Skip to main content
SpringerLink
Log in

Influence of Diet on the Course of Inflammatory Bowel Disease

Digestive Diseases and Sciences volume 62, pages 2087–2094 (2017)Cite this article

Abstract

Background

While the importance of diet in the pathogenesis of inflammatory bowel disease (IBD) is generally recognized, influence of food on the course of IBD is little understood.

Aim

The purpose of this study was to assess the association between food intake and course of disease in patients with IBD.

Methods

We performed a cross-sectional study on 103 adult patients (50 with active disease and 53 in remission, divided by their calprotectin level), who completed a food frequency questionnaire on their intake of several foods over 1 year. Diet, as assessed using a 146-item self-administered food frequency questionnaire, was correlated with objective evidence of disease based on fecal calprotectin levels.

Results

Legumes and potato were inversely associated with disease relapse (p value for trend 0.023) with patients in the highest quartile for legume and potato consumption carrying a 79% lower risk of active disease (adjusted OR 0.21, 95% CI 0.57–0.81). A positive association emerged between meat intake and disease relapse, the highest quartile for meat consumption coinciding with a higher risk of active disease (OR 3.61, 95% CI 1.15–11.38), though this was not significant in the adjusted analysis. No statistically significant associations were found between disease relapse and the intake of vegetables, cereals, dairy products, or fish.

Conclusions

Our results suggest a potentially protective role of legumes and potato and a detrimental influence of meat in maintaining clinical remission in IBD patients. These findings have important public health implications, but further interventional studies will be needed to demonstrate these associations.

This is a preview of subscription content, access via your institution.

Access options

Buy single article

Instant access to the full article PDF.

USD 39.95

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

References

  1. Fauci A, Braunwald E, Kasper D, Hauser S, Longo D. Harrison’s principles of internal medicine. 2008. doi:10.1036/007149619X.

  2. Bernstein CN, Eliakim A, Fedail S, et al. Inflammatory bowel disease. World Gastroenterol Global Guidelines. 2015;50:803–818.

    Google Scholar 

  3. Lee D, Albenberg L, Compher C, et al. Diet in the pathogenesis and treatment of inflammatory bowel diseases. Gastroenterology. 2015;148:1087–1106.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  4. Wu GD, Bushmanc FD, Lewis JD. Diet, the human gut microbiota, and IBD. Anaerobe. 2013;24:117–120.

    Article  CAS  PubMed  Google Scholar 

  5. Dutta AK, Chacko A. Influence of environmental factors on the onset and course of inflammatory bowel disease. World J Gastroenterol. 2016;22:1088–1100.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  6. Tilg H, Moschen AR. Food, immunity, and the microbiome. Gastroenterology. 2015;148:1107–1119.

    Article  PubMed  Google Scholar 

  7. Hart AR, Luben R, Olsen A, et al. Diet in the aetiology of ulcerative colitis: a European prospective cohort study. Digestion. 2008;77:57–64.

    Article  PubMed  Google Scholar 

  8. Levine A, Wine E. Effects of enteral nutrition on Crohn’s disease. Inflamm Bowel Dis. 2013;19:1322–1329.

    Article  PubMed  Google Scholar 

  9. Martin TD, Chan SSM, Hart AR. Environmental factors in the relapse and recurrence of inflammatory bowel disease: a review of the literature. Dig Dis Sci. 2015;60:1396–1405. doi:10.1007/s10620-014-3437-3.

    Article  CAS  PubMed  Google Scholar 

  10. Chiba M, Abe T, Tsuda H, et al. Lifestyle-related disease in Crohn’s disease: relapse prevention by a semi-vegetarian diet. World J Gastroenterol. 2010;16:2484–2495.

    Article  PubMed  PubMed Central  Google Scholar 

  11. Faghfoori Z, Shakerhosseini R, Navai L, Somi MH, Nikniaz Z, Abadi A. Effects of an oral supplementation of germinated barley foodstuff on serum CRP level and clinical signs in patients with ulcerative colitis. Health Promot Perspect. 2014;4:116–121.

    PubMed  PubMed Central  Google Scholar 

  12. Halmos EP. A low fodmap diet in patients with Crohn’s disease. J Gastroenterol Hepatol. 2016;31:14–15.

    Article  PubMed  Google Scholar 

  13. Cohen S, Gold BD, Oliva S, et al. Clinical and mucosal improvement with the specific carbohydrate diet in pediatric Crohn’s disease: a prospective pilot study. J Pediatr Gastroenterol Nutr. 2014;59:516–521.

  14. Obih C, Wahbeh G, Lee D, et al. Specific carbohydrate diet for pediatric inflammatory bowel disease in clinical practice within an academic IBD center. Nutrition. 2015;32:418–425.

    Article  PubMed  Google Scholar 

  15. Lev-Tzion R, Griffiths A, Leder O. Omega 3 fatty acids (fish oil) for maintenance of remission in Crohn’s disease. Cochrane Database Syst Rev. 2014.

  16. Jowett SL, Seal CJ, Pearce MS, et al. Influence of dietary factors on the clinical course of ulcerative colitis: a prospective cohort study. Inflamm Bowel Dis. 2004;54:1479–1484.

    Google Scholar 

  17. Laparra JM, Sanz Y. Interactions of gut microbiota with functional food components and nutraceuticals. Pharmacol Res. 2010;61:219–225.

    Article  CAS  PubMed  Google Scholar 

  18. Mao R, Xiao YL, Gao X, et al. Fecal calprotectin in predicting relapse of inflammatory bowel diseases: a meta-analysis of prospective studies. Inflamm Bowel Dis. 2012;18:1894–1899.

    Article  PubMed  Google Scholar 

  19. Zittan E, Kelly OB, Kirsch R, et al. Low fecal calprotectin correlates with histological remission and mucosal healing in ulcerative colitis and colonic Crohn’s disease. Inflamm Bowel Dis. 2016;23:1–8.

    Google Scholar 

  20. Lobatón T, López-García A, Rodríguez-Moranta F, Ruiz A, Rodríguez L, Guardiola J. A new rapid test for fecal calprotectin predicts endoscopic remission and postoperative recurrence in Crohn’s disease. J Crohn’s Colitis. 2013;7:e641–e651.

    Article  Google Scholar 

  21. Molander P, Färkkilä M, Ristimäki A, et al. Does fecal calprotectin predict short-term relapse after stopping TNFα-blocking agents in inflammatory bowel disease patients in deep remission? J Crohns Colitis. 2015;9:33–40.

    PubMed  Google Scholar 

  22. Yamaguchi S, Takeuchi Y, Arai K, et al. Fecal calprotectin is a clinically relevant biomarker of mucosal healing in patients with quiescent ulcerative colitis. J Gastroenterol Hepatol. 2015;1:93–98.

    Google Scholar 

  23. Day N, Oakes S, Luben R, et al. EPIC-Norfolk: study design and characteristics of the cohort. European prospective investigation of cancer. Br J Cancer. 1999;80:95–103.

    PubMed  Google Scholar 

  24. Van Assche G, Dignass A, Panes J, et al. The second European evidence-based consensus on the diagnosis and management of Crohn’ s disease: definitions and diagnosis. J Crohn’s Colitis. 2010;4:7–27.

    Article  Google Scholar 

  25. Fantuzzi F, Chiunchiù M, Bedogni G. Atlante fotografico delle porzioni degli alimenti. Milano: Istituto Scotti Bassani; 2005.

    Google Scholar 

  26. James SL, Christophersen CT, Bird AR, et al. Abnormal fibre usage in UC in remission. Gut. 2015;64:562–570.

    Article  CAS  PubMed  Google Scholar 

  27. McRorie JW. Evidence-based approach to fiber supplements and clinically meaningful health benefits, Part 2: what to look for and how to recommend an effective fiber therapy. Nutr Today. 2015;50:90–97.

    Article  PubMed  PubMed Central  Google Scholar 

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

    Article  CAS  PubMed  Google Scholar 

  29. Scaldaferri F, Gerardi V, Lopetuso LR, et al. Gut microbial flora, prebiotics, and probiotics in IBD: their current usage and utility. Biomed Res Int. 2013;2013:435268.

    Article  PubMed  PubMed Central  Google Scholar 

  30. Verspreet J, Damen B, Broekaert WF, Verbeke K, Delcour JA, Courtin CM. A critical look at prebiotics within the dietary fiber concept. Annu Rev Food Sci Technol. 2016;7:annurev-food-081315-032749.

  31. Krumbeck JA, Maldonado-Gomez MX, Ramer-Tait AE, Hutkins RW. Prebiotics and synbiotics. Curr Opin Gastroenterol. 2016;32:110–119.

    Article  CAS  PubMed  Google Scholar 

  32. Johnson CR, Thavarajah D, Combs GF, Thavarajah P. Lentil (Lens culinaris L.): a prebiotic-rich whole food legume. Food Res Int. 2013;51:107–113.

    Article  CAS  Google Scholar 

  33. Johnson CR, Thavarajah D, Thavarajah P, Payne S, Moore J, Ohm JB. Processing, cooking, and cooling affect prebiotic concentrations in lentil (Lens culinaris Medikus). J Food Compos Anal. 2015;38:106–111.

    Article  CAS  Google Scholar 

  34. Kutoš T, Golob T, Kač M, Plestenjak A. Dietary fibre content of dry and processed beans. Food Chem. 2003;80:231–235.

    Article  Google Scholar 

  35. Dwivedi S, Sahrawat K, Puppala N, Ortiz R. Plant prebiotics and human health: biotechnology to breed prebiotic-rich nutritious food crops. Electron J Biotechnol. 2014;17:238–245.

    Article  CAS  Google Scholar 

  36. Zheng Y, Wang Q, Li B, et al. Characterization and prebiotic effect of the resistant starch from purple sweet potato. Molecules. 2016;21:932.

    Article  Google Scholar 

  37. Fuentes-Zaragoza E, Sánchez-Zapata E, Sendra E, et al. Resistant starch as prebiotic: a review. Starch/Staerke. 2011;63:406–415.

    Article  CAS  Google Scholar 

  38. Deschasaux M, Pouchieu C, His M, Hercberg S, Latino-martel P, Touvier M. Dietary total and insoluble fiber intakes are inversely associated with prostate cancer. J Nutr. 2014;144:504–510.

    Article  CAS  PubMed  Google Scholar 

  39. Di Bartolomeo F, Startek JB, Van Den Ende W. Prebiotics to fight diseases: reality or fiction? Phyther Res. 2013;27:1457–1473.

    Google Scholar 

  40. Franco-Robles E, Lopez MG. Implication of fructans in health: immunomodulatory and antioxidant mechanisms. Sci World J. 2015;2015:289267.

    Article  Google Scholar 

  41. Verspreet J, Holmgaard Hansen A, Dornez E, et al. LC-MS analysis reveals the presence of graminan- and neo-type fructans in wheat grains. J Cereal Sci. 2015;61:133–138.

    Article  CAS  Google Scholar 

  42. Peshev D, Van den Ende W. Fructans: prebiotics and immunomodulators. J Funct Foods. 2014;8:348–357.

    Article  CAS  Google Scholar 

  43. Verspreet J, Dornez E, van den Ende W, Delcour JA, Courtin CM. Cereal grain fructans: structure, variability and potential health effects. Trends Food Sci Technol. 2015;43:32–42.

    Article  CAS  Google Scholar 

  44. Dahl WJ, Ford AL, Ukhanova M, et al. Resistant potato starches (type 4 RS) exhibit varying effects on laxation with and without phylum level changes in microbiota: a randomised trial in young adults. J Funct Foods. 2016;23:1–11.

    Article  CAS  Google Scholar 

  45. Khodaei N, Karboune S. Enzymatic generation of galactose-rich oligosaccharides/oligomers from potato rhamnogalacturonan i pectic polysaccharides. Food Chem. 2016;197:406–414.

    Article  CAS  PubMed  Google Scholar 

  46. Verspreet J, Hemdane S, Dornez E, Cuyvers S, Delcour JA, Courtin CM. Maximizing the concentrations of wheat grain fructans in bread by exploring strategies to prevent their yeast (Saccharomyces cerevisiae)-mediated degradation. J Agric Food Chem. 2013;61:1397–1404.

    Article  CAS  PubMed  Google Scholar 

  47. Chiba M, Yoshida T, Komatsu M. From low-residue diets to plant-based diets in inflammatory bowel disease. Dig Dis Sci. 2014;59:3129–3130. doi:10.1007/s10620-014-3399-5.

    Article  PubMed  Google Scholar 

  48. Walton M, Alaunyte I. Do patients living with ulcerative colitis adhere to healthy eating guidelines? A cross-sectional study. Br J Nutr. 2014;112:1628–1635.

    Article  CAS  PubMed  Google Scholar 

  49. Marsh A, Eslick EM, Eslick GD. Does a diet low in FODMAPs reduce symptoms associated with functional gastrointestinal disorders? A comprehensive systematic review and meta-analysis. Eur J Nutr. 2016;55:897–906.

    Article  CAS  PubMed  Google Scholar 

  50. Gearry RB, Irving PM, Barrett JS, Nathan DM, Shepherd SJ, Gibson PR. Reduction of dietary poorly absorbed short-chain carbohydrates (FODMAPs) improves abdominal symptoms in patients with inflammatory bowel disease: a pilot study. J Crohn’s Colitis. 2009;3:8–14.

    Article  Google Scholar 

  51. Prince AC, Myers CE, Joyce T, Irving P, Lomer M, Whelan K. Fermentable carbohydrate restriction (low FODMAP diet) in clinical practice improves functional gastrointestinal symptoms in patients with inflammatory bowel disease. Inflamm Bowel Dis. 2016;22:1.

    Article  Google Scholar 

  52. Wedlake L, Slack N, Andreyev HJN, Whelan K. Fiber in the treatment and maintenance of inflammatory bowel disease: a systematic review of randomized controlled trials. Inflamm Bowel Dis. 2014;20:576–586.

    Article  PubMed  Google Scholar 

  53. Marchesi JR, Adams DH, Fava F, et al. The gut microbiota and host health: a new clinical frontier. Gut. 2015;65:1–10.

    Google Scholar 

  54. Marion-Letellier R, Savoye G, Beck PL, Panaccione R, Ghosh S. Polyunsaturated fatty acids in inflammatory bowel diseases: a reappraisal of effects and therapeutic approaches. Inflamm Bowel Dis. 2013;19:650–661.

    Article  PubMed  Google Scholar 

  55. Windey K, de Preter V, Verbeke K. Relevance of protein fermentation to gut health. Mol Nutr Food Res. 2012;56:184–196.

    Article  CAS  PubMed  Google Scholar 

  56. Tjonneland A, Overvad K, Bergmann MM, et al. Linoleic acid, a dietary n-6 polyunsaturated fatty acid, and the aetiology of ulcerative colitis: a nested case-control study within a European prospective cohort study. Gut. 2009;58:1606–1611.

    Article  CAS  PubMed  Google Scholar 

  57. Cohen AB, Lee D, Long MD, et al. Dietary patterns and self-reported associations of diet with symptoms of inflammatory bowel disease. Dig Dis Sci. 2013;58:1322–1328. doi:10.1007/s10620-012-2373-3.

    Article  CAS  PubMed  Google Scholar 

  58. Limdi JK, Aggarwal D, McLaughlin JT. Dietary practices and beliefs in patients with inflammatory bowel disease. Inflamm Bowel Dis. 2015;22:1.

    Google Scholar 

  59. Brasil Lopes M, Rocha R, Castro Lyra A, et al. Restriction of dairy products; a reality in inflammatory bowel disease patients. Nutr Hosp. 2014;29:575–581.

    PubMed  Google Scholar 

  60. Szilagyi A, Galiatsatos P, Xue X. Systematic review and meta-analysis of lactose digestion, its impact on intolerance and nutritional effects of dairy food restriction in inflammatory bowel diseases. Nutr J. 2015;15:67.

    Article  Google Scholar 

  61. Lorea Baroja M, Kirjavainen PV, Hekmat S, Reid G. Anti-inflammatory effects of probiotic yogurt in inflammatory bowel disease patients. Clin Exp Immunol. 2007;149:470–479.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  62. Shen J, Zuo ZX, Mao AP. Effect of probiotics on inducing remission and maintaining therapy in ulcerative colitis, Crohn’s disease, and pouchitis: meta-analysis of randomized controlled trials. Inflamm Bowel Dis. 2014;20:21–35.

    Article  PubMed  Google Scholar 

Download references

Acknowledgment

The authors acknowledge Fabio Canesso who provided his expertise and greatly helped the research and Renata d’Incà who authorized the access to patients and data. The authors would also like to acknowledge the contribution of the staff and participants of the EPIC-Norfolk Study. EPIC-Norfolk is supported by the Medical Research Council program Grants (G0401527, G1000143) and Cancer Research UK program Grant (C864/A8257).

Author information

Authors and Affiliations

  1. Department of Surgery, Mirano, Italy

    Laura Tasson

  2. Department of Molecular Medicine, University of Padova, Via Loredan 18, 35131, Padua, Italy

    Cristina Canova & Renzo Zanotti

  3. Department of Surgical, Oncological and Gastroenterological Sciences, University of Padova, Via Giustiniani 2, 35128, Padua, Italy

    Maria Grazia Vettorato & Edoardo Savarino

Authors
  1. Laura Tasson
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Cristina Canova
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Maria Grazia Vettorato
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Edoardo Savarino
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Renzo Zanotti
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Renzo Zanotti.

Ethics declarations

Conflict of interest

The authors whose names are listed certify that they have no conflict of interest.

Rights and permissions

Reprints and Permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Tasson, L., Canova, C., Vettorato, M.G. et al. Influence of Diet on the Course of Inflammatory Bowel Disease. Dig Dis Sci 62, 2087–2094 (2017). https://doi.org/10.1007/s10620-017-4620-0

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s10620-017-4620-0

Keywords

search

Navigation