Perceived dietary intolerances, habitual intake and diet quality of patients with an ileoanal pouch: Associations with pouch phenotype (and behaviour).

Background and Aims: Ileoanal pouch patients frequently attribute pouch-related symptoms and pouchitis with diet. We aimed to assess perceived food intolerance and habitual dietary intake and their relationship with pouch indication, symptoms and current or history of pouchitis.
Methods: In this cross-sectional study, patients with an ileoanal pouch completed a dietary intolerance and a food frequency questionnaire, that specifically quantifies habitual intake of FODMAPs. Perceived dietary intolerance rates, nutrient intake and diet quality, and their differences based on pouch indication, symptom, and current or history of pouchitis were assessed. Associations between intolerances and intake, and between dietary intake with pouchitis risk were analysed using univariable and multivariable regression analysis.
Results: Of the 58 (10 FAP and 48 UC) patients with complete data, 81% of UC and 80% of FAP patients reported dietary intolerances. Overall diet quality was good. Differences in dietary intake were limited to a few food groups. Patients with a history of pouchitis had a lower intake of fruits (p = 0.03) and nuts (p = 0.004). Patients with current pouchitis had a lower intake of nuts (p = 0.02). On multivariable logistic regression, intake of dietary fibre was associated negatively [OR 0.68(95%CI:0.51-0.92)] and of non-digestible oligosaccharides positively with pouchitis history [OR 5.5(95% CI:1.04-29.1)].
Conclusions: In patients with an ileoanal pouch, perceived dietary intolerances are common but had minimal impact on nutritional adequacy and diet quality. Negative associations of the intakes of fruits, nuts and dietary fibre and positive association with non-digestible oligosaccharides with a history of pouchitis require further study to inform dietary recommendations.
Competing Interests: Conflicts of interest Zaid S Ardalan has no disclosures to declare. CKY has received research support for investigator-driven studies for Atmo Biosciences, Ferring Pharmaceuticals, Danone and Yakult Australia. KML: has no disclosures to declare. LP: has no disclosures to declare. JA: has no disclosures to declare. FR: has no disclosures to declare. MPS: Has (i) received educational grants or research support – Ferring, Orphan, Gilead; and (ii) received speaker’s fees – Janssen, Abbvie, Ferring, Takeda, Pfizer, Shire, and (iii) Serves as a consultant and advisory board member for Janssen, Takeda, Pfizer, Celgene, Abbvie, MSD, and Emerge Health. PRG has served as consultant or advisory board member for Anatara, Atmo Biosciences, Immunic Therapeutics, Janssen, Novozymes, Falk Pharma and Takeda. He has received research grants for investigator-driven studies from Atmo Biosciences. He holds shares in Atmo Biosciences. He has published two educational/recipe books on the low FODMAP diet. ZSA, PRG and CKY also work in a department that financially benefits from the sales of a digital application and booklets on the low FODMAP diet. Funds raised contribute to research of the Department of Gastroenterology and to the University. No author receives personal remuneration.
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