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Meta-Analysis
. 2019 Feb 8;2(2):CD012839.
doi: 10.1002/14651858.CD012839.pub2.

Dietary interventions for induction and maintenance of remission in inflammatory bowel disease

Berkeley N Limketkai  1 , Zipporah Iheozor-Ejiofor, Teuta Gjuladin-Hellon, Alyssa Parian, Laura E Matarese, Kelly Bracewell, John K MacDonald, Morris Gordon, Gerard E Mullin
Affiliations
Meta-Analysis

Dietary interventions for induction and maintenance of remission in inflammatory bowel disease

Berkeley N Limketkai et al. Cochrane Database Syst Rev. .

Abstract

Background: Inflammatory bowel disease (IBD), comprised of Crohn's disease (CD) and ulcerative colitis (UC), is characterized by chronic mucosal inflammation, frequent hospitalizations, adverse health economics, and compromised quality of life. Diet has been hypothesised to influence IBD activity.

Objectives: To evaluate the efficacy and safety of dietary interventions on IBD outcomes.

Search methods: We searched the Cochrane IBD Group Specialized Register, CENTRAL, MEDLINE, Embase, Web of Science, Clinicaltrials.gov and the WHO ICTRP from inception to 31 January 2019. We also scanned reference lists of included studies, relevant reviews and guidelines.

Selection criteria: We included randomized controlled trials (RCTs) that compared the effects of dietary manipulations to other diets in participants with IBD. Studies that exclusively focused on enteral nutrition, oral nutrient supplementation, medical foods, probiotics, and parenteral nutrition were excluded.

Data collection and analysis: Two review authors independently performed study selection, extracted data and assessed bias using the risk of bias tool. We conducted meta-analyses where possible using a random-effects model and calculated the risk ratio (RR) and corresponding 95% confidence interval (CI) for dichotomous outcomes. We assessed the certainty of evidence using GRADE.

Main results: The review included 18 RCTs with 1878 participants. The studies assessed different dietary interventions for active CD (six studies), inactive CD (seven studies), active UC (one study) and inactive UC (four studies). Dietary interventions involved either the consumption of low amounts or complete exclusion of one or more food groups known to trigger IBD symptoms. There was limited scope for data pooling as the interventions and control diets were diverse. The studies were mostly inadequately powered. Fourteen studies were rated as high risk of bias. The other studies were rated as unclear risk of bias.The effect of high fiber, low refined carbohydrates, low microparticle diet, low calcium diet, symptoms-guided diet and highly restricted organic diet on clinical remission in active CD is uncertain. At 4 weeks, remission was induced in: 100% (4/4) of participants in the low refined carbohydrates diet group compared to 0% (0/3) of participants in the control group (RR 7.20, 95% CI 0.53 to 97.83; 7 participants; 1 study; very low certainty evidence). At 16 weeks, 44% (23/52) of participants in the low microparticle diet achieved clinical remission compared to 25% (13/51) of control-group participants (RR 3.13, 95% CI 0.22 to 43.84; 103 participants; 2 studies; I² = 73%; very low certainty evidence). Fifty per cent (16/32) of participants in the symptoms-guided diet group achieved clinical remission compared to 0% (0/19) of control group participants (RR 20.00, 95% CI 1.27 to 315.40; 51 participants ; 1 study; very low certainty evidence) (follow-up unclear). At 24 weeks, 50% (4/8) of participants in the highly restricted organic diet achieved clinical remission compared to 50% (5/10) of participants in the control group (RR 1.00, 95% CI 0.39 to 2.53; 18 participants; 1 study; very low certainty evidence). At 16 weeks, 37% (16/43) participants following a low calcium diet achieved clinical remission compared to 30% (12/40) in the control group (RR 1.24, 95% CI 0.67 to 2.29; 83 participants; 1 study; very low certainty evidence).The effect of low refined carbohydrate diets, symptoms-guided diets and low red processed meat diets on relapse in inactive CD is uncertain. At 12 to 24 months, 67% (176/264) of participants in low refined carbohydrate diet relapsed compared to 64% (193/303) in the control group (RR 1.04, 95% CI 0.87 to 1.25; 567 participants; 3 studies; I² = 35%; low certainty evidence). At 6 to 24 months, 48% (24/50) of participants in the symptoms-guided diet group relapsed compared to 83% (40/48) participants in the control diet (RR 0.53, 95% CI 0.28 to 1.01; 98 participants ; 2 studies; I² = 54%; low certainty evidence). At 48 weeks, 66% (63/96) of participants in the low red and processed meat diet group relapsed compared to 63% (75/118) of the control group (RR 1.03, 95% CI 0.85 to 1.26; 214 participants; 1 study; low certainty evidence). At 12 months, 0% (0/16) of participants on an exclusion diet comprised of low disaccharides / grains / saturated fats / red and processed meat experienced clinical relapse compared to 26% (10/38) of participants on a control group (RR 0.11, 95% CI 0.01 to 1.76; 54 participants; 1 study; very low certainty evidence).The effect of a symptoms-guided diet on clinical remission in active UC is uncertain. At six weeks, 36% (4/11) of symptoms-guided diet participants achieved remission compared to 0% (0/10) of usual diet participants (RR 8.25, 95% CI 0.50 to 136.33; 21 participants; 1 study; very low certainty evidence).The effect of the Alberta-based anti-inflammatory diet, the Carrageenan-free diet or milk-free diet on relapse rates in inactive UC is uncertain. At 6 months, 36% (5/14) of participants in the Alberta-based anti-inflammatory diet group relapsed compared to 29% (4/14) of participants in the control group (RR 1.25, 95% CI 0.42 to 3.70; 28 participants; 1 study; very low certainty evidence). Thirty per cent (3/10) of participants following the carrageenan-free diet for 12 months relapsed compared to 60% (3/5) of the participants in the control group (RR 0.50, 95% CI 0.15 to 1.64; 15 participants; 1 study; very low certainty evidence). At 12 months, 59% (23/39) of milk free diet participants relapsed compared to 68% (26/38) of control diet participants (RR 0.83, 95% CI 0.60 to 1.15; 77 participants; 2 studies; I² = 0%; low certainty evidence).None of the included studies reported on diet-related adverse events.

Authors' conclusions: The effects of dietary interventions on CD and UC are uncertain. Thus no firm conclusions regarding the benefits and harms of dietary interventions in CD and UC can be drawn. There is need for consensus on the composition of dietary interventions in IBD and more RCTs are required to evaluate these interventions. Currently, there are at least five ongoing studies (estimated enrollment of 498 participants). This review will be updated when the results of these studies are available.

PubMed Disclaimer

Conflict of interest statement

Berkeley N Limketkai: None known

Zipporah Iheozor‐Ejiofor: None known

Teuta Gjuladin‐Hellon: None known

Alyssa Parian: None known

Laura E Matarese: None known

Kelly Bracewell: None known

John K MacDonald: None known

Morris Gordon has received travel fees to attend international scientific and training meeting such as DDW, Advances in IBD, ESPGHAN, BSPGHAN and Cochrane focused international events from companies including: Abbott, Nutricia, Biogaia, Ferring, Allergan, and Tillots.

Gerard E Mullin has received grants or grants pending (paid to institution) from Abbott Laboratories; and royalties from Rodale Press, Oxford University Press, and CRC Press for books written and or edited on nutrition, generically, and only a few chapters as an expert on the role of diet in IBD.

Figures

1
1
Source: Mullin 2016.
2
2
Study flow diagram.
3
3
Risk of bias summary: review authors' judgements about each risk of bias item for each included study.
See this image and copyright information in PMC

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References

References to studies included in this review

Albenberg 2018 {published data only}
    1. Albenberg L, Brensinger C, Wu Q, Gilroy E, Kappelman M, Sandler R, et al. A diet low in red and processed meats does not reduce the rate of Crohn's disease flares in a randomized controlled trial: results of the food and Crohn's disease exacerbation study (FACES). Gastroenterology 2018;154(1):S3. - PMC - PubMed
Bartel 2008 {published data only}
    1. Bartel G, Weiss I, Turetschek K, Schima W, Püspök A, Waldhoer T, et al. Ingested matter affects intestinal lesions in Crohn's disease. Inflammatory Bowel Diseases 2008;14(3):374‐82. [PUBMED: 17932967] - PubMed
Bhattacharyya 2017 {published data only}
    1. Bhattacharyya S, Shumard T, Xie H, Dodda A, Varady KA, Feferman L, et al. A randomized trial of the effects of the no‐carrageenan diet on ulcerative colitis disease activity. Nutrition and Healthy Aging 2017;4:181–192. - PMC - PubMed
Brandes 1981 {published data only}
    1. Brandes JW, Lorenz‐Meyer H. Sugar free diet: a new perspective in the treatment of Crohn disease? Randomized, control study. Zeitschrift fur Gastroenterologie 1981;19(1):1‐12. [PUBMED: 7013307] - PubMed
Brotherton 2014 {published data only}
    1. Brotherton CS, Taylor AG, Bourguignon C, Anderson JG. A high‐fiber diet may improve bowel function and health‐related quality of life in patients with Crohn disease. Gastroenterology Nursing 2014;37(3):206‐16. [PUBMED: 24871666] - PMC - PubMed
Candy 1995 {published data only}
    1. Candy S, Borok G, Wright JP, Boniface V, Goodman R. The value of an elimination diet in the management of patients with ulcerative colitis. South African Medical Journal 1995;85(11):1176‐9. [PUBMED: 8597010] - PubMed
Dariel 2007 {published data only}
    1. Dariel I, Levi Z, Fraser A, Hadad B, Niv Y, Fraser G. Elimination diets in the treatment of mildly active Crohn's disease ‐ results of a randomized controlled trial. Gastroenterology 2207;132(4):A506‐7.
Jones 1985 {published data only}
    1. Jones VA, Dickinson RJ, Workman E, Wilson AJ, Freeman AH, Hunter JO. Crohn's disease: maintenance of remission by diet. Lancet 1985;2(8448):177‐80. [PUBMED: 2862371] - PubMed
Keshteli 2016 {published data only}
    1. Keshteli AH, Valcheva R, Nickurak C, Halloran BP, Zanten SV, Kroeker K, et al. Adherence to an "Anti‐Inflammatory Diet" for 6 months can decrease fecal calprotectin in ulcerative colitis patients: preliminary findings of a randomized controlled trial. Gastroenterology 2016;150(4):S807‐8.
Levenstein 1985 {published data only}
    1. Levenstein S, Prantera C, Luzi C, D'Ubaldi A. Low residue or normal diet in Crohn's disease: a prospective controlled study in Italian patients. Gut 1985;26(10):989‐93. [PUBMED: 2996991] - PMC - PubMed
Lomer 2001 {published data only}
    1. Lomer MC, Harvey RS, Evans SM, Thompson RP, Powell JJ. Efficacy and tolerability of a low microparticle diet in a double blind, randomized, pilot study in Crohn's disease. European Journal of Gastroenterology & Hepatology 2001;13(2):101‐6. [PUBMED: 11246607] - PubMed
Lomer 2005 {published data only}
    1. Lomer MC, Grainger SL, Ede R, Catterall AP, Greenfield SM, Cowan RE, et al. Lack of efficacy of a reduced microparticle diet in a multi‐centred trial of patients with active Crohn's disease. European Journal of Gastroenterology & Hepatology 2005;17(3):377‐84. [PUBMED: 15716665] - PubMed
Lorenz‐Meyer 1996 {published data only}
    1. Lorenz‐Meyer H, Bauer P, Nicolay C, Schulz B, Purrmann J, Fleig WE, et al. Omega‐3 fatty acids and low carbohydrate diet for maintenance of remission in Crohn's disease. A randomized controlled multicenter trial. Scandinavian Journal of Gastroenterology 1996;31(8):778‐85. [PUBMED: 8858747] - PubMed
Mutlu 2016 {published data only}
    1. Mutlu E, Mikolaitis S, Sedghi S, Chakradeo PS, Engen P, Chlipala G, et al. Dietary treatment of Crohn's disease: a randomized, placebo‐controlled, double‐blinded clinical trial. Gastroenterology 2016;150(4):S778.
Riordan 1993 {published data only}
    1. Riordan AM, Hunter JO, Cowan RE, Crampton JR, Davidson AR, Dickinson RJ, et al. Treatment of active Crohn's disease by exclusion diet: East Anglian multicentre controlled trial. Lancet 1993;342(8880):1131‐4. [PUBMED: 7901473] - PubMed
Ritchie 1987 {published data only}
    1. Ritchie JK, Wadsworth J, Lennard‐Jones JE, Rogers E. Controlled multicentre therapeutic trial of an unrefined carbohydrate, fibre rich diet in Crohn's disease. British Medical Journal Clinical Research Edition 1987;295(6597):517‐20. [PUBMED: 2822203] - PMC - PubMed
Strisciuglio 2013 {published data only}
    1. Strisciuglio C, Giannetti E, Martinelli M, Sciorio E, Staiano A, Miele E. Does cow's milk protein elimination diet have a role on induction and maintenance of remission in children with ulcerative colitis?. Acta Paediatrica 2013;102(6):e273‐8. [PUBMED: 23445275] - PubMed
Wright 1965 {published data only}
    1. Wright R, Truelove SC. A controlled therapeutic trial of various diets in ulcerative colitis. British Medical Journal 1965;2(5454):138‐41. [PUBMED: 14304053] - PMC - PubMed

References to studies excluded from this review

Barnes 2016 {published data only}
    1. Barnes EL, Nestor MA, Onyewadume L, Silva PS, Korzenik JR. A prospective study: the role of diet in exacerbations of patients with ulcerative colitis in remission on monotherapy with mesalamine. Gastroenterology 2016;150(4):S5‐6.
Beattie 1994 {published data only}
    1. Beattie RM, Walker‐Smith JA. Treatment of active Crohn's disease by exclusion diet. Journal of Pediatric Gastroenterology and Nutrition 1994;19(1):135‐6. [PUBMED: 7965469] - PubMed
Bentz 2010 {published data only}
    1. Bentz S, Hausmann M, Piberger H, Kellermeier S, Paul S, Held L, et al. Clinical relevance of IgG antibodies against food antigens in Crohn's disease: a double‐blind cross‐over diet intervention study. Digestion 2010;81(4):252‐64. [PUBMED: 20130407] - PubMed
Boneh 2017 {published data only}
    1. Boneh, R. S, Shabat, C. S, Yanai, H, Chermesh, I, Ben Avraham, S, Boaz, M, Levine, A. Dietary Therapy With the Crohn's Disease Exclusion Diet is a Successful Strategy for Induction of Remission in Children and Adults Failing Biological Therapy. Journal of Crohns & Colitis Oct 2017;11(10):1205‐1212. - PubMed
Brandes 1982 {published data only}
    1. Brandes JW, Körst HA, Littman KP. Sugar‐free diet as long‐term or interval treatment in the remission phase of Crohn disease ‐ a prospective study. Leber Magen Darm 1982;12(6):225‐8. [PUBMED: 6135129] - PubMed
Castro 1995 {published data only}
    1. Castro M, Lucidi V, Colombo AM, Gambarara M. Diet therapy or drug therapy in Crohn's disease. Rivista Italiana Di Pediatria 1995;21(4):439‐45.
Ciccimarra 1998 {published data only}
    1. Ciccimarra E, Borrelli O, Franco MT, Iula VD, Montisci A, Vizia B, et al. Nutritional therapy of Crohn's disease. Rivista Italiana Di Pediatria 1998;24(1):108‐16.
Cohen 2012 {published data only}
    1. Cohen SA, Stallworth AN, Koch BM, Mason DH, Blumenthal J, Gold BD. Mucosal healing with the Specific Carbohydrate Diet in pediatric Crohn's disease: preliminary results of a prospective pilot study. Gastroenterology 2012;142(5):S376.
Davies 1978 {published data only}
    1. Davies PS, Rhodes J. Maintenance of remission in ulcerative colitis with sulphasalazine or a high‐fibre diet: a clinical trial. British Medical Journal 1978;1(6126):1524‐5. [PUBMED: 26448] - PMC - PubMed
Dunn 2017 {published data only}
    1. Dunn KA, Boneh RS, Bielawski JP, Turner D, Limbergen JE, Levine A. Crohn's disease exclusion diet and partial enteral nutrition (CDED+PEN) vs exclusive enteral nutrition (EEN) ‐ microbiome changes of a randomized clinical trial (RCT) in pediatric CD: Remission is associated with similar structural and functional profiles. Gastroenterology 2017;152(5):S213.
El‐Tahir 1998 {published data only}
    1. El‐Tahir A, Heys SD, Sinclair T, Mowat NAG, Ewen S, Eremin O. Effects of dietary supplementation on disease activity in patients with ulcerative colitis: a randomized controlled clinical study. British Journal of Surgery 1998;85(11):1566.
Gunasekeera 2016 {published data only}
    1. Gunasekeera V, Mendall MA, Chan D, Kumar D. Treatment of Crohn's disease with an IgG4‐guided exclusion diet: a randomized controlled trial. Digestive Diseases and Sciences 2016;61(4):1148‐57. [PUBMED: 26809868] - PubMed
Halmos 2016 {published data only}
    1. E. P. Halmos, C. T. Christophersen, A. R. Bird, S. J. Shepherd, J. G. Muir, P. R. Gibson. Consistent Prebiotic Effect on Gut Microbiota With Altered FODMAP Intake in Patients with Crohn’s Disease: A Randomised, Controlled Cross‐Over Trial of Well‐Defined Diets. Clinical and Translational Gastroenterology 2016;7:e164. - PMC - PubMed
Kyaw 2014 {published data only}
    1. Kyaw MH, Moshkovska T, Mayberry J. A prospective, randomized, controlled, exploratory study of comprehensive dietary advice in ulcerative colitis: impact on disease activity and quality of life. European Journal of Gastroenterology & Hepatology 2014;26(8):910‐7. [PUBMED: 24942954] - PubMed
Mikolaitis 2013 {published data only}
    1. Mikolaitis S, Chakradeo P, Fogg L, Keshavarzian A, Mutlu E. Blinding of patients and physicians during a one‐year randomized clinical trial of dietary interventions for treatment of Crohn's disease. American Journal of Gastroenterology 2013;108:S495.
NCT01749813 {published data only}
    1. NCT01749813. Specific Carbohydrate Diet as Maintenance Therapy in Crohn's Disease. ClinicalTrials.gov/show/NCT01749813 (accessed 31 January 2018).
NCT02093780 {published data only}
    1. NCT02093780. Personalized "Alberta" Diet for Prevention of Relapse in Ulcerative Colitis. ClinicalTrials.gov/show/NCT02093780 (accessed 31 January 2018).
NCT02213835 {published data only}
    1. NCT02213835. Treatment With the Specific Carbohydrate Diet for Children With Active Crohns Disease and Ulcerative Colitis. ClinicalTrials.gov/show/NCT02213835 (accessed 31 January 2018).
NCT02231814 {published data only}
    1. NCT02231814. Pilot Study of Partial Enteral Nutrition With a Unique Diet for the Treatment of Adult Patients With Crohn's Disease. ClinicalTrials.gov/show/NCT02231814 (accessed 31 January 2018).
NCT02345733 {published data only}
    1. NCT02345733. Use of a Novel Diet (UC DIET) for Treatment of Mild to Moderate Active Pediatric Ulcerative Colitis. ClinicalTrials.gov/show/NCT02345733 (accessed 31 January 2018).
NCT02357537 {published data only}
    1. NCT02357537. Decentralized Dietary UC Pilot Trial. ClinicalTrials.gov/show/NCT02357537 (accessed 31 January 2018).
NCT02426567 {published data only}
    1. NCT02426567. The Impact of "Crohn's Disease‐TReatment‐with‐EATing" Diet and Exclusive Enteral Nutrition on Healthy Gut Bacteria. ClinicalTrials.gov/show/NCT02426567 (accessed 31 January 2018).
NCT02469220 {published data only}
    1. NCT02469220. Diet Treatment of Patients With Ulcerative Colitis in Remission. ClinicalTrials.gov/show/NCT02469220 (accessed 31 January 2018).
NCT02610101 {published data only}
    1. NCT02610101. Nutritional Therapy Study in Pediatric Crohn's Disease. ClinicalTrials.gov/show/NCT02610101 (accessed 31 January 2018).
NCT02922881 {published data only}
    1. NCT02922881. Microbiota‐targeted Diet for Pediatric UC (UCD). ClinicalTrials.gov/show/NCT02922881 (accessed 31 January 2018).
NCT02930564 {published data only}
    1. NCT02930564. The Challenge Study: A Dietary Personalization Protocol for Patients With Crohn's Disease and Deep Remission. ClinicalTrials.gov/show/NCT02930564 (accessed 31 January 2018).
NCT02945488 {published data only}
    1. NCT02945488. Exercise and Nutrition in IBD & Preconception. ClinicalTrials.gov/show/NCT02945488 (accessed 31 January 2018).
NCT03171246 {published data only}
    1. NCT03171246. CD‐TREAT Diet: a Novel Therapy for Active Luminal Crohn's Disease. ClinicalTrials.gov/show/NCT03171246 (accessed 31 January 2018).
Pedersen 2014 {published data only}
    1. Pedersen N, Vinding KK, Vegh Z, Casen C, Ankersen DV, Carlsen K, et al. Gut microbiota in IBD patients with IBS before and after 6 weeks of low FODMAP diet. Gastroenterology 2014;146(5):S241.
Pedersen 2017 {published data only}
    1. Pedersen N, Ankersen DV, Felding M, Wachmann H, Végh Z, Molzen L, et al. Low‐FODMAP diet reduces irritable bowel symptoms in patients with inflammatory bowel disease. World Journal of Gastroenterology 2017;23(18):3356‐66. [PUBMED: 28566897] - PMC - PubMed
Pituch‐Zdanowska 2018 {published data only}
    1. Pituch‐Zdanowska A, Albrecht P, Banasiuk M, Banaszkiewicz A. Dietary fiber intake in children with inflammatory bowel disease. Journal of Pediatric Gastroenterology and Nutrition 2018;66:624‐9. - PubMed
Stange 1990 {published data only}
    1. Stange EF, Schmid U, Fleig WE, Ditschuneit H. Exclusion diet in Crohn disease: a controlled, randomized study. Zeitschrift fur Gastroenterologie 1990;28(10):561‐4. [PUBMED: 2275253] - PubMed
Strohm 1981 {published data only}
    1. Strohm WD, Steinhardt HJ, Brandes JW, Jarnum S, Leonhardt H, Ehms H, et al. Low‐molecular fully balanced diets for the treatment of Crohn's disease ‐ a randomized controlled study. Zeitschrift fur Gastroenterologie 1981;19(9):525.
Svolos 2016 {published data only}
    1. Svolos V, Hansen R, Kughes K, Ijaz UZ, Quince C, Gaya D, et al. The impact of 'Crohn's Disease‐TReatment‐with‐EATing' diet (CD‐TREAT diet) and exclusive enteral nutrition on healthy gut bacteria. Journal of Crohn's & Colitis 2016;10(Supplement 1):S14‐5.
Vincenzi 2016 {published data only}
    1. Vincenzi M, Paolini B, Ciondolo I, Pasquini E, Ceccarelli L, Gennai K, et al. Effects on symptoms and on nutritional adequacy of a low FODMAPs diet and Specific Carbohydrate Diet on inflammatory bowel disease. Double blind and randomized study. Preliminary result. Gastroenterology 2016;150(4):S425.

References to studies awaiting assessment

Bodini 2018 {published data only}
    1. Bodini G, Giannini EGB, Savarino V, Crespi M, Lo Pumo S, Zanella C, et al. Low FODMAP diet improve disease activity and quality of life in patients with inflammatory bowel disease. Digestive and Liver Disease 2018;50:e197‐8.
Tapete 2018 {published data only}
    1. Tapete G, Bortoli N, Ceccarelli L, Mumolo MG, Vinci E, Albano E, et al. Low‐FODMAPs diet improves intestinal symptoms in IBD patients with disease remission: Randomized case‐control study. Digestive and Liver Disease 2018;50:e195.

References to ongoing studies

NCT02825316 {published data only}
    1. NCT02825316. Mediterranean Diet as an add‐on Therapy for Induction of Remission in Patients With Active Crohn's Disease. ClinicalTrials.gov/show/NCT02825316 (accessed 31 January 2018).
NCT02858557 {published data only}
    1. NCT02858557. The Effect of Diet on Microbial Profile and Disease Outcomes in Patients With Inflammatory Bowel Diseases. ClinicalTrials.gov/show/NCT02858557 (accessed 31 January 2018).
NCT03012542 {published data only}
    1. NCT03012542. Diet as Essential Therapy (DIET) for Inflammatory Bowel Disease. ClinicalTrials.gov/show/NCT03012542 (accessed 31 January 2018).
NCT03053713 {published data only}
    1. NCT03053713. The Effect of Diet on Disease Activity and Symptoms in Patients With Ulcerative Colitis. ClinicalTrials.gov/show/NCT03053713 (accessed 31 January 2018).
NCT03058679 {published data only}
    1. NCT03058679. Trial of Specific Carbohydrate and Mediterranean Diets to Induce Remission of Crohn's Disease. ClinicalTrials.gov/show/NCT03058679 (accessed 31 January 2018).

Additional references

Abraham 2009
    1. Abraham C, Cho JH. Inflammatory bowel disease. New England Journal of Medicine 2009;361:2066‐78. - PMC - PubMed
Akobeng 2018
    1. Akobeng AK, Zhang D, Gordon M, MacDonald JK. Enteral nutrition for maintenance of remission in Crohn's disease. Cochrane Database of Systematic Reviews 2018, Issue 8. [DOI: 10.1002/14651858.CD005984.pub3] - DOI - PMC - PubMed
Amre 2007
    1. Amre DK, D'Souza S, Morgan K, Seidman G, Lambrette P, Grimard G, et al. Imbalances in dietary consumption of fatty acids, vegetables, and fruits are associated with risk for Crohn's disease in children. American Journal of Gastroenterology 2007;102:2016‐25. - PubMed
Ananthakrishnan 2013
    1. Ananthakrishnan AN, Khalili H, Konijeti GG, Higuchi LM, Silva P, Korzenik JR, et al. A prospective study of long‐term intake of dietary fiber and risk of Crohn's disease and ulcerative colitis. Gastroenterology 2013;145:970‐7. - PMC - PubMed
Ananthakrishnan 2014
    1. Ananthakrishnan AN, Khalili H, Konijeti GG, Higuchi LM, Silva P, Fuchs CS, et al. Long‐term intake of dietary fat and risk of ulcerative colitis and Crohn's disease. Gut 2014;63:776‐84. - PMC - PubMed
Ananthakrishnan 2015
    1. Ananthakrishnan AN, Khalili H, Song M, Higuchi LM, Richter JM, Nimptsch K, et al. High School Diet and Risk of Crohn's Disease and Ulcerative Colitis. Inflammatory Bowel Diseases 2015;21:2311‐9. - PMC - PubMed
Benchimol 2015
    1. Benchimol EI, Mack DR, Guttmann A, Nguyen GC, To T, Mojaverian N, et al. Inflammatory bowel disease in immigrants to Canada and their children: a population‐based cohort study. American Journal of Gastroenterology 2015;110:553‐63. - PubMed
Bianchi 1985
    1. Bianchi Porro G, Panza E. Smoking, sugar, and inflammatory bowel disease. British Medical Journal (Clinical Research Edition) 1985;291:971‐2. - PMC - PubMed
Birrenbach 2004
    1. Birrenbach T, Böcker U. Inflammatory bowel disease and smoking: a review of epidemiology, pathophysiology, and therapeutic implications. Inflammatory Bowel Diseases 2004;10:848‐59. - PubMed
Brown 2011
    1. Brown AC, Rampertab SD, Mullin GE. Existing dietary guidelines for Crohn's disease and ulcerative colitis. Expert Review of Gastroenterology and Hepatology 2011;5:411‐25. - PubMed
Chan 2014
    1. Chan SS, Luben R, Olsen A, Tjonneland A, Kaaks R, Lindgren S, et al. Association between high dietary intake of the n‐3 polyunsaturated fatty acid docosahexaenoic acid and reduced risk of Crohn's disease. Alimentary Pharmacology and Therapeutics 2014;39(8):834‐42. - PMC - PubMed
Chapman‐Kiddell 2010
    1. Chapman‐Kiddell CA, Davies PS, Gillen L, Radford‐Smith GL. Role of diet in the development of inflammatory bowel disease. Inflammatory Bowel Diseases 2010;16:137‐51. - PubMed
Cornish 2008
    1. Cornish JA, Tan E, Simillis C, Clark SK, Teare J, Tekkis PP. The risk of oral contraceptives in the etiology of inflammatory bowel disease: a meta‐analysis. American Journal of Gastroenterology 2008;103:2394‐400. - PubMed
Critch 2012
    1. Critch J, Day AS, Otley A, King‐Moore C, Teitelbaum JE, Shashidhar H, et al. Use of enteral nutrition for the control of intestinal inflammation in pediatric Crohn disease. Journal of Pediatric Gastroenterology and Nutrition 2012;54:298‐305. - PubMed
Damas 2013
    1. Damas OM, Jahann DA, Reznik R, McCauley JL, Tamariz L, Deshpande AR, et al. Phenotypic manifestations of Inflammatory Bowel Disease differ between Hispanics and non‐Hispanic whites: results of a large cohort study. American Journal of Gastroenterology 2013;108(2):231‐9. - PubMed
Damas 2017
    1. Damas OM, Avalos DJ, Palacio AM, Gomez L, Quintero MA, Deshpande AR, et al. Inflammatory bowel disease is presenting sooner after immigration in more recent US immigrants from Cuba. Alimentary Pharmacology and Therapeutics 2017;46(3):303‐9. - PMC - PubMed
Devkota 2012
    1. Devkota S, Wang Y, Musch MW, Leone V, Fehlner‐Peach H, Nadimpalli A, et al. Dietary‐fat‐induced taurocholic acid promotes pathobiont expansion and colitis in Il10‐/‐ mice. Nature 2012;487:104‐8. - PMC - PubMed
Foster 2013
    1. Foster A, Jacobson K. Changing incidence of inflammatory bowel disease: environmental influences and lessons learnt from the South Asian population. Frontiers in Pediatrics 2013;1:34. - PMC - PubMed
Galvez 2005
    1. Galvez J, Rodríguez‐Cabezas ME, Zarzuelo A. Effects of dietary fiber on inflammatory bowel disease. Molecular Nutrition and Food Research 2005;49:601‐8. - PubMed
Garcia Rodriguez 2006
    1. García Rodríguez LA, Ruigómez A, Panés J. Acute gastroenteritis is followed by an increased risk of inflammatory bowel disease. Gastroenterology 2006;130:1588‐94. - PubMed
Gearry 2009
    1. 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. Journal of Crohn's and Colitis 2009;3:8‐14. - PubMed
Gibson 2015
    1. Gibson PR, Varney J, Malakar S, Muir JG. Food components and irritable bowel syndrome. Gastroenterology 2015;148:1158‐74. - PubMed
Gradel 2009
    1. Gradel KO, Nielsen HL, Schønheyder HC, Ejlertsen T, Kristensen B, Nielsen H. Increased short‐ and long‐term risk of inflammatory bowel disease after salmonella or campylobacter gastroenteritis. Gastroenterology 2009;137:495‐501. - PubMed
Gruber 2013
    1. Gruber L, Kisling S, Lichti P, Martin FP, May S, Klingenspor M, et al. High fat diet accelerates pathogenesis of murine Crohn's disease‐like ileitis independently of obesity. PLoS One 2013;8:e71661. - PMC - PubMed
Guyatt 2008
    1. Guyatt GH, Oxman AD, Vist GE, Kunz R, Falck‐Ytter Y, Alonso‐Coello P, et al. GRADE: an emerging consensus on rating quality of evidence and strength of recommendations. BMJ 2008;336(7650):924‐6. - PMC - PubMed
Guyatt 2011
    1. Guyatt GH, Oxman AD, Sultan S, Glasziou P, Akl EA, Alonso‐Coello P, et al. GRADE guidelines: 9. Rating up the quality of evidence. Journal of Clinical Epidemiology 2011;64(12):1311‐6. - PubMed
Halmos 2015
    1. Halmos EP, Christophersen CT, Bird AR, Shepherd SJ, Gibson PR, Muir JG. Diets that differ in their FODMAP content alter the colonic luminal microenvironment. Gut 2015;64:93‐100. - PubMed
Hansen 2011
    1. Hansen TS, Jess T, Vind I, Elkjaer M, Nielsen MF, Gamborg M, et al. Environmental factors in inflammatory bowel disease: a case‐control study based on a Danish inception cohort. Journal of Crohn's and Colitis 2011;5:577‐84. - PubMed
Higgins 2011
    1. Higgins JP, Green S. Cochrane Handbook for Systematic Reviews of Interventions Version 5.1.0 (updated March 2011). The Cochrane Collaboration, 2011.
Hou 2011
    1. Hou JK, Abraham B, El‐Serag H. Dietary intake and risk of developing inflammatory bowel disease: a systematic review of the literature. American Journal of Gastroenterology 2011;106:563‐73. - PubMed
Jakobsen 2013
    1. Jakobsen C, Paerregaard A, Munkholm P, Wewer V. Environmental factors and risk of developing paediatric inflammatory bowel disease ‐‐ a population based study 2007‐2009. Journal of Crohn's and Colitis 2013;7:79‐88. - PubMed
Janerot 1983
    1. Jarnerot G, Jarnmark I, Nilsson K. Consumption of refined sugar by patients with Crohn’s disease, ulcerative colitis, or irritable bowel syndrome. Scandinavian Journal of Gastroenterology 1983;18(8):999‐1002. - PubMed
Jantchou 2010
    1. Jantchou P, Morois S, Clavel‐Chapelon F, Boutron‐Ruault MC, Carbonnel F. Animal protein intake and risk of Inflammatory Bowel Disease: the E3N prospective study. American Journal of Gastroenterology 2010;105(10):2195‐201. - PubMed
Jowett 2004
    1. Jowett SL, Seal CJ, Pearce MS, Phillips E, Gregory W, Barton JR, et al. Influence of dietary factors on the clinical course of ulcerative colitis: a prospective cohort study. Gut 2004;53(10):1479‐84.. - PMC - PubMed
Kono 2010
    1. Kono H, Fujii H, Ogiku M, Tsuchiya M, Ishii K, Hara M. Enteral diets enriched with medium‐chain triglycerides and N‐3 fatty acids prevent chemically induced experimental colitis in rats. Translational Research 2010;156:282‐91. - PubMed
Lih‐Brody 1996
    1. Lih‐Brody L, Powell SR, Collier KP, Reddy GM, Cerchia R, Kahn E, et al. Increased oxidative stress and decreased antioxidant defenses in mucosa of inflammatory bowel disease. Digestive Diseases and Sciences 1996;41:2078‐86. - PubMed
Limdi 2016
    1. Limdi JK, Aggarwal D, McLaughlin JT. Dietary Practices and Beliefs in Patients with Inflammatory Bowel Disease. Inflammatory Bowel Diseases 2016;22:164‐70. - PubMed
Limketkai 2016
    1. Limketkai BN, Bechtold ML, Nguyen DL. Vitamin D and the pathogenesis of Inflammatory Bowel Disease. Current Gastroenterology Reports 2016;18:52. - PubMed
Martini 1976
    1. Martini GA, Brandes JW. Increased consumption of refined carbohydrates in patients with Crohn's disease. Klinische Wochenschrift 1976;54:367‐71. - PubMed
Matt 1961
    1. Matts SF. The value of rectal biopsy in the diagnosis of ulcerative colitis. QJM 1961;30:393‐407. - PubMed
Molodecky 2012
    1. Molodecky NA, Soon IS, Rabi DM, Ghali WA, Ferris M, Chernoff G, et al. Increasing incidence and prevalence of the inflammatory bowel diseases with time, based on systematic review. Gastroenterology 2012;142:46‐54. - PubMed
Mullin 2016
    1. Mullin GE. Role of diet in Inflammatory Bowel Disease. Presented at: Digestive Disease Week; May 2016; San Diego, CA.
Narula 2018
    1. Narula N, Dhillon A, Zhang D, Sherlock ME, Tondeur M, Zachos M. Enteral nutritional therapy for induction of remission in Crohn's disease. Cochrane Database of Systematic Reviews 2018, Issue 4. [DOI: 10.1002/14651858.CD000542.pub3] - DOI - PMC - PubMed
NICE 2016
    1. National Institute for Health and Care Excellence (2014). Crohn's disease: management. NICE guideline (CG183). - PubMed
Ooi 2016
    1. Ooi CJ, Makharia GK, Hilmi I, Gibson PR, Fock KM, Ahuja V, et al. Asia Pacific consensus statements on Crohn's disease. Part 1: definition, diagnosis, and epidemiology. Journal of Gastroenterology and Hepatology 2016;31:45‐55. - PubMed
Papada 2014
    1. Papada E, Kaliora AC, Gioxari A, Papalois A, Forbes A. Anti‐inflammatory effect of elemental diets with different fat composition in experimental colitis. British Journal of Nutrition 2014;111:1213‐20. - PubMed
Persson 1992
    1. Persson PG, Ahlbom A, Hellers G. Diet and inflammatory bowel disease: a case‐control study. Epidemiology 1992;3:47‐52. - PubMed
Pinsk 2007
    1. Pinsk V, Lemberg D A, Grewal K, Barker C C, Schreiber R A, Jacobson K. Inflammatory bowel disease in the South Asian pediatric population of British Columbia. American Journal of Gastroenterology 2007;102:1077‐83. - PubMed
Prince 2016
    1. 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. Inflammatory Bowel Diseases 2016;22:1129‐36. - PubMed
Rajendran 2011
    1. Rajendran N, Kumar D. Food‐specific IgG4‐guided exclusion diets improve symptoms in Crohn's disease: a pilot study. Colorectal Disease 2011;13:1009‐13. - PubMed
Reif 1997
    1. Reif S, Klein I, Lubin F, Farbstein M, Hallak A, Gilat T. Pre‐illness dietary factors in inflammatory bowel disease. Gut 1997;40:754‐60. - PMC - PubMed
Sakamoto 2005
    1. Sakamoto N, Kono S, Wakai K, Fukuda Y, Satomi M, Shimoyama T, et al. Dietary risk factors for inflammatory bowel disease: a multicenter case‐control study in Japan. Inflammatory Bowel Diseases 2005;11:154‐63. - PubMed
Schünemann 2011
    1. Schünemann HJ, Oxman AD, Vist GE, Higgins JPT, Deeks JJ, Glasziou P, et al. Chapter 12: Interpreting results and drawing conclusions. In: Higgins JPT, Green S editor(s). Cochrane Handbook for Systematic Reviews of Interventions Version 5.1.0 (updated March 2011). The Cochrane Collaboration, 2011. Available from www.cochrane‐handbook.org.
Silkoff 1980
    1. Silkoff K, Hallak A, Yegena L, Rozen P, Mayberry JF, Rhodes J, et al. Consumption of refined carbohydrate by patients with Crohn's disease in Tel‐Aviv‐Yafo. Postgraduate Medical Journal 1980;56:842‐6. - PMC - PubMed
Thornton 1979
    1. Thornton JR, Emmett PM, Heaton KW. Diet and Crohn's disease: characteristics of the pre‐illness diet. British Medical Journal 1979;2:762‐4. - PMC - PubMed
Ungaro 2014
    1. Ungaro R, Bernstein CN, Gearry R, Hviid A, Kolho KL, Kronman MP, et al. Antibiotics associated with increased risk of new‐onset Crohn's disease but not ulcerative colitis: a meta‐analysis. American Journal of Gastroenterology 2014;109:1728‐38. - PubMed
van der Logt 2013
    1. Logt EM, Blokzijl T, Meer R, Faber KN, Dijkstra G. Westernized high‐fat diet accelerates weight loss in dextran sulfate sodium‐induced colitis in mice, which is further aggravated by supplementation of heme. Journal of Nutritional Biochemistry 2013;24:1159‐65. - PubMed
Zuo 2007
    1. Zuo XL, Li YQ, Li WJ, Guo YT, Lu XF, Li JM, et al. Alterations of food antigen‐specific serum immunoglobulins G and E antibodies in patients with irritable bowel syndrome and functional dyspepsia. Clinical and Experimental Allergy 2007;37(6):823‐30. - PubMed

References to other published versions of this review

Limketkai 2017
    1. Limketkai BN, Parian A, Koretz RL, Nanavati JE, Shinohara RT, Mullin GE. Dietary interventions for induction and maintenance of remission in inflammatory bowel disease. Cochrane Database of Systematic Reviews 2017, Issue 10. [DOI: 10.1002/14651858.CD012839] - DOI - PMC - PubMed