Dietary Practices in Patients With Inflammatory Bowel Disease: Food for Thought

Abstract

Introduction: An epidemiological association implicating diet in inflammatory bowel disease (IBD) risk or protection is widely accepted. Patients with IBD often make links to diet in clinical consultations, but there is a dearth of literature exploring dietary perceptions and practices. Our aim was to evaluate dietary beliefs and practices and to identify potential predictors that influence dietary patterns in IBD patients. Methods: A validated and modified 25-item questionnaire was prospectively self-administered to consecutive IBD patients over 6 months, asking for demographic information, dietary beliefs, food habits and impact of diet on social life. Responses were summarized descriptively and predictors for dietary patterns were determined by univariate/multivariate analyses. Results: A total of 400 patients were recruited (mean age 48 years, 55% females, 88% white). Fifty-one percent had ulcerative colitis (UC) and 39% had Crohn’s disease (CD). Forty-eight percent felt that diet could initiate the disease, 57% believed it to play a role in relapse, and 68% imposed food restrictions to prevent relapse. Sixty percent had worsening of symptoms with specific food groups (spicy, fatty, alcohol), and only 16% had improvement in symptoms with certain foods (high-fiber, starch-rich food). Sixty-six percent deprived themselves of their favorite foods to prevent relapse. Seventy-four percent reported a change in their appetite since diagnosis. Rating appetite on a scale of 10, patients reported lower mean scores during than outside relapse (4.3 vs. 8.0; p<0.0001). A higher proportion of CD patients believed that diet played a role in relapse (67% vs. 53%; p=0.007) and avoided specific foods to prevent relapse (77% vs. 63%; p=0.003). More CD patients felt that IBD affected their appetite (87% vs. 66%; p<0.0001) with lower appetite scores during relapse (3.2 vs. 5.0; p<0.001) and outside relapse (7.8 vs. 8.3; p=0.009). Compared to whites, the Asian-British were more likely to implicate diet in disease initiation (71%, vs. 47%; p=0.005), place dietary restrictions (89% vs. 67%; p=0.007), and refuse outdoor dining (49% vs. 18%; p<0.0001). On multivariate analyses, IBD subtype and ethnicity remained significant factors influencing dietary beliefs and habits, whereas gender, patient age, disease duration, and level of education were not. Conclusion: Patients hold beliefs and report specific patterns pertaining to the role of diet in IBD. Disease subtype and ethnic background were identified as significant predictors influencing dietary patterns. Potential exists for dietary components to trigger active disease and perpetuate gut injury, impacting quality of life and health care costs.This should serve as an impetus for further patient centered research.