Clin Nutr Res.  2018 Jan;7(1):48-55. 10.7762/cnr.2018.7.1.48.

Food Elimination Diet and Nutritional Deficiency in Patients with Inflammatory Bowel Disease

• Lim HS
• Kim SK
• Hong SJ

• KMID: 2402342
• DOI: http://doi.org/10.7762/cnr.2018.7.1.48

Abstract

Certain types of foods are common trigger for bowel symptoms such as abdominal discomfort or pain in patients with inflammatory bowel disease (IBD). But indiscriminate food exclusions from their diet can lead extensive nutritional deficiencies. The aim of this study was to investigate nutritional status, food restriction and nutrient intake status in IBD patients. A total 104 patients (food exclusion group: n = 49; food non-exclusion group: n = 55) participated in the survey. The contents were examined by 3 categories: 1) anthropometric and nutritional status; 2) diet beliefs and food restriction; and 3) nutrient intake. The malnutrition rate was significantly higher in the food exclusion group (p = 0.007) compared to food non-exclusion group. Fifty-nine percent of patients in the food exclusion group held dietary beliefs and reported modifying their intake according to their dietary belief. The most common restricted food was milk, dairy products (32.7%), raw fish (24.5%), deep-spicy foods (22.4%), and ramen (18.4%). The mean daily intake of calcium (p = 0.002), vitamin A (p < 0.001), and zinc (p = 0.001) were significantly lower in the food exclusion group. Considering malnutrition in IBD patients, nutrition education by trained dietitians is necessary for the patients to acquire disease-related knowledge and overall balanced nutrition as part of strategies in treating and preventing nutrition deficiencies.

Keyword

Inflammatory bowel diseases; Malnutrition; Attitude to health; Food intolerance

MeSH Terms

Attitude to Health
Calcium
Dairy Products
Diet*
Education
Humans
Inflammatory Bowel Diseases*
Malnutrition*
Milk
Nutritional Status
Nutritionists
Vitamin A
Zinc
Calcium
Vitamin A
Zinc

Figure

• 

  Figure 1 Comparison of nutritional status between groups. Data were reported as frequency (percentage) for categorical variables. p value for the significant difference between 2 groups is 0.007 and was calculated by χ2 test.

Reference

1. Goyal N, Rana A, Ahlawat A, Bijjem KR, Kumar P. Animal models of inflammatory bowel disease: a review. Inflammopharmacology. 2014; 22:219–233.

2. Chan W, Shim HH, Lim MS, Sawadjaan FL, Isaac SP, Chuah SW, Leong R, Kong C. Symptoms of anxiety and depression are independently associated with inflammatory bowel disease-related disability. Dig Liver Dis. 2017; 49:1314–1319.

3. Bennebroek Evertsz' F, Sprangers MA, Sitnikova K, Stokkers PC, Ponsioen CY, Bartelsman JF, van Bodegraven AA, Fischer S, Depla AC, Mallant RC, Sanderman R, Burger H, Bockting CL. Effectiveness of cognitive-behavioral therapy on quality of life, anxiety, and depressive symptoms among patients with inflammatory bowel disease: a multicenter randomized controlled trial. J Consult Clin Psychol. 2017; 85:918–925.

4. Sarbagili-Shabat C, Sigall-Boneh R, Levine A. Nutritional therapy in inflammatory bowel disease. Curr Opin Gastroenterol. 2015; 31:303–308.

5. Bassaganya-Riera J, Hontecillas R. Dietary conjugated linoleic acid and n-3 polyunsaturated fatty acids in inflammatory bowel disease. Curr Opin Clin Nutr Metab Care. 2010; 13:569–573.

6. Maconi G, Ardizzone S, Cucino C, Bezzio C, Russo AG, Bianchi Porro G. Pre-illness changes in dietary habits and diet as a risk factor for inflammatory bowel disease: a case-control study. World J Gastroenterol. 2010; 16:4297–4304.

7. Cohen AB, Lee D, Long MD, Kappelman MD, Martin CF, Sandler RS, Lewis JD. Dietary patterns and self-reported associations of diet with symptoms of inflammatory bowel disease. Dig Dis Sci. 2013; 58:1322–1328.

8. Knight-Sepulveda K, Kais S, Santaolalla R, Abreu MT. Diet and inflammatory bowel disease. Gastroenterol Hepatol (N Y). 2015; 11:511–520.

9. Vidarsdottir JB, Johannsdottir SE, Thorsdottir I, Bjornsson E, Ramel A. A cross-sectional study on nutrient intake and -status in inflammatory bowel disease patients. Nutr J. 2016; 15:61.

10. Forbes A, Escher J, Hébuterne X, Kłęk S, Krznaric Z, Schneider S, Shamir R, Stardelova K, Wierdsma N, Wiskin AE, Bischoff SC. ESPEN guideline: Clinical nutrition in inflammatory bowel disease. Clin Nutr. 2017; 36:321–347.

11. Limdi JK, Aggarwal D, McLaughlin JT. Dietary practices and beliefs in patients with inflammatory bowel disease. Inflamm Bowel Dis. 2016; 22:164–170.

12. Vagianos K, Clara I, Carr R, Graff LA, Walker JR, Targownik LE, Lix LM, Rogala L, Miller N, Bernstein CN. What are adults with inflammatory bowel disease (IBD) eating? A closer look at the dietary habits of a population-based Canadian IBD Cohort. JPEN J Parenter Enteral Nutr. 2016; 40:405–411.

13. Sandborn WJ, Hanauer S, Van Assche G, Panés J, Wilson S, Petersson J, Panaccione R. Treating beyond symptoms with a view to improving patient outcomes in inflammatory bowel diseases. J Crohn's Colitis. 2014; 8:927–935.

14. Vasudevan A, Gibson PR, van Langenberg DR. Time to clinical response and remission for therapeutics in inflammatory bowel diseases: what should the clinician expect, what should patients be told? World J Gastroenterol. 2017; 23:6385–6402.

15. Choi CH, Moon W, Kim YS, Kim ES, Lee BI, Jung Y, Yoon YS, Lee H, Park DI, Han DS. IBD Study Group of the Korean Association for the Study of the Intestinal Diseases. Second Korean guideline for the management of ulcerative colitis. Korean J Gastroenterol. 2017; 69:1–28.

16. Park JJ, Yang SK, Ye BD, Kim JW, Park DI, Yoon H, Im JP, Lee KM, Yoon SN, Lee H. IBD Study Group of the Korean Association for the Study of the Intestinal Diseases. Second Korean guidelines for the management of Crohn's disease. Korean J Gastroenterol. 2017; 69:29–54.

17. Rajendran N, Kumar D. Role of diet in the management of inflammatory bowel disease. World J Gastroenterol. 2010; 16:1442–1448.

18. Ballegaard M, Bjergstrøm A, Brøndum S, Hylander E, Jensen L, Ladefoged K. Self-reported food intolerance in chronic inflammatory bowel disease. Scand J Gastroenterol. 1997; 32:569–571.

19. MacDermott RP. Treatment of irritable bowel syndrome in outpatients with inflammatory bowel disease using a food and beverage intolerance, food and beverage avoidance diet. Inflamm Bowel Dis. 2007; 13:91–96.

20. Nguyen DL, Limketkai B, Medici V, Saire Mendoza M, Palmer L, Bechtold M. Nutritional strategies in the management of adult patients with inflammatory bowel disease: dietary considerations from active disease to disease remission. Curr Gastroenterol Rep. 2016; 18:55.