Nutritional support and dietary interventions for patients with ulcerative colitis: current insights

Abstract

Ulcerative colitis (UC) demonstrates a remitting and relapsing course, and patients have long believed diet plays a role in their symptoms. Ad hoc removal of foods and food groups from the diet without strong evidence for therapeutic benefit places patients at risk for nutritional deficiencies. This review discusses the need for nutritional support in UC and the role of dietary modification in its management in humans. Current evidence suggests patients with UC are not nutritionally compromised during remission, but with increasing disease activity, nutritional status is worth monitoring, in particular through body composition assessment and investigation for anemia. There is no clear evidence for dietary modulation to relieve symptoms in UC. Neither enteral nutrition nor parenteral nutrition is efficacious for symptom control or mucosal healing. While early studies suggested avoidance of dairy foods, no recent work has replicated these results. A low intake of insoluble fiber is recommended during acute disease flares; however, the role of fiber in modulating the gut microbiota and their metabolites warrants further attention. Several studies have investigated polyunsaturated fatty acids for UC; however, current evidence is not supportive for either inactive or active disease. There is emerging evidence that curcumin supplementation may be a new dietary treatment option. Often, evidence for therapeutic diets is difficult to interpret due to the reporting of combined results for both Crohn's disease and UC. In general, there is no evidenced specific dietary advice for patients with UC other than to follow healthy eating guidelines. Further work should determine if diet as treatment efficacy lies in modification of dietary patterns, thereby investigating the synergistic relationship between foods and their components, rather than investigation of single foods/nutrients. Large randomized controlled trials investigating dietary modification for UC are needed.