Nutrition, Nutritional Status, Micronutrients Deficiency, and Disease Course of Inflammatory Bowel Disease.

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• Dietary intervention to support optimal weight management, contain anti-inflammatory components, and specific micronutrient intake should be the basis of any treatment protocol.
• Vitamin C deficiency was noted in patients who under consume fruit and vegetables, had resection surgery, and disease progress and should therefore be addressed via diet and supplementation.
• Serum screening of iron, zinc, folate, vitamin A, B1, B12, C, and D is essential and supplementation based on those findings should be considered alongside specific dietary interventions that can be different for CD and UC patients.
• Comprehensive stool analysis should be considered to elicit any potential dysbiosis that may impact on nutrient absorption in a population that is at greater risk of sub-optimal nutritional status.

Introduction

The aim of this systematic review was to establish a clear connection between nutrition, malnutrition, and micronutrient deficiency pertaining to disease pathology of Inflammatory Bowel Disease (IBD).

Methods

Following a PubMed/MEDLINE and Scopus literature search, a total of 227 human IBD studies were reviewed.

Results

• High fibre diets protect against relapse.
• Overall exclusion diets had insufficient data. Positive outcomes noted by Sarbagili-Shabat et al. 2021 and Yanai et al., 2022.
• Sarcopenia in CD patients may result in a slight increase of disease pathophysiology.
• All studies showed that albumin plays a fundamental role in the disease course, response to drugs, surgery rates, and post-surgical complications.
• All studies showed anaemia appears to be associated with high severity of IBD, or higher risk of post-surgical complications.
• Obesity may worsen the effectiveness of IBD therapies and increase post-operative complications.
• Iron deficiency affects about 50% of IBD patients.
• Vitamin B12 deficiency is prevalent in 33% of CD patients (particularly patients who had an ileal resection longer than 20 cm) compared to 16% in UC patients.
• Folate deficiency is more common in UC patients.
• Low vitamin D levels in IBD patients increased odds of disease activity (OR:1.53, CI 1.32-1.77), mucosal inflammation (OR:1.30, CI 1.06-1.60), and future clinical relapse (OR:1.23, CI 1.03-1.47).
• Plasma vitamin A is significantly lower in active UC patients compared to controls (p = 0.0005). Note a significant association between vitamin A in CD patients and C-reactive protein (p = 0.03).
• Vitamin B1 supplementation (600-1800 mg/d) showed a mean reduction of 4.5 points (95% CI 2.6-6.2) in fatigue compared with a mean increase of 0.75 point (95% CI -1.3-2.8; p = 0.0003) after placebo (Bager et al., 2021).
• Oral zinc sulfate supplements (110 mg t.i.d.) significantly lowered intestinal permeability after 8 weeks (0.041 ± 0.003 versus 0.026 ± 0.005; p = 0.0028) (Sturniolo et al., 2001).

Conclusion

Specific dietary and micronutrient interventions could potentially alter IBD progress inclusive of nutritional status, delay of surgical intervention, earlier remission and improved quality of life.

• Optimal weight maintenance is important for IBD patients given the association with disease complications.
• Regular screening for nutritional status is essential based on the potential impact of nutrient deficiencies on disease outcome.
• Oral iron supplementation may be not well tolerated in IBS patients and intravenous supplementation should be considered depending on regular screening of iron status.

Larger homogeneous studies and stronger evidence are needed to elicit specific protocols to induce remission and the effect on risk of surgical intervention in IBD patients.