Special diet may help reduce disease activity in IBD

Diet plays an important role in reducing disease activity in patients with inflammatory bowel disease (IBD) — particularly when diet leans towards anti-inflammatory food or a CD exclusion diet (CDED), according to studies presented at the Crohn’s and Colitis Congress (CCC) 2022.

In an open-label, single-centre study, 32 patients with active Crohn’s disease (CD; defined as CDAI* >150 points) underwent CDED with a whole-protein, nutritionally-complete, powdered formulation (Modulen). They were assessed on anthropometric measurements, CDAI, laboratory test, and Inflammatory Bowel Disease Questionnaire (IBDQ) at baseline, weeks 6 and 12.

Compared with baseline, a substantial proportion of patients achieved clinical remission (defined as CDAI <150 points) after 6 weeks (76.7 percent, 95 percent confidence interval [CI], 57.7–90.1) and 12 weeks (82.1 percent, 95 percent CI, 63.1–93.9), the latter which was the study primary outcome.

CDAI dropped significantly from a mean of 253.00 at baseline to 53.40 after 6 weeks and 45.00 after 12 weeks of dietary intervention (p<0.001 for both).

The secondary endpoint of clinical response (defined as a reduction in CDAI by ≥100 points) was seen in 83.3 percent of the patients after 6 weeks (95 percent CI, 65.3–94.4) and in 85.7 percent of patients after 12 weeks (95 percent CI, 67.3–96.0).

In addition, the patients saw a significant drop in the inflammatory biomarker calprotectin from 393 µg/mL at baseline to 231 µg/mL at 6 weeks and 122 at 12 weeks (p=0.021).

Quality of life, as assessed using IBDQ, also improved significantly during the first and the second follow-up (p<0.001).

“The CDED with a supply of liquid formula is an effective therapy for inducing remission in the adult CD population,” concluded the researchers. “However, a randomized trial is needed to obtain higher-level evidence.”

Complementary approach in UC

Another cross sectional cohort study looked at the relationship between diet as well as physical activity and disease activity in 2,052 participants with self-reported ulcerative colitis (UC).

“Individuals diagnosed with UC often seek complementary lifestyle methods, such as diet and physical activity, to self-manage disease symptoms and respond to the psychosocial challenges of living with chronic illness,” explained the researchers.

They found that patients with a higher E-DII** score — which indicates the pro-inflammatory potential of dietary intake) — had significantly increased disease activity (β=0.166; p<0.001).

Accordingly, having a higher E-DII score was also associated with reduced health-related quality of life (β=-0.056; p<0.001), poorer sleep (β=0.339; p=0.003), increased fatigue (β=0.386; p=0.005), depression (β=0.408; p=0.004), anxiety (β=0.342; p=0.006), and lower social well-being (β=-0.370; p=0.004).

On the other hand, physical activity levels, assessed using the Godin-Shephard Leisure Time Activity Index, showed an inverse association with disease activity (β=-0.108; p<0.001), as were for sleep disturbance (β=-0.019; p=0.008), fatigue (β=-0.058; p<0.001), depression (β=-0.025; p=0.001), and anxiety (β=-0.025; p=0.001).

Participants who were more active physically also reported better IBD-related quality of life (β=0.005; p<0.001) and greater sense of satisfaction with social role (β=0.063; p<0.001).

“These findings suggest that an anti-inflammatory diet and physical activity are each complementary lifestyle methods that may contribute [improvements in disease symptoms and the ability to respond to the psychosocial challenges of living with the disease],” said the researchers.

“Such modalities may aid in managing systemic and localized inflammation associated with UC and reduce the burden of UC on daily living,” they added.

*CDAI: Crohn’s disease activity index
**E-DII: The Energy Adjusted Dietary Inflammatory