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DOP006 Research gaps in diet and nutrition in inflammatory bowel disease. A topical review by ECCO

Sigall Boneh R.1, Levine A.1,2, Lomer M.3, Wierdsma N.4, Alan P.5, Fiorino G.6, Gatti S.7, Jonkers D.8, Kierkus J.9, Katsanos K.H.10, Melgar S.11, Saritas Yuksel E.12, Whelan K.13, Wine E.14, Gerasimidis K.*15

1Wolfson Medical Center, Pediatric Gastroenterology and Nutrition Unit, Tel Aviv, Israel 2Tel Aviv University, Tel Aviv, Israel 3Guy's and St Thomas' NHS Foundation Trust and King's College London, Department of Nutrition and Dietetics, London, United Kingdom 4VU University Medical Centre, Department of Nutrition and Dietetics, Amsterdam, Netherlands 5John Radcliffe Hospital, Department of Translational Gastroenterology, Oxford, United Kingdom 6Humanitas Research Hospital, Department of Gastroenterology, IBD Center, Rozzano, Italy 7Polytechnic University of Marche, Department of Paediatrics, Ancona, Italy 8NUTRIM School for Nutrition and Translation Research in Metabolism, Maastricht University Medical Center, Division Gastroenterology-Hepatology, Department of Internal Medicine, Maastricht, Netherlands 9Children's Memorial Health Institute, Department of Gastroenterology, Hepatology, Feeding Disorders and Pediatrics, Warsaw, Poland 10University and Medical School of Ioannina, Department of Gastroenterology and Hepatology, Ioannina, Greece 11APC Microbiome Institute, University College Cork, Cork, Ireland 12Izmir Katip Celebi University Ataturk Teaching and Research Hospital, Department of Gastroenterology, Izmir, Turkey 13King's College London, Division of Diabetes and Nutritional Sciences, London, United Kingdom 14University of Alberta, Department of Paediatrics, Edmonton, Canada 15University of Glasgow, Human Nutrition, School of Medicine, Dentistry and Nursing, Glasgow, United Kingdom

Background

The role of diet in IBD has recently attracted substantial interest by the scientific community and dietary influences are likely to explain the rapid rise in disease epidemiology.

Methods

The D-ECCO working group along with other ECCO experts reviewed the evidence looking at the role of diet and nutritional therapy in the onset, perpetuation and management of IBD.

Results

Evidence pertinent to the role of diet in IBD is summarized collectively under three main thematic domains: i) the role of diet in IBD aetiology; ii) the role of diet as induction and maintenance therapy in IBD; and assessment of nutritional status and supportive nutritional support in IBD. Future research should:

Address causation in the interaction between diet, microbiome and IBD

Investigate the ability to modify the gut microbiota by dietary interventions, and its effect on disease activity

Study the role of industrialized food, including, but not limited to nutrients, additives and processing in IBD

Explore mechanisms of action of Exclusive Enteral Nutrition (EEN)

Evaluating optimal food reintroduction following EEN

Assess the optimal regimen of Partial Enteral Nutrition (PEN) for maintenance of CD and type of accompanying diet

Evaluate the efficacy of elimination diets for induction and maintenance of remission in IBD

Study evolution of malnutrition following diagnosis and whether this is predictive of disease outcomes

Develop new biomarkers that can predict, diagnose, monitor intestinal failure or insufficiency in IBD

Study mechanisms of food-related functional symptoms in IBD

Study the efficacy and safety of dietary therapies for the management of functional symptoms in patients with inactive IBD

Conclusion

This summary of research gaps is anticipated to be agenda setting for future research in the area of diet and nutrition in IBD.