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Disease activity and treatment with a small-molecule or an investigation drug were independently linked to an exclusion diet, while a history of stenosis and active disease were associated with fasting.
A large portion of patients with inflammatory bowel disease (IBD) participate in total or partial food exclusion, as well as fasting in an effort to manage the symptoms of IBD.1
A team, led by Olivier Bonsack, Department of Gastroenterology, University of Lorraine, Nancy University Hospital, characterized the prevalence of exclusion diets and fasting and identified associated risk factors for patients with IBD.
Patients with IBD frequently rely on diet to control symptoms, frequently asking physicians for additional guidance on diets.
“Recent research evidence points to a plausible role of diet and the microbiome in the pathogenesis of Crohn's disease (CD) and ulcerative colitis (UC),” the authors wrote. “Importantly, self-prescribed food avoidance fails to prevent relapse but can lead to poor outcomes with regard to mental health, quality of life, nutritional status, and nutritional deficiencies.”
Some other factors that influence food avoidance include limited or unclear dietary guidance and advice from alternative health practitioners.
The International Organization for the Study of Inflammatory Bowel Diseases published a dietary guidance consensus in 2020 that refers to several common dietary patterns for patients with IBD, including the Mediterranean diet, a specific carbohydrate diet, and the Crohn’s disease exclusion diet.
However, there aren’t many clinical trials for dietary patterns to yield strong recommendations.
In the study, the investigators used an anonymous questionnaire to screen patients attending an IBD nutrition clinic for exclusion diets between November 2021 and April 2022. The team defined the avoidance of a food category completely as a total exclusion, while a partial exclusion was defined by avoidance the majority of time. Patients also were asked whether they fasted totally, intermittently, or partially.
The investigators also collected sociodemographic data, including age and sex and clinical data such as regular tobacco use, previous IBD surgery, disease characteristic, IBD treatments, and the presence of extraintestinal manifestations. They also collected data on disease activity, including whether active disease corresponded with the need for corticosteroids or a treatment change.
The study included 434 patients with IBD, 36.6% (n = 159) of which totally excluded at least 1 food category and 62.4% (n = 271) of which partially excluded at least 1 food.
In addition, 30.8% of the patients reported intermittent, total, or partial fasting.
The results show disease activity (odds ratio [OR], 1.7; 95% confidence interval [CI], 1.1-2.7; P = 0.0130) and treatment with a small-molecule or an investigation drug (OR, 4.0; 95% CI, 1.5-10.6; P = 0.0059) were independently linked to an exclusion diet.
On the other hand, a history of stenosis (OR, 2.0; 95% CI, 1.2-3.2; P = 0.0063) and active disease (OR, 1.9; 95% CI, 1.2-3.1; P = 0.0059) were associated with fasting.
“In this real-world study, approximately two-thirds of our patients with IBD reported the partial or total exclusion of at least one food category and one third reported fasting,” the authors wrote. “A systematic nutritional evaluation might improve clinical management and quality of care for patients with IBD both Crohn's disease and ulcerative colitis.”
Bonsack, O., Caron, B., Baumann, C., Heba, A. C., Vieujean, S., Arnone, D., Netter, P., Danese, S., Quilliot, D., & Peyrin‐Biroulet, L. (2023). Food avoidance and fasting in patients with inflammatory bowel disease: Experience from the Nancy Ibd Nutrition Clinic. United European Gastroenterology Journal. https://doi.org/10.1002/ueg2.12385