Adherence to Mediterranean Diet and Diet Quality in Patients with Inflammatory Bowel Disease: A Single-Center, Observational, Case-Control Study

Abstract

The nutritional status in inflammatory bowel disease (IBD) is often impaired, and adherence to the Mediterranean diet (MedDiet) remains under-investigated. The aim of this study was to assess diet quality (DQ) and adherence to MedDiet in a cohort of Sardinian IBD patients. We conducted a case-control study in which 50 Crohn's disease (CD) and 50 ulcerative colitis (UC) patients were matched with 100 healthy controls each. The Diet Quality Index (DQI-I) and Medi-Lite were used to assess DQ and adherence to MedDiet, respectively. Subgroup analysis by disease characteristics and use of advanced therapies were also carried out. DQI-I scored significantly lower in IBD, independently of disease localization and behavior (CD) and disease extent (UC): [DQI-I: CD 34.5 (IQR 33-37) vs. CTRL 40 (IQR 38.5-43) p < 0.0001; UC 34.5 (IQR 33-37) vs. CTRL 42 (IQR 40-44) p < 0.0001]. Medi-Lite scores were significantly lower in stricturing and ileo-colonic CD and in extensive UC: [Medi-Lite CD 7.5 (IQR 7-9)] vs. CTRL 9 (IQR 7-10) p = 0.0379]; [UC 8 (IQR7-10) vs. CTRL 9 (IQR 8-10.5) p = 0.0046]. IBD patients had a low DQ independently of disease type and phenotype. Patients with ileo-colonic stenosing CD or extensive UC had lower MedDiet adherence, suggesting that its benefits may be mitigated by low acceptance in specific subgroups.

Keywords: Crohn’s disease; DQI-I; Medi-Lite score; Mediterranean diet; diet quality; inflammatory bowel disease; ulcerative colitis.

Figure 1

Medi-Lite score (a), adherence to the MedDiet (b) and DQI-I (c) in patients affected by Crohn’s disease (CD), ulcerative colitis (UC) and their matched controls, CTRL_(CD) and CTRL_(UC), respectively. In violin plots, broken lines (---) indicate median and dotted lines (…) indicate interquartile range. Numbers above the bars indicate the percent of adherent patients.

Figure 2

Impact of CD phenotype on Medi-Lite score, MedDiet adherence, and diet quality. Medi-Lite score (a,b), MedDiet adherence (c,d), and diet quality (e,f) by disease behavior (a,c,e) and phenotype (b,d,f). In violin plots, broken lines (---) indicate median and dotted lines (…) indicate interquartile range. Numbers above the bars indicate the percent of adherent patients.

Figure 3

Impact of UC phenotype on Medi-Lite score, MedDiet adherence, and diet quality. Medi-Lite score (a), MedDiet adherence (b), and diet quality (c) by disease extent. In violin plots, broken lines (---) indicate median and dotted lines (…) indicate interquartile range. Numbers above the bars indicate the percent of adherent patients.

Figure 4

Impact of need for advanced therapy in IBD on MedDiet adherence and quality. Medi-Lite score (a,b), MedDiet adherence (c,d), and diet quality (e,f) in CD vs. CTRL_(CD) (a,c,e) and in UC vs. CTRL_(UC) (b,d,f). In violin plots, broken lines (---) indicate median and dotted lines (…) indicate interquartile range. Numbers above the bars indicate the percent of adherent patients.

Figure 5

Impact of surgery on Medi-Lite score, MedDiet adherence, and DQI-I. Medi-Lite score (a), MedDiet adherence (b), and diet quality (c). In violin plots, broken lines (---) indicate median and dotted lines (…) indicate interquartile range. Numbers above the bars indicate the percent of adherent patients.