Lifestyle-related disease in Crohn's disease: relapse prevention by a semi-vegetarian diet

Abstract

Aim: To investigate whether semi-vegetarian diet (SVD) has a preventive effect against relapse of Crohn's disease (CD) in patients who have achieved remission, who are a high-risk group for relapse.

Methods: A prospective, single center, 2-year clinical trial was conducted. Twenty-two adult CD patients who achieved clinical remission either medically (n = 17) or surgically (n = 5) and consumed an SVD during hospitalization were advised to continue with an SVD and avoid known high-risk foods for inflammatory bowel disease. The primary endpoint was clinical relapse defined as the appearance of active symptoms of CD. Kaplan-Meier survival analysis was used to calculate the cumulative proportion of patients who had a relapse. A 2-year analysis of relapse rates of patients who followed an SVD and those who did not (an omnivorous diet group) was undertaken.

Results: SVD was continued by 16 patients (compliance 73%). Remission was maintained in 15 of 16 patients (94%) in the SVD group vs two of six (33%) in the omnivorous group. Remission rate with SVD was 100% at 1 year and 92% at 2 years. SVD showed significant prevention in the time to relapse compared to that in the omnivorous group (P = 0.0003, log rank test). The concentration of C-reactive protein was normal at the final visit in more than half of the patients in remission who were taking an SVD, who maintained remission during the study (9/15; 60%), who terminated follow-up (8/12; 67%), and who completed 2 years follow-up (7/10; 70%). There was no untoward effect of SVD.

Conclusion: SVD was highly effective in preventing relapse in CD.

Figure 1

Nutritional elements of brown rice in comparison with white rice[50]. The amount of elements in 100 g of edible food is expressed in comparison with those in white rice, whose value is 1. Brown rice is richer in almost all elements in comparison. En: Energy; Pr: Protein; F: Fat; CH: Carbohydrate; E: Vitamin E; B1: Vitamin B1; B2: Vitamin B2; NI: Niacin; B6: Vitamin B6; FA: Folic acid; PA: Pantothenic acid; DF: Dietary fiber.

Figure 2

A sample of a 1700-kcal/d semi-vegetarian diet (SVD) for Crohn’s disease (CD). From left to right, breakfast (A), lunch (B), and dinner (C). Boiled brown rice is seen at the bottom left of the tray and miso (fermented bean paste) soup is at the bottom right. Breakfast (A): Raw grated nagaimo (yam) and shredded toasted nori seaweed are at the top left; natto (fermented soybeans) and grated daikon (Japanese radish) are at the top right; and braised hijiki seaweed, nama-age (thick deep-fried beancurd), and edamame (young soybeans) are in the center; Lunch (B): Boiled potato, onion, and corn in tomato soup are at the top left; isomaki-tamago (dried nori seaweed inside egg roll) and boiled chrysanthemum with sesame dressing are at the top right; takuan (pickled radish) is in the center; and a mixture of banana and plain yoghurt is at the bottom right; Dinner (C): Boiled chingensai (qing gin cai), soybeans, and wakame seaweed with vinegar soy sauce dressing are at the top left; simmered ganmodoki (bean-curd-based mixture), tofu (bean curd), boiled egg, Japanese-variety eggplant, Japanese butterbur, Japanese-variety pumpkin, and snow peas are at the top right; and citrus fruit is in the center.

Figure 3

SVD food guide pyramid.

Figure 4

Life table estimate of maintaining remission with SVD or omnivorous diet.