Nutritional Therapy for IBD

As #ASPENMAW24 is approaching, we raise awareness that patients with #IBD are three times more likely to have malnutrition Sarcopenia, obesity, undernutrition, and micronutrient deficiencies are all components of malnutrition in IBD Patients with active IBD or with a planned surgery are at a higher risk of undernutrition 🔸 Every IBD patient should be screened for malnutrition using the validated Malnutrition Universal Screening Tool (MUST), especially patients on hospital admission 🔸 Anyone found at risk for malnutrition should undergo an assessment with the Global Leadership Initiative on Malnutrition (GLIM) diagnostic criteria to determine whether they are malnourished 🔸 Adequate nutritional support may improve biologics' efficacy and reduce hospital stays Stay tuned for upcoming resources on the ins and outs of malnutrition management of patients with IBD 🤝 We're proud to be an American Society for Parenteral & Enteral Nutrition (ASPEN) Malnutrition Awareness Week Ambassador this year

Liquid meal replacement diets offer a complete nutritional profile broken down into its most elemental form worth considering in patients with IBD. In patients with IBD: 🔸 Exclusive enteral nutrition with liquid elemental, semi-elemental, or polymeric formula intake for 6–8 weeks effectively induces Crohn’s disease remission in adults and children 🔸 Upon induction of remission, liquid formulas can be complemented with the exclusion of dietary components hypothesized to affect the microbiome or intestinal permeability for maintaining remission The main reasons why an elemental diet works in IBD involve: ✅ Favouring the absorption of nutrients in the first part of the small intestine while the colon rests ✅ Including a low-fat content that may favor disease evolution ✅ Improving gut mucosal permeability that is altered in IBD ✅ Providing a complete macro and micronutrient nutrient that benefits patients with IBD with undernutrition ✅ Switching the gut microbiome towards a composition that is less pro-inflammatory ✅ Providing a low content of food additives and allergens Also, this diet may be effective in other conditions that often accompany inflammatory symptoms in patients with IBD, such as bile acid diarrhea, small intestinal bacterial overgrowth, and irritable bowel syndrome. 📸 Recent review article on mechanisms through which elemental diets exert their beneficial effects by Ali Rezaie, Mark Pimentel, and colleagues in Digestive Diseases and Sciences journal.

Nutritional therapy is ready to be integrated into the medical management of #Crohnsdisease.   📣 The ECCO European Crohn' and Colitis Organisation has recently released a new update of guidelines on when to use enteral nutrition and food-based diets Here are the most relevant takeaways for your clinical practice: 1⃣ Exclusive enteral nutrition: It involves replacing food with medical nutrition supplement drinks for 6-12 weeks (formula type does not affect efficacy)   🔸 Children: ✅ first choice for inducing clinical remission ✅ superior over corticosteroids for mucosal healing   🔸 Adults (including pregnant women and adults over 65 years): ✅ induction of remission ✅ optimization of outcomes in patients requiring bowel resection surgery ✅ a registered dietitian is vital to improve tolerance However, enteral nutrition is not recommended in: ❌ Perianal disease ❌ Peripheral and axial spondyloarthropathy ❌ Patients who aren’t motivated to follow the formula  ❌ Patients who don’t have access to dietetic support 2⃣ Diet may help in the maintenance of remission of #Crohnsdisease ✅ Partial enteral nutrition, with or without medication ✅ Crohn’s Disease Exclusion Diet (alone or in combination with partial enteral nutrition) ✅ Specific Carbohydrate Diet ✅ Anti-inflammatory diet ✅ Low FODMAP diet is recommended primarily for patients with quiescent CD experiencing functional symptoms We are living in exciting times when it comes to integrating nutritional therapies, an important adjunct and, in some cases, a primary therapy for IBD. 👉 Follow us to find out more about which dietary options exist in IBD and practical insights to understand how they work:

Children with Inflammatory Bowel Disease can have some unique challenges that may affect their ability to participate in a normal school routine. Prolonged absences due to disease flare-ups or hospitalizations, missed days due to infusions or medical appointments, or requiring multiple restroom trips during one class period are all things that a student with IBD may face. A student should never be penalized for having a chronic health condition. Having IBD should never get in the way of a child’s chances of success at school. With proper planning and collaboration with school administration, having a 504 plan can reduce some of the barriers a child may face at school and allow them to thrive academically. Read more: https://loom.ly/2KX7bRo #504plan #IBD #Crohnsdisease #ulcerativecolitis #IBDnutrition #IBDawareness

Nutrition support matters for surgery outcomes in patients with IBD. Increased risk of surgical complications may be reversed (at least 54%!) with adequate pre-surgical support: ✅ Less abdominal abscesses & anastomotic leaks ✅ Less wound infection ✅ Less pneumonia 💡 Most studies provide 2-4 oral supplements for seven days before surgery According to a new timely review article from Julie Vanderstappen, Sien Hoekx, Gabriele Bislenghi, André D'Hoore, Bram Verstockt & João Sabino, there are three critical steps: 1⃣ Pre-operative assessment 📌 All patients with IBD need to be screened for malnutrition regularly and in preoperative setting 2⃣ Diagnosis of nutritional risk 📌 Addressing malnutrition before surgery is essential to optimize outcomes 3⃣ Pre-operative nutritional strategies 📌 25% (13/51) of patients on exclusive enteral nutrition may avoid their planned surgery This year, we're proud to be an American Society for Parenteral & Enteral Nutrition (ASPEN) Malnutrition Awareness Week Ambassador. Save the date 👉 September 16-20 is #ASPENMAW24! In the first comment we share with you educational resources to combat malnutrition in IBD.

Short bowel syndrome (SBS) can occur when a significant portion of the small intestine is missing or not functioning properly, which can lead to malnutrition, dehydration, and other health problems. Patients with IBD who had a surgical removal of damaged sections of the intestine can be at risk for developing SBS. Resources are available from our organizational partners IFFGD, United Ostomy Associations of America, and Girls With Guts guts to help manage this condition. Visit their websites to learn more. IFFGD: https://loom.ly/XbeaQfE Girls with Guts: https://loom.ly/cL7QO-A UOAA: https://loom.ly/mEpuTX0

Which new dietary options exist for improving inflammatory markers, quality of life, and IBS-like symptoms in patients with IBD❓ 👉 We've summarized for you the most relevant nutritional highlights discussed at Digestive Disease Week 2024 #DDW2024: 🔸 A catered low-fat, high-fiber diet is a new potential nutrition therapy option to manage Crohn's disease based on findings from Hajar Hazime, who trained at the Maria Abreu Lab 🔸 A personalized Mediterranean diet based on individual needs is a feasible and safe option for patients with IBD, according to novel mechanisms of action shared by Lihi Godny, RD PhD and Natasha Haskey PhD RD 🔸 A Mediterranean not only can improve IBS symptoms, but also improve psychological symptoms in patients with IBS based on recent data from Heidi Staudacher 🔸 Two 5-day cycles of a low-calorie, high-fiber (plant-based) diet that mimics fasting may improve clinical response to medications in patients with moderate-severely active UC based on new findings from Oriana Damas 🔸 A low FODMAP diet that only restricts fructans and galacto-oligosaccharides is feasible and can overcome the challenges of following the traditional low FODMAP diet, according to new research from William D Chey and Prashant Singh 🔸 Up to 53% of patients with IBD are more likely to have avoidant and restrictive food intake disorder symptoms (in the article, we share with you some sensitive questions shared by Micaela Atkins, that may help explore patients’ eating habits) 🔸 A direct-to-consumer microbiome test can identify the types of microbes in your gut, but the results may not provide clear guidance on the best diet or food supplements for improving gut health or preventing IBD explained Kevin Whelan 🤝 Thank you, American Association for the Study of Liver Diseases (AASLD), American Gastroenterological Association (AGA), American Society for Gastrointestinal Endoscopy (ASGE) & The Society for Surgery of the Alimentary Tract for making this leading event possible 📚 Access the second part of our Digestive Disease Week 2024 nutritional highlights in the first comment

Two of the best treatments currently used in people with Crohn’s disease are biologics and a liquid-only diet using specialized milkshakes. However: 🔸 treatment with biologics is only successful in 40% of the patients 🔸 it is difficult for patients to stick to a liquid-only diet as their sole source of nutrients Emerging research is investigating whether replacing half of a habitual diet with specialized milkshakes will improve response to standard treatment with biologics in adults with Crohn's disease. Consuming at least 50% of daily calories with liquid formulas and allowing unrestricted food for the remaining intake usually leads to clinical remission rates of 15% - 64% if based on Crohn's disease activity indices. And it seems that a higher proportion of partial enteral nutrition correlates with efficacy. Konstantinos Gerasimidis, Vaios Svolos, Konstantinos Gkikas, and colleagues found that specialized milkshakes covering 50% of daily calories were comparable to a liquid-only diet regarding fecal metabolites and pH. Partial enteral nutrition is better accepted and tolerated by adults, which may allow for a longer duration of diet therapy. 🙋♂️ Are you familiar with recommending partial enteral nutrition with biologics to optimize induction and maintenance therapy for adults with Crohn's disease? 👉 If you think this content could help more people, please share it ♻️ .

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📣 Popular herbal supplements commonly used by patients with IBD could damage liver health ✅ The survey of 9685 US adults examined the use of six common herbal supplements 👉 All of which have been implicated in cases of drug-induced liver injury: 🔸turmeric 🔸green tea extract 🔸Garcinia cambogia 🔸black cohosh 🔸red yeast rice 🔸ashwagandha ✅ 15.6 million US adults used at least 1 of 6 potentially hepatotoxic botanical products within the past 30 days, similar to the number of adults prescribed nonsteroidal anti-inflammatory drugs or simvastatin ✅ Products associated with confirmed liver toxic effects do not need to demonstrate that they are safe or effective before selling and show frequent discrepancies between product labels and detected ingredients 🔍 Users of plant-derived, complex multi-ingredient botanicals tended to be female, older, more educated, non-Hispanic, and more likely to have chronic conditions like arthritis 👉 The bottom line: As a healthcare professional helping patients with IBD, keep under the radar possible adverse effects of herbal and dietary supplements that patients with IBD may take on their own and not typically disclose their use