Nutritional modulation of gut microbiota in inflammatory bowel disease: a systematic review

Abstract

Introduction: Inflammatory bowel diseases (IBD) have shown an increase in incidence worldwide. The pathogenesis of IBD is that genetically susceptible individuals develop intolerance to dysregulated gut microbiota (dysbiosis) and chronic inflammation develops as a result of poor dietary triggers. Diet plays an important role in modulating the gut microbiota and can be applied as a therapeutic tool to improve the course of the disease. Objective: It was to carry out a systematic review of the main interactions between nutrology, gut microbiota, and inflammatory bowel disease, to elucidate the main clinical outcomes of the disease after nutrological treatment, analyzing the main macro and micronutrients. Methods: The PRISMA Platform systematic review rules were followed. The search was carried out from August to October 2023 in the Scopus, PubMed, Science Direct, Scielo, and Google Scholar databases. The quality of the studies was based on the GRADE instrument and the risk of bias was analyzed according to the Cochrane instrument. Results and Conclusion: 144 articles were found. A total of 39 articles were evaluated in full and 30 were included and developed in the present systematic review study. Considering the Cochrane tool for risk of bias, the overall assessment resulted in 27 studies with a high risk of bias and 22 studies that did not meet GRADE and AMSTAR-2. Most studies showed homogeneity in their results, with X2=59.9%>50%. With nutritional treatment, several micronutrients have the potential to modulate intestinal inflammation. Immunonutrition has demonstrated its importance through vitamins A, C, E, and D, folic acid, beta-carotene, and trace elements such as zinc, selenium, manganese, and iron. The Specific Carbohydrate Diet, fermentable oligosaccharides, disaccharides, monosaccharides, and polyol diet, and the Mediterranean diet also appear to show strong anti-inflammatory properties and promise to improve symptoms of inflammatory bowel disease. Diet modulation can control IBD by reducing persistent intestinal symptoms, balancing the gut microbiota, and reducing markers of inflammation. Dietary therapy can improve the quality of life of IBD patients.