Search

Summary: Background: Dietary management of patients with inflammatory bowel disease (IBD) involves more than defining a therapeutic diet. The profusion of 'expert advice' is not necessarily built on evidence. Aims: To provide evidence‐based guidance on all clinically relevant aspects of nutritional and dietary management of patients with IBD. Methods: A comprehensive review of the published literature was made. Results: Four pillars of management should be considered in all patients. First, nutritional status should be optimised, since myopenia and visceral obesity are associated with poorer outcomes, which can be improved with attention to their correction. Accurate point‐of‐care measurement of body composition is advocated to identify problems, guide interventions and monitor outcomes. Second, exclusive enteral nutrition and the Crohn's Disease Exclusion Diet with partial enteral nutrition in reducing intestinal inflammation in patients with Crohn's disease have sufficient evidence to be advocated. Multiple other dietary approaches, while promising, have insufficient evidence to be recommended. Third, dietary approaches are important in symptomatic control in many non‐inflammatory scenarios. Finally, guidance on following a healthy diet is fundamental to the general health of patients. Multiple approaches are advocated, but the optimal strategy is unclear. The precarious nutritional status of patients with IBD together with the risks of nutritional inadequacy and maladaptive eating behaviours associated with restrictive diets dictate involvement of expert dietitians in assessment and personalised delivery of dietary interventions. Conclusions: Four pillars of nutritional management require specific assessment and interventional strategies that should be chosen by evidence. Optimal delivery requires the skills of a specialised dietitian. [ABSTRACT FROM AUTHOR]

Summary: Background: Although dietary emulsifiers are implicated in the pathogenesis of Crohn's disease, their effect has not been studied in humans. Aim: To determine the effects of high‐ and low‐emulsifier diets (HED, LED) on intestinal barrier function in healthy subjects in unstressed and acutely stressed states. Methods: We conducted a single‐blinded, cross‐over, controlled feeding trial in 22 healthy adults. After recording 7 days of their habitual diet, we randomised participants to HED or LED with ≥3‐week washout between diets. On dietary completion, acute stress was induced via intravenous corticotrophin‐releasing hormone. We assessed dietary adherence, effects on 2‐h urinary lactulose: rhamnose ratio (LRR), serum concentrations of lipopolysaccharide‐binding protein, soluble‐CD14 and markers of epithelial injury and inflammation. Results: Dietary adherence was excellent. In an unstressed state, median (interquartile range) LRR during HED was 0.030 (0.018–0.042); on LED, this was 0.042 (0.029–0.078; p = 0.04). LPB concentrations were lower on HED than LED (p = 0.026), but no differences were observed for epithelial injury or inflammation. Under acute stress, LRR increased by 89% (−1% to 486%) on HED (p = 0.004), differing (p = 0.001) from 39% (1%–90%) decrease on LED (p = 0.009). Soluble‐CD14 also increased (p < 0.001). The LED had a prolonged carry‐over effect on suppressing HED‐induced changes during stress. Similar changes in LRR and soluble‐CD14 were observed when HED was used as the first diet (both p < 0.01). Conclusion: High intake of emulsifiers improved barrier function in the unstressed state, but increased intestinal permeability to stress, without evidence of inflammation. A LED was protective of the stress effect. [ABSTRACT FROM AUTHOR]

The Gastroenterology Immunology Neuroscience (GIN) Discovery Program represents a new model for research that overcomes the limitations imposed by traditional "research silos" in science. By uniting these three fields, the GIN Program aims to enhance the understanding and treatment of chronic conditions through a system‐wide perspective focusing on the gut–immune–brain axis. Key initiatives include monthly interdisciplinary seminars, an annual symposium, and GINnovate, a commercialization and entrepreneurship event. Additionally, the program offers a seed grant competition for early and mid‐career researchers, promoting advancements in gut–immune–brain axis research through the power of collaboration. The GIN Program in a short period of time has facilitated the formation of a vibrant community, captivating attention from both national and international institutions. This effort to break down barriers in research aims to inspire similar models that prioritize open communication, mutual respect and a commitment to impactful science. [ABSTRACT FROM AUTHOR]

Until recently, diet as a therapeutic tool to treat inflammatory bowel disease (IBD) has not been proven effective. Nearly a century in the making we are in the grips of a revolution in diet therapies for IBD, driven by emerging data revealing diet as a key environmental factor associated with IBD susceptibility, and observational studies suggesting that dietary intake may play a role in the disease course of established IBD. This review summarizes the current evidence for diets trialed as induction and maintenance therapy for IBD. For Crohn's disease, exclusive enteral nutrition and the Crohn's disease exclusion diet with partial enteral nutrition are supported by emerging high‐quality evidence as induction therapy, but are short‐term approaches that are not feasible for prolonged use. Data on diet as maintenance therapy for Crohn's disease are conflicting, with some studies supporting fortification, and others suppression, of certain food components. For ulcerative colitis, data are not as robust for diet as induction and maintenance therapy; however, consistent themes are emerging, suggesting benefits for diets that are plant‐based, high in fiber and low in animal protein. Further studies for both Crohn's disease and ulcerative colitis are eagerly awaited, which will allow specific recommendations to be made. Until this time, recommendations default to population based healthy eating guidelines. [ABSTRACT FROM AUTHOR]

Background: The aims of this study were to develop and evaluate a high/low-emulsifier diet and compare emulsifier content with preclinical studies that have associated Crohn's disease with emulsifiers. Methods: Supermarkets were audited with a seven-day high- (HED) and low-emulsifier diet (LED) meal plan developed. The emulsifier content of food was sought from food manufacturers, compared to acceptable daily intake (ADI), and doses were provided in trials. Nutritional composition analysis was completed. Healthy adults ate these diets for seven days in a randomized single-blinded cross-over feeding study to assess palatability, tolerability, satiety, food variety, dietary adherence, blinding and the ease of following the meal plan via visual analogue scale. Results: A database of 1680 foods was created. There was no difference in nutritional content between the HED and LED, except HED had a higher ultra-processed food content (p < 0.001). The HED contained 41 emulsifiers, with 53% of the products able to be quantified for emulsifiers (2.8 g/d), which did not exceed the ADI, was similar to that in observational studies, and was exceeded by doses used in experimental studies. In ten participants, diets were rated similarly in palatability—HED mean 62 (5% CI 37–86) mm vs. LED 68 (54–82) mm—in tolerability—HED 41 (20–61) mm vs. LED 55 (37–73) mm—and in satiety HED 57 (32–81) mm vs. LED 49 (24–73) mm. The combined diets were easy to follow (82 (67–97) mm) with good variety (65 (47–81)) and excellent adherence. Conclusion: Nutritionally well-matched HED and LED were successfully developed, palatable and well tolerated. [ABSTRACT FROM AUTHOR]

The FODMAP diet has been a treatment of irritable bowel syndrome (IBS) for many years. Rigorous scientific evaluation and clinical application of the FODMAP diet have generated deep understanding regarding clinical efficacy, mechanisms of action, and potential adverse effects of this dietary approach. In turn, this knowledge has allowed fine‐tuning of the diet to optimize treatment benefits and minimize risks, in the form of the traditional three‐phase diet; the FODMAP‐gentle approach, which is a less restrictive iteration; and a proposed FODMAP‐modified, Mediterranean‐style diet which endeavours to optimise both gastrointestinal symptoms and other health parameters. Furthermore, recognition that IBS‐like symptoms feature in other conditions has seen the FODMAP diet tested in non‐IBS populations, including in older adults with diarrhea and women with endometriosis. These areas represent new frontiers for the FODMAP diet and a space to watch as future research evaluates the validity of these novel clinical applications. [ABSTRACT FROM AUTHOR]

Background: Variation of circulating concentrations of putative biomarkers of intestinal barrier function over the day and after acute physiological interventions are poorly documented on humans. This study aimed to examine the stability and pharmacokinetics of changes in plasma concentrations of intestinal Fatty-acid -binding -protein (IFABP), Lipopolysaccharide-binging–protein (LBP), soluble CD14, and Syndecan-1 after acute stress and high fat-high-carbohydrate meal. Methods: In a single-blinded, cross-over, randomised study, healthy volunteers received on separate days corticotropin-releasing hormone (CRH, 100 μg) or normal saline (as placebo) intravenously in random order, then a HFHC meal. Participants were allowed low caloric food. Markers of intestinal barrier function were measured at set timed intervals from 30 minutes before to 24 hours after interventions. Results: 10 participants (50% female) completed all three arms of the study. IFABP decreased by median 3.6 (IQR 1.4–10)% from -30 minutes to zero time (p = 0.001) and further reduced by 25 (20–52)% at 24 hours (p = 0.01) on the low caloric diet, but did not change in response to the meal. Syndecan-1, LBP and sCD14 were stable over a 24-hour period and not affected acutely by food intake. LBP levels 2 hours after CRH reduced by 0.61 (-0.95 to 0.05) μg/ml compared with 0.16 (-0.3 to 0.5) μg/ml post placebo injection (p = 0.05), but other markers did not change. Conclusion: Concentrations of IFABP, but not other markers, are unstable over 24 hours and should be measured fasting. A HFHC meal does not change intestinal permeability. Transient reduction of LPB after CRH confirms acute barrier dysfunction during stress. [ABSTRACT FROM AUTHOR]

Australasia, encompassing Australia, New Zealand, and Papua New Guinea, has some of the highest prevalence's of inflammatory bowel disease (IBD) in the world. The way IBD medicine is practiced varies between and within these countries. There are numerous shared issues of IBD care between Australia and New Zealand, whereas Papua New Guinea has its' own unique set of circumstances. This review looks to explore some of the barriers to IBD care across the continent from the perspective of local IBD healthcare professionals. Barriers to IBD care that are explored include access to IBD multidisciplinary teams, provision of nutritional-based therapies, the prevalence and engagement of IBD-associated mental health disorders, access to medicine, access to endoscopy, rural barriers to care, Indigenous IBD care and paediatric issues. We look to highlight areas where improvements to IBD care across Australasia could be made as well as address research needs. [ABSTRACT FROM AUTHOR]

LINKED CONTENT: This article is linked to Fitzpatrick et al papers. To view these articles, visit https://doi.org/10.1111/apt.18172 and https://doi.org/10.1111/apt.18226 [ABSTRACT FROM AUTHOR]

LINKED CONTENT: This article is linked to Fitzpatrick et al papers. To view these articles, visit https://doi.org/10.1111/apt.18172 and https://doi.org/10.1111/apt.18222 [ABSTRACT FROM AUTHOR]