Diet and Its Effect on Nutritional Status of Inflammtory Bowel Disease (IBD) Patients

• Inflammatory Bowel Disease (IBD) is estimated to affect nearly 1.6 million Americans.
• Diet and nutrition concerns of patients with IBD is extremely common.
• Diet could affect the symptoms of IBD and play some role in the underlying inflammatory process.

Inflammatory bowel disease (IBD) is a common disorder which affects the large intestine involving cramping, abdominal pain, bloating, gas, diarrhea or constipation. Although the exact cause of IBD is not known, few of the common triggers include food allergy or intolerance, stress and hormonal changes. Major categories of IBD include Crohn’s disease and ulcerative colitis. While Crohn’s disease is a chronic inflammatory condition of the gastrointestinal tract, ulcerative colitis is limited to the colon area.

Although there is no systematic review for relation between diet and IBD, it is believed that shift to the popular ‘Western’ diet which is high in fat and protein and low in fruits and vegetables could be attributed to a rise of inflammatory bowel disease cases.

Study

• A study was undertaken to evaluate the relationship between IBD and dietary intake, food preferences and nutritional status in Iceland.
• This cross-sectional study involved a total of 78 patients (35 men and 43 women aged 18-74 years) suffering from either Crohn’s disease or ulcerative colitis.
• Most patients (80%) were on infliximab infusion therapy; rest used other IBD drugs or no medications at all.
• All participants answered a questionnaire involving questions mainly regarding their disease, medications, diet, and food preferences.
• Body mass index was calculated for all the patients from their height and weight and percentage of body fat was also calculated.
• Blood samples were analyzed to estimate nutritional status.
• The participants recorded their intake of food, drinks and dietary supplements during three days and the average intake for each participant was calculated.

Observation and Results

• The results demonstrated that diet affected the digestive tract symptoms in nearly 87% of patients and 72% of patients had reportedly changed their diet accordingly.
• List of commonly restricted foods included dairy products (60%), processed meat (55%), soft drinks (46%), alcohol (45%) and fast food (44%), citrus fruits (41%).
• Foods which were reported to have positive effects on symptoms were mainly fish (22%) and non-processed foods (8%) amongst others.
• About 46% of patients were diagnosed with some form of nutritional deficiency (iron deficiency was seen in about 39% of patients). Iron deficiency could eventually lead to anemia.
• Intake of vitamin D and calcium were found to be 65% below the recommended intake value for both. This is an important observation since IBD patients are at a greater risk of developing metabolic bone disease and use of calcium and vitamin D supplements could possibly have positive effects on bone health.
• Thus dietary supplements such as those for calcium, vitamin D, iron, vitamin B12 and folate are recommended for IBD patients to prevent deficiency from occurring. However, a word of caution: vitamin and mineral supplements could cause gastrointestinal (GI) symptoms, hence, should be taken only under the supervision of your physician.

Limitations

• Since this was a cross-sectional study, it could not differentiate between cause and effect in an observed association.
• Study participants were a selected group of IBD patients most of whom were on biological treatment; hence study results could not be extrapolated to an unselected group of IBD patients, who probably are more affected by nutritional deficiency.

Conclusion

Restriction of dairy and meat intake was commonly seen in IBD patients which could have a negative effect on status of micronutrients such as calcium and iron, hence should be done under the guidance of a dietitian or physician.

Reference:

1. The Relationship Between Food & IBD
   http://www.ibdetermined.org/ibd-information/ibd-diet.aspx

Source-Medindia