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Nutrition and dietary interventions in adults with inflammatory bowel disease

Mark H DeLegge, MD, FACG, AGAF
Section Editors
Paul Rutgeerts, MD, PhD, FRCP
Timothy O Lipman, MD
Deputy Editor
Kristen M Robson, MD, MBA, FACG


Inflammatory bowel disease (IBD) is an inflammatory disorder of the gastrointestinal tract leading to symptoms of pain, nausea, fever, and diarrhea [1]. These symptoms can result in loss of appetite, reduced nutrient intake, altered nutrient metabolism, and ultimately impaired nutritional status. Loss of appetite is most likely the result of inflammation and the release of cytokines such as IL-1, IL-6, and tumor necrosis factor.

Dietary interventions in IBD focus on maximizing nutritional status, maintaining adequate intake, and avoiding foods that can exacerbate symptoms.

The prevalence of nutritional deficiencies and malnutrition has been well documented in IBD, especially in Crohn disease [2]. It is important to identify patients who are malnourished in order to identify those patients who may require nutritional intervention. Optimizing nutritional status is important both to prevent long-term health consequences of malnutrition as well as to prevent relapses in patients with IBD.

This topic review will discuss nutrition and dietary interventions in adults with inflammatory bowel disease. Specific nutrient deficiencies in IBD, as well as growth failure and poor weight gain in children with IBD, are discussed separately. Dietary risk factors for IBD are also discussed separately. (See "Nutrient deficiencies in inflammatory bowel disease" and "Growth failure and poor weight gain in children with inflammatory bowel disease" and "Definition, epidemiology, and risk factors in inflammatory bowel disease", section on 'Diet'.)


The nutritional status of patients with inflammatory bowel disease (IBD) should be assessed to determine if dietary intervention is necessary. Measuring a patient's nutritional status involves a comprehensive assessment. This may include measuring body composition, dietary intake, energy expenditure, body function, and serum protein markers. (See "Dietary assessment in adults".)

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Literature review current through: Dec 2017. | This topic last updated: Dec 17, 2015.
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  1. Geerling BJ, Stockbrügger RW, Brummer RJ. Nutrition and inflammatory bowel disease: an update. Scand J Gastroenterol Suppl 1999; 230:95.
  2. Husain A, Korzenik JR. Nutritional issues and therapy in inflammatory bowel disease. Semin Gastrointest Dis 1998; 9:21.
  3. Vanek VW. The use of serum albumin as a prognostic or nutritional marker and the pros and cons on IV albumin therapy. Nutr Clin Pract 1998; 13:110.
  4. Delgado-Rodríguez M, Medina-Cuadros M, Gómez-Ortega A, et al. Cholesterol and serum albumin levels as predictors of cross infection, death, and length of hospital stay. Arch Surg 2002; 137:805.
  5. Vagianos K, Bector S, McConnell J, Bernstein CN. Nutrition assessment of patients with inflammatory bowel disease. JPEN J Parenter Enteral Nutr 2007; 31:311.
  6. Detsky AS, McLaughlin JR, Baker JP, et al. What is subjective global assessment of nutritional status? JPEN J Parenter Enteral Nutr 1987; 11:8.
  7. Valentini L, Schaper L, Buning C, et al. Malnutrition and impaired muscle strength in patients with Crohn's disease and ulcerative colitis in remission. Nutrition 2008; 24:694.
  8. Bin CM, Flores C, Alvares-da-Silva MR, Francesconi CF. Comparison between handgrip strength, subjective global assessment, anthropometry, and biochemical markers in assessing nutritional status of patients with Crohn's disease in clinical remission. Dig Dis Sci 2010; 55:137.
  9. Kugathasan S, Nebel J, Skelton JA, et al. Body mass index in children with newly diagnosed inflammatory bowel disease: observations from two multicenter North American inception cohorts. J Pediatr 2007; 151:523.
  10. Long MD, Crandall WV, Leibowitz IH, et al. Prevalence and epidemiology of overweight and obesity in children with inflammatory bowel disease. Inflamm Bowel Dis 2011; 17:2162.
  11. Blain A, Cattan S, Beaugerie L, et al. Crohn's disease clinical course and severity in obese patients. Clin Nutr 2002; 21:51.
  12. Filippi J, Al-Jaouni R, Wiroth JB, et al. Nutritional deficiencies in patients with Crohn's disease in remission. Inflamm Bowel Dis 2006; 12:185.
  13. Geerling BJ, Badart-Smook A, Stockbrügger RW, Brummer RJ. Comprehensive nutritional status in patients with long-standing Crohn disease currently in remission. Am J Clin Nutr 1998; 67:919.
  14. O'Keefe SJ. Nutrition and gastrointestinal disease. Scand J Gastroenterol Suppl 1996; 220:52.
  15. Burke A, Lichtenstein GR, Rombeau JL. Nutrition and ulcerative colitis. Baillieres Clin Gastroenterol 1997; 11:153.
  16. Rocha R, Santana GO, Almeida N, Lyra AC. Analysis of fat and muscle mass in patients with inflammatory bowel disease during remission and active phase. Br J Nutr 2009; 101:676.
  17. Oliva MM, Lake AM. Nutritional considerations and management of the child with inflammatory bowel disease. Nutrition 1996; 12:151.
  18. Jahnsen J, Falch JA, Mowinckel P, Aadland E. Body composition in patients with inflammatory bowel disease: a population-based study. Am J Gastroenterol 2003; 98:1556.
  19. Stokes MA. Crohn's disease and nutrition. Br J Surg 1992; 79:391.
  20. Yao GX, Wang XR, Jiang ZM, et al. Role of perioperative parenteral nutrition in severely malnourished patients with Crohn's disease. World J Gastroenterol 2005; 11:5732.
  21. Bjarnason I, Macpherson A, Mackintosh C, et al. Reduced bone density in patients with inflammatory bowel disease. Gut 1997; 40:228.
  22. American Gastroenterological Association medical position statement: guidelines on osteoporosis in gastrointestinal diseases. Gastroenterology 2003; 124:791.
  23. Lochs H, Dejong C, Hammarqvist F, et al. ESPEN Guidelines on Enteral Nutrition: Gastroenterology. Clin Nutr 2006; 25:260.
  24. Sands BE, Anderson FH, Bernstein CN, et al. Infliximab maintenance therapy for fistulizing Crohn's disease. N Engl J Med 2004; 350:876.
  25. Zachos M, Tondeur M, Griffiths AM. Enteral nutritional therapy for induction of remission in Crohn's disease. Cochrane Database Syst Rev 2007; :CD000542.
  26. Harries AD, Jones LA, Danis V, et al. Controlled trial of supplemented oral nutrition in Crohn's disease. Lancet 1983; 1:887.
  27. Akobeng AK, Thomas AG. Enteral nutrition for maintenance of remission in Crohn's disease. Cochrane Database Syst Rev 2007; :CD005984.
  28. Takagi S, Utsunomiya K, Kuriyama S, et al. Effectiveness of an 'half elemental diet' as maintenance therapy for Crohn's disease: A randomized-controlled trial. Aliment Pharmacol Ther 2006; 24:1333.
  29. Verma S, Holdsworth CD, Giaffer MH. Does adjuvant nutritional support diminish steroid dependency in Crohn disease? Scand J Gastroenterol 2001; 36:383.
  30. Yamamoto T, Nakahigashi M, Umegae S, Matsumoto K. Prospective clinical trial: enteral nutrition during maintenance infliximab in Crohn's disease. J Gastroenterol 2010; 45:24.
  31. Verma S, Kirkwood B, Brown S, Giaffer MH. Oral nutritional supplementation is effective in the maintenance of remission in Crohn's disease. Dig Liver Dis 2000; 32:769.
  32. González-Huix F, Fernández-Bañares F, Esteve-Comas M, et al. Enteral versus parenteral nutrition as adjunct therapy in acute ulcerative colitis. Am J Gastroenterol 1993; 88:227.
  33. Lashner BA, Provencher KS, Seidner DL, et al. The effect of folic acid supplementation on the risk for cancer or dysplasia in ulcerative colitis. Gastroenterology 1997; 112:29.
  34. Koretz RL, Avenell A, Lipman TO, et al. Does enteral nutrition affect clinical outcome? A systematic review of the randomized trials. Am J Gastroenterol 2007; 102:412.
  35. Koretz RL. Enteral nutrition: a hard look at some soft evidence. Nutr Clin Pract 2009; 24:316.
  36. Koretz RL, Lipman TO, Klein S, American Gastroenterological Association. AGA technical review on parenteral nutrition. Gastroenterology 2001; 121:970.
  37. Evans JP, Steinhart AH, Cohen Z, McLeod RS. Home total parenteral nutrition: an alternative to early surgery for complicated inflammatory bowel disease. J Gastrointest Surg 2003; 7:562.
  38. Riordan AM, Hunter JO, Cowan RE, et al. Treatment of active Crohn's disease by exclusion diet: East Anglian multicentre controlled trial. Lancet 1993; 342:1131.
  39. Jones VA, Dickinson RJ, Workman E, et al. Crohn's disease: maintenance of remission by diet. Lancet 1985; 2:177.
  40. Giaffer MH, Cann P, Holdsworth CD. Long-term effects of elemental and exclusion diets for Crohn's disease. Aliment Pharmacol Ther 1991; 5:115.
  41. Lorenz-Meyer H, Bauer P, Nicolay C, et al. Omega-3 fatty acids and low carbohydrate diet for maintenance of remission in Crohn's disease. A randomized controlled multicenter trial. Study Group Members (German Crohn's Disease Study Group). Scand J Gastroenterol 1996; 31:778.
  42. Gottschall E. Breaking the Viscious Cycle. In: The Specific Carbohydrate Diet(TM), Kirkton Press Limited, 1994.
  43. www.ccfa.org/about/news/scd (Accessed on October 27, 2010).
  44. Nieves R, Jackson RT. Specific carbohydrate diet in treatment of inflammatory bowel disease. Tenn Med 2004; 97:407.
  45. Geier MS, Butler RN, Howarth GS. Inflammatory bowel disease: current insights into pathogenesis and new therapeutic options; probiotics, prebiotics and synbiotics. Int J Food Microbiol 2007; 115:1.
  46. Gionchetti P, Rizzello F, Venturi A, et al. Oral bacteriotherapy as maintenance treatment in patients with chronic pouchitis: a double-blind, placebo-controlled trial. Gastroenterology 2000; 119:305.
  47. Kruis W, Schütz E, Fric P, et al. Double-blind comparison of an oral Escherichia coli preparation and mesalazine in maintaining remission of ulcerative colitis. Aliment Pharmacol Ther 1997; 11:853.
  48. Seksik P, Dray X, Sokol H, Marteau P. Is there any place for alimentary probiotics, prebiotics or synbiotics, for patients with inflammatory bowel disease? Mol Nutr Food Res 2008; 52:906.
  49. Chapman MA. The role of the colonic flora in maintaining a healthy large bowel mucosa. Ann R Coll Surg Engl 2001; 83:75.
  50. Fernández-Bañares F, Hinojosa J, Sánchez-Lombraña JL, et al. Randomized clinical trial of Plantago ovata seeds (dietary fiber) as compared with mesalamine in maintaining remission in ulcerative colitis. Spanish Group for the Study of Crohn's Disease and Ulcerative Colitis (GETECCU). Am J Gastroenterol 1999; 94:427.
  51. Heaton KW, Thornton JR, Emmett PM. Treatment of Crohn's disease with an unrefined-carbohydrate, fibre-rich diet. Br Med J 1979; 2:764.
  52. Ritchie JK, Wadsworth J, Lennard-Jones JE, Rogers E. Controlled multicentre therapeutic trial of an unrefined carbohydrate, fibre rich diet in Crohn's disease. Br Med J (Clin Res Ed) 1987; 295:517.
  53. Benjamin JL, Hedin CR, Koutsoumpas A, et al. Randomised, double-blind, placebo-controlled trial of fructo-oligosaccharides in active Crohn's disease. Gut 2011; 60:923.
  54. Turner D, Steinhart AH, Griffiths AM. Omega 3 fatty acids (fish oil) for maintenance of remission in ulcerative colitis. Cochrane Database Syst Rev 2007; :CD006443.
  55. Turner D, Zlotkin SH, Shah PS, Griffiths AM. Omega 3 fatty acids (fish oil) for maintenance of remission in Crohn's disease. Cochrane Database Syst Rev 2009; :CD006320.
  56. Yamamoto T, Nakahigashi M, Saniabadi AR. Review article: diet and inflammatory bowel disease--epidemiology and treatment. Aliment Pharmacol Ther 2009; 30:99.
  57. Trebble TM, Arden NK, Wootton SA, et al. Fish oil and antioxidants alter the composition and function of circulating mononuclear cells in Crohn disease. Am J Clin Nutr 2004; 80:1137.
  58. Feagan BG, Sandborn WJ, Mittmann U, et al. Omega-3 free fatty acids for the maintenance of remission in Crohn disease: the EPIC Randomized Controlled Trials. JAMA 2008; 299:1690.
  59. Aghdassi E, Wendland BE, Steinhart AH, et al. Antioxidant vitamin supplementation in Crohn's disease decreases oxidative stress. a randomized controlled trial. Am J Gastroenterol 2003; 98:348.