at 6 months (16% vs 39%; P = 0.045) compared to SOC. Aliment Pharmacol Ther . 2021 Jan 13. doi: 10.1111/apt.16249
Feb 2021 Elemental Diet Therapy Plays a Significant Role in Preventing Surgical Recurrence of Crohn's Disease in the Era of Biologics PEN Shinozaki M et al Although univariate analyses revealed that all three treatment strategies had significant effects on surgical recurrence in patients with CD, multivariate analysis revealed that only ED therapy was significantly associated with surgical recurrence rates. Thus, ED therapy plays an important role in the management of CD, even in the era of biological therapies. Surg Today . 2021 Feb;51(2):250-257. doi: 10.1007/s00595-020-02112-5. Epub 2020 Aug 18.
May 2021 A Randomized Trial Comparing the Specific Carbohydrate Diet to a Mediterranean Diet in Adults with Crohn's Disease SCD, MED Lewis JD et al This study compares the SCD and MD on symptoms, fecal calprotectin and CRP at 6 and 12 weeks finding no statistical significance in these endpoints. Gastroenterology. 2021;S0016-5085(21)03069-9. doi:10.1053/j.gastro.2021.05.047
Jun 2021 Low-Fat, High-Fiber Diet Reduces Markers of Inflammation and Dysbiosis and Improves Quality of Life in Patients With Ulcerative Colitis Other Diets - UC Fritsch J et al In a cross-over study of patients with UC in remission, we found that a catered LFD or iSAD were each well tolerated and increased quality of life. However, the LFD decreased markers of inflammation and reduced intestinal dysbiosis in fecal samples. Dietary interventions therefore might benefit patients with UC in remission. Clin Gastroenterol Hepatol . 2021 Jun;19(6):1189-1199.e30. doi: 10.1016/j.cgh.2020.05.026. Epub 2020 May 20.
Nov 2021 The Crohn's disease exclusion diet for induction and maintenance of remission in adults with mild-to-moderate Crohn's disease (CDED-AD): an open-label, pilot, randomised trial CDED Yanai, H. et al. CDED with or without partial enteral nutrition was effective for induction and maintenance of remission in adults with mild-to-moderate biologic naive Crohn's disease and might lead to endoscopic remission. Lancet Gastroenterol Hepatol. 2021;S2468-1253(21)00299-5. doi:10.1016/S2468-1253(21)00299-5
Jan 2022 Dietary manipulation of the gut microbiome in inflammatory bowel disease patients: Pilot study IBD-AID Olendzki B et al Consumption of prebiotics, probiotics, and beneficial foods correlated with increased abundance of Clostridia and Bacteroides, commonly depleted in IBD cohorts. We further show that specific foods categorized as prebiotics or adverse foods are correlated to levels of cytokines in serum (i.e., GM-CSF, IL-6, IL-8, TNF-alpha) that play a central role in IBD pathogenesis. Gut Microbes . Jan-Dec 2022;14(1):2046244. doi: 10.1080/19490976.2022.2046244.
Feb 2022 Clinical and Histologic Remission in an Adult Crohn’s Disease Patient Following the Specific Carbohydrate Diet and Its Impact on Healthcare Costs SCD Arjomand, A This case highlights the rapid and sustainable benefits of the SCD intervention in Crohn’s disease from both a clinical and economic standpoint. Cureus 14(2): e22032. doi:10.7759/cureus.22032
Mar 2022 Adherence to the Mediterranean Diet Improved Clinical Scores and Inflammatory Markers in Children with Active Inflammatory Bowel Disease: A Randomized Trial MED El Amrousy D, et al. Adherence to the Mediterranean diet improves clinical scores and inflammatory markers in children and adolescents with mild-moderate active IBD. J Inflamm Res. 2022;15:2075-2086. doi:10.2147/JIR.S349502
Jun 2022 Personalized Research on Diet in Ulcerative Colitis and Crohn's Disease (PRODUCE): A Series of N-of-1 Diet Trials SCD, mSCD Kaplan HC et al “SCD and MSCD did not consistently improve symptoms or inflammation although some individuals may have benefited.” Am J of Gastroenterol 2022 June 1;117(6):902-917.

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