Plain language summary
Inflammatory Bowel Disease (IBD) are chronic inflammatory diseases, mediated by the immune system, which affect the gastrointestinal tract. The two main manifestations are Crohn’s Disease and ulcerative colitis. Patients with IBD often experience malnutrition, undernutrition, or overnutrition during their disease. This study aimed to evaluate the connection between nutrition, nutritional status (including undernutrition and overnutrition), micronutrient deficiency, and the disease course in adult IBD patients. This study was a systematic review of 227 articles. The findings of this review showed that addressing various nutritional aspects could lead to better symptom control, deeper remission, and an overall improvement in the quality of life for IBD patients. The authors concluded that optimising nutritional management plays a crucial role in managing IBD effectively. Understanding the impact of nutrition on disease course can guide targeted interventions for better patient outcomes.
Expert Review
Conflicts of interest:
None
Take Home Message:
- Dietary intervention to support optimal weight management, contain anti-inflammatory components, and specific micronutrient intake should be the basis of any treatment protocol.
- Vitamin C deficiency was noted in patients who under consume fruit and vegetables, had resection surgery, and disease progress and should therefore be addressed via diet and supplementation.
- Serum screening of iron, zinc, folate, vitamin A, B1, B12, C, and D is essential and supplementation based on those findings should be considered alongside specific dietary interventions that can be different for CD and UC patients.
- Comprehensive stool analysis should be considered to elicit any potential dysbiosis that may impact on nutrient absorption in a population that is at greater risk of sub-optimal nutritional status.
Evidence Category:
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A: Meta-analyses, position-stands, randomized-controlled trials (RCTs)
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X
B: Systematic reviews including RCTs of limited number
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C: Non-randomized trials, observational studies, narrative reviews
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D: Case-reports, evidence-based clinical findings
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E: Opinion piece, other
Summary Review:
Introduction
The aim of this systematic review was to establish a clear connection between nutrition, malnutrition, and micronutrient deficiency pertaining to disease pathology of Inflammatory Bowel Disease (IBD).
Methods
Following a PubMed/MEDLINE and Scopus literature search, a total of 227 human IBD studies were reviewed.
Results
- High fibre diets protect against relapse.
- Overall exclusion diets had insufficient data. Positive outcomes noted by Sarbagili-Shabat et al. 2021 and Yanai et al., 2022.
- Sarcopenia in CD patients may result in a slight increase of disease pathophysiology.
- All studies showed that albumin plays a fundamental role in the disease course, response to drugs, surgery rates, and post-surgical complications.
- All studies showed anaemia appears to be associated with high severity of IBD, or higher risk of post-surgical complications.
- Obesity may worsen the effectiveness of IBD therapies and increase post-operative complications.
- Iron deficiency affects about 50% of IBD patients.
- Vitamin B12 deficiency is prevalent in 33% of CD patients (particularly patients who had an ileal resection longer than 20 cm) compared to 16% in UC patients.
- Folate deficiency is more common in UC patients.
- Low vitamin D levels in IBD patients increased odds of disease activity (OR:1.53, CI 1.32-1.77), mucosal inflammation (OR:1.30, CI 1.06-1.60), and future clinical relapse (OR:1.23, CI 1.03-1.47).
- Plasma vitamin A is significantly lower in active UC patients compared to controls (p = 0.0005). Note a significant association between vitamin A in CD patients and C-reactive protein (p = 0.03).
- Vitamin B1 supplementation (600-1800 mg/d) showed a mean reduction of 4.5 points (95% CI 2.6-6.2) in fatigue compared with a mean increase of 0.75 point (95% CI -1.3-2.8; p = 0.0003) after placebo (Bager et al., 2021).
- Oral zinc sulfate supplements (110 mg t.i.d.) significantly lowered intestinal permeability after 8 weeks (0.041 ± 0.003 versus 0.026 ± 0.005; p = 0.0028) (Sturniolo et al., 2001).
Conclusion
Specific dietary and micronutrient interventions could potentially alter IBD progress inclusive of nutritional status, delay of surgical intervention, earlier remission and improved quality of life.
Clinical practice applications:
- Optimal weight maintenance is important for IBD patients given the association with disease complications.
- Regular screening for nutritional status is essential based on the potential impact of nutrient deficiencies on disease outcome.
- Oral iron supplementation may be not well tolerated in IBS patients and intravenous supplementation should be considered depending on regular screening of iron status.
Considerations for future research:
Larger homogeneous studies and stronger evidence are needed to elicit specific protocols to induce remission and the effect on risk of surgical intervention in IBD patients.
Abstract
During the disease course, most Inflammatory Bowel Disease patients present a condition of malnutrition, undernutrition, or even overnutrition. These conditions are mainly due to suboptimal nutritional intake, alterations in nutrient requirements and metabolism, malabsorption, and excessive gastrointestinal losses. A suboptimal nutritional status and low micronutrient serum levels can have a negative impact on both induction and maintenance of remission and on the quality of life of Inflammatory Bowel Disease patients. We performed a systematic review including all the studies evaluating the connection between nutrition, nutrition status (including undernutrition and overnutrition), micronutrient deficiency, and both disease course and therapeutic response in Inflammatory Bowel Disease patients. This systematic review was performed using PubMed/MEDLINE and Scopus. Four main clinical settings concerning the effect of nutrition on disease course in adult Inflammatory Bowel Disease patients were analyzed (induction of remission, maintenance of remission, risk of surgery, post-operative recurrence, and surgery-related complications). Four authors independently reviewed abstracts and manuscripts for eligibility. 6077 articles were found; 762 duplicated studies were removed. Out of 412 full texts analyzed, 227 were included in the review. The evidence summarized in this review showed that many nutritional aspects could be potential targets to induce a better control of symptoms, a deeper remission, and overall improve the quality of life of Inflammatory Bowel Disease patients.
Methodological quality
Jadad score
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Not applicable
Allocation concealment
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Not applicable
