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

• Published in: Nature reviews. Gastroenterology & hepatology Vol. 19; no. 10; pp. 652 - 669
• Main Authors: Fitzpatrick, Jessica A., Melton, Sarah L., Yao, Chu Kion, Gibson, Peter R., Halmos, Emma P.
• Format: Journal Article
• Language: English
• Published: London Nature Publishing Group UK 01.10.2022; Nature Publishing Group
• Subjects: 631/326/2565/2134; 692/4020/1503/257; Biomedicine; Crohn's disease; Diet; Dietitians; Disaccharides; Disease management; Gastroenterology; Hepatology; Induction therapy; Inflammatory bowel disease; Inflammatory bowel diseases; Intestinal obstruction; Intestine; Life span; Malnutrition; Medicine; Medicine & Public Health; Monosaccharides; Oligosaccharides; Polyols; Review Article; Ulcerative colitis
• ISSN: 1759-5045; 1759-5053
• DOI: 10.1038/s41575-022-00619-5

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. Diet is part of the multidisciplinary management of inflammatory bowel disease (IBD). This Review outlines a step-based approach to the dietary management of IBD, outlining the role of dietary therapy with practical insights for dietitians and clinicians. 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.