Patients with IBD may see health improvements with Mediterranean diet

(Reuters Health) - Patients with inflammatory bowel disease (IBD) who stayed on a Mediterranean diet for six months saw significant improvements in malnutrition-related parameters and steatosis, according to a new study.

Of 165 volunteers enrolled, the 142 patients with ulcerative colitis (UC) or Crohn’s disease (CD) who adhered to the diet for six months saw reductions in body mass index (BMI), waist circumference, inflammatory markers and disease activity as well, Italian researchers report in Inflammatory Bowel Diseases.

“Our data support the role of nutritional counseling in the multidisciplinary management of IBD,” Dr. Fabio Chicco of the University of Cagliari and colleagues write. “The adoption of a proper alimentary habit based on (a Mediterranean diet) and the achievement of compliance might be pivotal in the clinical management of these patients.”

To study the potential impact of the Mediterranean diet, Dr. Chicco and colleagues analyzed data on 84 patients with UC (median age, 52; median BMI, 24.8) and 58 with CD (median age 48; median BMI, 25). At the outset, participants filled out questionnaires designed to evaluate quality of life and underwent clinical and disease activity evaluation, including abdominal ultrasound to evaluate possible steatosis. The volunteers also received dietary counseling from a nutritionist.

At baseline, obesity was present in 43 UC patients (51.2%) and 30 CD patients (51.7%). After six months, among patients with UC, BMI had decreased by a mean of 0.42 points and waist circumference by a mean of 1.25 cm; among those with CD, BMI had decreased by 0.48 points and waist circumference by 1.4 cm.

Seven UC patients (8.33%) showed high-grade, 13 (15.48%) moderate-grade, and 11 (13.09%) mild-grade liver steatosis at baseline. After 6 months, liver steatosis was high grade in 3 patients (3.57%), moderate in 9 (10.71%), and mild in 6 (7.14%). Similarly, at baseline 31 CD patients (53.45%) had no signs of steatosis; 6 (10.34%) had mild, 10 (17.24%) moderate, and 11 (18.97%) high-grade liver steatosis. After six months, 40 CD patients (68.97%) had no evidence of steatosis, with 10 (17.24%) having mild, 6 (10.34%) moderate, and 2 (3.45%) high grade steatosis.

Over the six months, the number of UC patients with active disease also declined from to 4 (6.8%), from 14 (23.7%) at baseline, and among those with CD, the number with active disease declined to 2 (3.8%), from 9 (17%) at baseline.

Dr. Aline Charabaty welcomed the new study.

“I’m a big fan of the Mediterranean diet,” said Dr. Charabaty, clinical director of the GI division at the Johns Hopkins School of Medicine and director of the IBD Center at the Johns Hopkins-Sibley Memorial Hospital, in Baltimore. “So I’m excited to see a study that looks at it.”

Earlier diet studies have tried to look at the impact of single foods on IBD, which is a mistake, Dr. Charabaty said. “IBD is more complex than that,” she explained. “We know it’s multifactorial. There’s a genetic component but also an environmental one.”

The evidence for that comes from countries where the incidence of IBD initially was low or non-existent, but increased once the culture westernized, Dr. Charabaty said.

“This study is very nicely done, and it mirrors what is known from epidemiological studies,” Dr. Charabaty said. “And I’m glad to see it backs up my recommendations to patients.”

SOURCE: Inflammatory Bowel Diseases, online May 22, 2020.