Dietary Interventions for the Treatment of Inflammatory Bowel Diseases: An Updated Systematic Review and Meta-analysis Clin Gastroenterol Hepatol. 2023 Sep;21(10):2508-2525.e10.doi: 10.1016/j.cgh.2022.11.026. Epub 2022 Dec 5.
Berkeley N Limketkai 1, Gala Godoy-Brewer 2, Alyssa M Parian 3, Shaya Noorian 4, Mahesh Krishna 3, Neha D Shah 5, Jacob White 6, Gerard E Mullin 3 |
Author information 1Center for Inflammatory Bowel Diseases, Vatche and Tamar Manoukian Division of Digestive Diseases, UCLA School of Medicine, Los Angeles, California; Division of Gastroenterology and Hepatology, Johns Hopkins University School of Medicine, Baltimore, Maryland. Electronic address: berkeley.limketkai@gmail.com. 2Department of Medicine, University of Miami, Miami, Florida. 3Division of Gastroenterology and Hepatology, Johns Hopkins University School of Medicine, Baltimore, Maryland. 4Center for Human Nutrition, Division of Clinical Nutrition, UCLA School of Medicine, Los Angeles, California. 5Colitis and Crohn's Disease Center, Division of Gastroenterology, UCSF School of Medicine, San Francisco, California. 6Welch Library, Johns Hopkins University School of Medicine, Baltimore, Maryland. Abstract Background & aims: This study aimed (1) to systematically review controlled trials of solid food diets for the treatment of inflammatory bowel disease (IBD); and (2) to grade the overall quality of evidence. Methods: Systematic review of prospective controlled trials of solid food diets for the induction or maintenance of remission in IBD. Two authors independently performed study selection, data extraction, and assessment of certainty of evidence. Meta-analyses were performed on studies with quantitative data on response, remission, and relapse. Results: There were 27 studies for meta-analysis. For induction of remission in Crohn's disease (CD), low refined carbohydrate diet and symptoms-guided diet outperformed controls, but studies had serious imprecision and very low certainty of evidence. The Mediterranean diet was similar to the Specific Carbohydrate Diet (low certainty of evidence), and partial enteral nutrition (PEN) was similar to exclusive enteral nutrition (very low certainty of evidence). PEN reduced risk of relapse (very low certainty of evidence), whereas reduction of red meat or refined carbohydrates did not (low certainty of evidence). For ulcerative colitis, diets were similar to controls (very low and low certainty of evidence). Conclusions: Among the most robust dietary trials in IBD currently available, certainty of evidence remains very low or low. Nonetheless, emerging data suggest potential benefit with PEN for induction and maintenance of remission in CD. Reduction of red meat and refined carbohydrates might not reduce risk of CD relapse. As more dietary studies become available, the certainty of evidence could improve, thus allowing for more meaningful recommendations for patients. |
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