The Role of Diet in the Pathogenesis and Management of Inflammatory Bowel Disease: A Review

Abstract

Inflammatory bowel diseases, which include ulcerative colitis and Crohn's disease, are chronic relapsing and remitting inflammatory diseases of the gastrointestinal tract that are increasing in prevalence and incidence globally. They are associated with significant morbidity, reduced quality of life to individual sufferers and are an increasing burden on society through direct and indirect costs. Current treatment strategies rely on immunosuppression, which, while effective, is associated with adverse events. Epidemiological evidence suggests that diet impacts the risk of developing IBD and modulates disease activity. Using diet as a therapeutic option is attractive to patients and clinicians alike due to its availability, low cost and few side effects. Diet may influence IBD risk and disease behaviour through several mechanisms. Firstly, some components of the diet influence microbiota structure and function with downstream effects on immune activity. Secondly, dietary components act to alter the structure and permeability of the mucosal barrier, and lastly dietary elements may have direct interactions with components of the immune response. This review will summarise the mechanisms of diet-microbial-immune system interaction, outline key studies examining associations between diet and IBD and evidence demonstrating the impact of diet on disease control. Finally, this review will outline current prescribed dietary therapies for active CD.

Keywords: Crohn’s disease (CD); diet; gut epithelium; gut immunity; gut microbiome; inflammatory bowel disease (IBD); macronutrients; ulcerative colitis (UC).

Figure 1

Schematic representation of proposed mechanism of favourable diet–gut immune interaction that may protect from the development of IBD and improve disease activity (Created with BioRender). Abbreviations: polyunsaturated fatty acid (PUFA), short-chain fatty acid (SCFA), and immunoglobulin (Ig).

Figure 2

Schematic representation of proposed mechanisms of pathological diet-immune interactions that may contribute to IBD risk and disease activity. (Created with BioRender). Abbreviations: polyunsaturated fatty acid (PUFA), short-chain fatty acid (SCFA), Ig (Immunoglobulin).