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Day AS, Ballard TM, Yao CK, Gibson PR, Bryant RV. Food-Based Interventions as Therapy for Inflammatory Bowel Disease: Important Steps in Diet Trial Design and Reporting of Outcomes. Inflamm Bowel Dis 2024:izae185. [PMID: 39177975 DOI: 10.1093/ibd/izae185] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/16/2024] [Indexed: 08/24/2024]
Abstract
Diet therapy for inflammatory bowel disease (IBD) is an international research priority but guidance for IBD-specific diet trial design is lacking. This review critically evaluates key elements of prospective IBD food-based intervention trials and identifies gaps. Electronic databases were searched for interventional IBD diet studies. Prospective primary studies/trials were included if used food-based dietary strategies. Forty studies/trials evaluating 29 food-based strategies as therapy for IBD were identified. Considerable heterogeneity in diets, trial design, and methodology exists. Thirty-one trials (78%) intended the diet to modulate inflammation but 14/31 (46%) did not have a primary endpoint measuring an objective change in inflammatory activity and 20/31 (65%) controlled for medication stability prior to application of diet at baseline. Higher-quality IBD diet trials used symptom-based assessment tools coupled with an objective evaluation of inflammatory activity. Dietary advice trials are the most common. One-third of trials developed and administered diet education without a dietitian. Evaluation and reporting on adherence to diet therapy occurred in <60% of trials. Failure to include or report on key elements of trial design reduced the interpretability and validity of the results. This is a considerable limitation to advancing scientific knowledge in this area. Diet therapy trials should adhere to similar rigorous quality standards used to develop other IBD therapies. Therefore, a set of practical recommendations was generated to provide the authors' perspective to help inform the future design of high-quality IBD diet trials.
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Affiliation(s)
- Alice S Day
- Department of Gastroenterology and Hepatology, Inflammatory Bowel Disease Services, The Queen Elizabeth Hospital, 28 Woodville Road, Woodville South 5011, South Australia, Australia
- School of Medicine, Faculty of Health Sciences, University of Adelaide, Frome Road, Adelaide 5000, South Australia, Australia
- Inflammatory Bowel Disease Research Group, Basil Hetzel Institute, 33 Woodville Road, Woodville South 5011, South Australia, Australia
| | - Tessa M Ballard
- Department of Gastroenterology and Hepatology, Inflammatory Bowel Disease Services, The Queen Elizabeth Hospital, 28 Woodville Road, Woodville South 5011, South Australia, Australia
- Discipline of Nutrition and Dietetics, College of Nursing and Health Sciences, Flinders University, GPO Box 2100, Adelaide 5001, South Australia, Australia
| | - Chu K Yao
- Department of Gastroenterology, Central Clinical School, Monash University & Alfred Hospital, 99 Commercial Road, Melbourne 3004, Victoria, Australia
| | - Peter R Gibson
- Department of Gastroenterology, Central Clinical School, Monash University & Alfred Hospital, 99 Commercial Road, Melbourne 3004, Victoria, Australia
| | - Robert V Bryant
- Department of Gastroenterology and Hepatology, Inflammatory Bowel Disease Services, The Queen Elizabeth Hospital, 28 Woodville Road, Woodville South 5011, South Australia, Australia
- School of Medicine, Faculty of Health Sciences, University of Adelaide, Frome Road, Adelaide 5000, South Australia, Australia
- Inflammatory Bowel Disease Research Group, Basil Hetzel Institute, 33 Woodville Road, Woodville South 5011, South Australia, Australia
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Migdanis A, Migdanis I, Gkogkou ND, Papadopoulou SK, Giaginis C, Manouras A, Polyzou Konsta MA, Kosti RI, Oikonomou KA, Argyriou K, Potamianos S, Kapsoritakis A. The Relationship of Adherence to the Mediterranean Diet with Disease Activity and Quality of Life in Crohn's Disease Patients. MEDICINA (KAUNAS, LITHUANIA) 2024; 60:1106. [PMID: 39064535 PMCID: PMC11279084 DOI: 10.3390/medicina60071106] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/27/2024] [Revised: 06/27/2024] [Accepted: 06/29/2024] [Indexed: 07/28/2024]
Abstract
Background and Objectives: Emerging evidence is placing the Mediterranean diet (MD) in the spotlight as a potential dietary model that could benefit inflammatory bowel disease (IBD) patients in terms of prevention and progress of the disease. The main aim of the present study is to shed some light on the relationship between the adherence to the MD and the degree of disease activity, as well as the quality of life in patients with Crohn's disease (CD). Materials and Methods: An administered questionnaire was used to assess and record a number of parameters, including recent medical and weight history, anthropometric characteristics, disease activity (in remission or active disease), and quality of life of both male and female CD patients. Moreover, the level of compliance of the participants to the Mediterranean diet model was evaluated and its relationship with disease activity and quality of life was investigated. Results: Adherence to the MD was significantly higher in patients with inactive disease than in those with active disease (p = 0.019). According to the correlation analysis conducted, adherence to the MD was negatively correlated with disease activity (p = 0.039) and positively correlated with quality of life (QoL) (p = 0.046) of the participants. Intake of fruits, vegetables, and dairy products was significantly higher in remission patients (p = 0.046, p = 0.001, p = 0.041, respectively). Conclusions: We conclude, according to the findings of the study, that adherence to the MD is associated with disease activity and QoL in patients with CD. Future research should focus on MD intervention studies on IBD patients in order to assess its effect on modulating disease activity/course and related inflammatory biomarkers.
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Affiliation(s)
- Athanasios Migdanis
- Nutrition and Dietetics Department, University of Thessaly, Argonafton 1C, 42132 Trikala, Greece; (I.M.); (A.M.); (R.I.K.)
- Faculty of Medicine, University of Thessaly, Viopolis Mezourlo, 41110 Larissa, Greece; (S.P.); (A.K.)
| | - Ioannis Migdanis
- Nutrition and Dietetics Department, University of Thessaly, Argonafton 1C, 42132 Trikala, Greece; (I.M.); (A.M.); (R.I.K.)
- Faculty of Medicine, University of Thessaly, Viopolis Mezourlo, 41110 Larissa, Greece; (S.P.); (A.K.)
| | - Nikoleta D. Gkogkou
- MSc Program Nutrition in Health and Disease, Faculty of Medicine, University of Thessaly, Viopolis Mezourlo, 41110 Larissa, Greece;
| | - Sousana K. Papadopoulou
- Department of Nutritional Sciences and Dietetics, International Hellenic University, Nea Moudania, 57001 Thessaloniki, Greece;
| | - Constantinos Giaginis
- Department of Food Science and Nutrition, University of the Aegean, Myrina, 81400 Lemnos, Greece;
| | - Athanasios Manouras
- Nutrition and Dietetics Department, University of Thessaly, Argonafton 1C, 42132 Trikala, Greece; (I.M.); (A.M.); (R.I.K.)
| | | | - Rena I. Kosti
- Nutrition and Dietetics Department, University of Thessaly, Argonafton 1C, 42132 Trikala, Greece; (I.M.); (A.M.); (R.I.K.)
| | - Konstantinos A. Oikonomou
- Department of Gastroenterology, University Hospital of Larissa, Viopolis Mezourlo, 41110 Larissa, Greece; (K.A.O.); (K.A.)
| | - Konstantinos Argyriou
- Department of Gastroenterology, University Hospital of Larissa, Viopolis Mezourlo, 41110 Larissa, Greece; (K.A.O.); (K.A.)
| | - Spyridon Potamianos
- Faculty of Medicine, University of Thessaly, Viopolis Mezourlo, 41110 Larissa, Greece; (S.P.); (A.K.)
- MSc Program Nutrition in Health and Disease, Faculty of Medicine, University of Thessaly, Viopolis Mezourlo, 41110 Larissa, Greece;
- Department of Gastroenterology, University Hospital of Larissa, Viopolis Mezourlo, 41110 Larissa, Greece; (K.A.O.); (K.A.)
| | - Andreas Kapsoritakis
- Faculty of Medicine, University of Thessaly, Viopolis Mezourlo, 41110 Larissa, Greece; (S.P.); (A.K.)
- MSc Program Nutrition in Health and Disease, Faculty of Medicine, University of Thessaly, Viopolis Mezourlo, 41110 Larissa, Greece;
- Department of Gastroenterology, University Hospital of Larissa, Viopolis Mezourlo, 41110 Larissa, Greece; (K.A.O.); (K.A.)
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Ryan K, Salozzo C, Schwartz S, Hart M, Tuo Y, Wenzel A, Saul S, Strople J, Brown J, Runde J. Following Through: The Impact of Culinary Medicine on Mediterranean Diet Uptake in Inflammatory Bowel Disease. Inflamm Bowel Dis 2024:izae141. [PMID: 38970369 DOI: 10.1093/ibd/izae141] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/20/2024] [Indexed: 07/08/2024]
Abstract
BACKGROUND The Mediterranean diet (MD) is recommended for all patients with inflammatory bowel disease (IBD) unless there is a specific contraindication. Culinary medicine has emerged as a method for improving dietary education. Patients and caregivers are often invested in making dietary changes to improve disease control. Here, we examine the dietary preferences of a group of young people with IBD and apply culinary medicine techniques with an in-person MD-focused cooking class. METHODS A survey evaluating dietary attitudes was sent to an IBD email listserv at our tertiary care center (n = 779). A validated questionnaire, the Mediterranean Diet Quality Index for Children and Adolescents was used to assess MD adherence. IBD dietitians customized 2 in-person MD-focused cooking classes, one for children 6 to 12 years of age (arm 1) and one for adolescents 13 to 17 years of age (arm 2). Baseline, 1-month follow-up, and 3-month follow-up surveys were completed. RESULTS There were 112 survey responses. Participants were 67.0% male with diagnosis of Crohn's disease (50.0%), ulcerative colitis (42.0%), or IBD unclassified (8.0%). Most were managed on advanced therapies (82.0%). Most reported making decisions about diet (82.0%) in order to help with IBD, had met with a dietitian (69.0%), and were interested in learning more about the MD (55.3%). MD scores were primarily in the average (49.5%) and poor (41.1%) diet categories. Only those eating together as a family 3 or more times per week or those who had met with a dietitian scored in the optimal diet category. The median MD score at baseline was 4.5, increasing to 6.0 at 1 month and 7.0 at 3 months postintervention. Almost all (90%) would recommend cooking classes to others. Common barriers to MD uptake included lack of knowledge about which foods to prepare, concern about taste, and time to prepare food. CONCLUSIONS This study showcases high patient and caregiver interest in dietary management of IBD and demonstrates efficacy of education via application of culinary medicine. Classes were well received by families and MD adherence scores increased postintervention. As patients with IBD and their families are often motivated to incorporate dietary therapy into their care, this work highlights the role of culinary medicine and value of future study.
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Affiliation(s)
- Kelsey Ryan
- Department of Pediatrics, Feinberg School of Medicine, Northwestern University, Chicago, IL 60611, USA
| | - Caroline Salozzo
- Department of Clinical Nutrition, Ann and Robert H. Lurie Children's Hospital of Chicago, Chicago, IL 60611, USA
| | - Sally Schwartz
- Department of Clinical Nutrition, Ann and Robert H. Lurie Children's Hospital of Chicago, Chicago, IL 60611, USA
| | - Micquel Hart
- Section of Gastroenterology, Hepatology and Nutrition, Ann and Robert H. Lurie Children's Hospital of Chicago, Chicago, IL 60611, USA
| | - Ya Tuo
- Stanley Manne Children's Research Institute, Ann and Robert H. Lurie Children's Hospital of Chicago, Chicago, IL 60611, USA
| | - Amanda Wenzel
- Section of Gastroenterology, Hepatology and Nutrition, Children's Wisconsin, Medical College of Wisconsin, Milwaukee, WI 53226, USA
| | - Samantha Saul
- Section of Gastroenterology, C.S. Mott Children's Hospital, University of Michigan Medicine, Ann Arbor, MI 48109, USA
| | - Jennifer Strople
- Department of Pediatrics, Feinberg School of Medicine, Northwestern University, Chicago, IL 60611, USA
- Section of Gastroenterology, Hepatology and Nutrition, Ann and Robert H. Lurie Children's Hospital of Chicago, Chicago, IL 60611, USA
| | - Jeffrey Brown
- Department of Pediatrics, Feinberg School of Medicine, Northwestern University, Chicago, IL 60611, USA
- Section of Gastroenterology, Hepatology and Nutrition, Ann and Robert H. Lurie Children's Hospital of Chicago, Chicago, IL 60611, USA
| | - Joseph Runde
- Department of Pediatrics, Feinberg School of Medicine, Northwestern University, Chicago, IL 60611, USA
- Section of Gastroenterology, Hepatology and Nutrition, Ann and Robert H. Lurie Children's Hospital of Chicago, Chicago, IL 60611, USA
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Ratajczak AE, Festa S, Aratari A, Papi C, Dobrowolska A, Krela-Kaźmierczak I. Should the Mediterranean diet be recommended for inflammatory bowel diseases patients? A narrative review. Front Nutr 2023; 9:1088693. [PMID: 36704787 PMCID: PMC9871561 DOI: 10.3389/fnut.2022.1088693] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2022] [Accepted: 12/07/2022] [Indexed: 01/12/2023] Open
Abstract
Inflammatory bowel diseases (IBD) are chronic, progressive and relapsing inflammatory disorders of unknown etiology that may cause disability over time. Data from epidemiologic studies indicate that diet may play a role in the risk of developing and the course of IBD. It is known that the group of beneficial bacteria was reduced in the IBD and that the Mediterranean diet (MD)-which is defined as eating habits characterized by high consumption of plant foods, mainly cereals, vegetables, fruit as well as olive oil, and small portions of dairy products, sweets, sugar and meat products-affects gut microbiota, enriching beneficial bacteria, which support gut barrier function and reduce inflammation. Although several studies support different favorable effects of MD on IBD, adherence to MD by IBD patients is generally low, including patients from the Mediterranean Basin. Patients avoid many products which are elements of MD because there cause gastrointestinal symptoms. Patients should be encouraged to have a healthy and well-balanced diet according to individual tolerance of products. A good option seems to be good modified MD, changing hard-to-digest products to easy digest.
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Affiliation(s)
- Alicja Ewa Ratajczak
- Department of Gastroenterology, Dietetics and Internal Medicine, Poznan University of Medical Sciences, Poznan, Poland,Doctoral School, Poznan University of Medical Sciences, Poznan, Poland,*Correspondence: Alicja Ewa Ratajczak ✉
| | - Stefano Festa
- Inflammatory Bowel Disease Unit, Department of Gastroenterology, S. Filippo Neri Hospital, Rome, Italy
| | - Annalisa Aratari
- Inflammatory Bowel Disease Unit, Department of Gastroenterology, S. Filippo Neri Hospital, Rome, Italy
| | - Claudio Papi
- Inflammatory Bowel Disease Unit, Department of Gastroenterology, S. Filippo Neri Hospital, Rome, Italy
| | - Agnieszka Dobrowolska
- Department of Gastroenterology, Dietetics and Internal Medicine, Poznan University of Medical Sciences, Poznan, Poland
| | - Iwona Krela-Kaźmierczak
- Department of Gastroenterology, Dietetics and Internal Medicine, Poznan University of Medical Sciences, Poznan, Poland
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The Relationship among Bowel [18]F-FDG PET Uptake, Pathological Complete Response, and Eating Habits in Breast Cancer Patients Undergoing Neoadjuvant Chemotherapy. Nutrients 2023; 15:nu15010211. [PMID: 36615868 PMCID: PMC9824388 DOI: 10.3390/nu15010211] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2022] [Revised: 12/28/2022] [Accepted: 12/28/2022] [Indexed: 01/03/2023] Open
Abstract
Recently, the impact of patients’ eating habits on both breast cancer (BC) management and inflammation have been proven. Here, we investigated whether inflammatory habits could correlate with baseline bowel [18]F-fluorodeoxyglucose (FDG) uptake and the latter, in turn, with pathological Complete Response (pCR) to neoadjuvant chemotherapy (NAC). We included stage I−III BC undergoing standard NAC at IRCCS Humanitas Research Hospital, Italy. Patients fulfilled a survey concerning eating/lifestyle behaviors and performed a staging [18]F-FDG positrone emission tomography/computed tomography (PET/CT). In the absence of data on the effects of individual foods, we aggregated drink and food intake for their known inflammatory properties. Data were recorded for 82 women (median age, 48). We found positive correlations between colon mean standardized uptake value (SUVmean) and pro-inflammatory drinks (alcohol and spirits; r = +0.33, p < 0.01) and foods (red and cured meats; r = +0.25, p = 0.04), and a significant negative correlation between rectum SUVmean and anti-inflammatory foods (fruits and vegetables; r = −0.23, p = 0.04). Furthermore, colon SUVmean was significantly lower in patients with pCR compared to non pCR (p = 0.02). Our study showed, for the first time, that patients’ eating habits affected bowel [18]F-FDG uptake and that colon SUVmean correlated with pCR, suggesting that PET scan could be an instrument for identifying patients presenting unhealthy behaviors.
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Karachaliou A, Yannakoulia M, Bletsa M, Mantzaris GJ, Archavlis E, Karampekos G, Tzouvala M, Bamias G, Kokkotis G, Kontogianni MD. Assessment of Dietary Adequacy and Quality in a Sample of Patients with Crohn's Disease. Nutrients 2022; 14:5254. [PMID: 36558412 PMCID: PMC9780994 DOI: 10.3390/nu14245254] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2022] [Revised: 12/05/2022] [Accepted: 12/06/2022] [Indexed: 12/13/2022] Open
Abstract
Both under-and over-nutrition are prevalent in patients with Crohn's Disease (CD). The aim of the present study was to evaluate dietary intake and compare it with relevant recommendations during active disease and remission, also taking into consideration the adequacy of energy reporting. Dietary quality was assessed through adherence to the Mediterranean diet and to the European dietary guidelines for cardiovascular disease prevention (CVD-score). Malnutrition was diagnosed with the GLIM criteria. There were 237 patients evaluated (54.9% males, 41.3 ± 14.1 years and 37.6% with active disease). In the total sample, high prevalence of overweight/obesity (61.6%) and low prevalence of malnutrition (11.4%) were observed, whereas 25.5% reported low protein intake in the sub-sample of adequate energy reporters. The mean MedDietScore was 28.0 ± 5.5 and the mean CVD-score was 5.25 ± 1.36, both reflecting moderate dietary quality. Patients with active disease reported higher prevalence of low protein intake, lower carbohydrate, fibers, fruits, vegetables, legumes, and sweets consumption and a lower MedDietScore compared to patients in remission. Consumption of fibers, fruits, vegetables, and legumes while in remission did not result in reaching the recommended intakes, and dietary quality was low as reflected by the MedDietScore. In conclusion, both protein undernutrition and energy overconsumption were prevalent in the current sample and overall patients adhered to a moderate quality diet irrespective of disease stage.
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Affiliation(s)
- Alexandra Karachaliou
- Department of Nutrition & Dietetics, School of Health Sciences and Education, Harokopio University of Athens, 70 El. Venizelou Avenue, 176 76 Kallithea, Greece
| | - Mary Yannakoulia
- Department of Nutrition & Dietetics, School of Health Sciences and Education, Harokopio University of Athens, 70 El. Venizelou Avenue, 176 76 Kallithea, Greece
| | - Maria Bletsa
- Department of Nutrition and Dietetics, ‘’Sotiria’’ Thoracic Diseases Hospital, 152 Mesogion Avenue, 115 27 Athens, Greece
| | - Gerassimos J. Mantzaris
- Department of Gastroenterology, ‘’Evangelismos-Ophthalmiatreion Athinon-Polykliniki’’ General Hospital, 45–47 Ypsilantou Street, 106 76 Athens, Greece
| | - Emmanuel Archavlis
- Department of Gastroenterology, ‘’Evangelismos-Ophthalmiatreion Athinon-Polykliniki’’ General Hospital, 45–47 Ypsilantou Street, 106 76 Athens, Greece
| | - George Karampekos
- Department of Gastroenterology, ‘’Evangelismos-Ophthalmiatreion Athinon-Polykliniki’’ General Hospital, 45–47 Ypsilantou Street, 106 76 Athens, Greece
| | - Maria Tzouvala
- Department of Gastroenterology, General Hospital of Nikaia Piraeus “Agios Panteleimon”-General Hospital Dytikis Attikis “Agia Varvara”, 3 Dim. Mantouvalou Street, 184 54 Athens, Greece
| | - Giorgos Bamias
- GI Unit, 3rd Academic Department of Internal Medicine, “Sotiria’’ Thoracic Diseases Hospital, Medical School, National and Kapodistrian University of Athens, 152 Mesogion Avenue, 115 27 Athens, Greece
| | - George Kokkotis
- GI Unit, 3rd Academic Department of Internal Medicine, “Sotiria’’ Thoracic Diseases Hospital, Medical School, National and Kapodistrian University of Athens, 152 Mesogion Avenue, 115 27 Athens, Greece
| | - Meropi D. Kontogianni
- Department of Nutrition & Dietetics, School of Health Sciences and Education, Harokopio University of Athens, 70 El. Venizelou Avenue, 176 76 Kallithea, Greece
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Ferrie S. Evidence as foundation of practice. Nutr Diet 2022; 79:184-186. [PMID: 35393760 DOI: 10.1111/1747-0080.12737] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
- Suzie Ferrie
- Royal Prince Alfred Hospital, Camperdown, New South Wales, Australia
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