Nutrition management puzzle in IBD- Front. Med. 2026

### Nutritional Management in IBD: Current Insights

1. **Importance of Nutrition in IBD**:

• Inflammatory bowel disease (IBD), which includes Crohn's disease (CD) and ulcerative colitis (UC), is influenced by genetic, immunological, environmental, and gut microbiota factors.
• Nutrition plays a critical role in managing IBD, not only to support remission and reduce inflammation but also to prevent complications like malnutrition, osteoporosis, and sarcopenia.

2. **Challenges in Nutritional Management**:

• IBD patients often experience malnutrition due to inflammation, dietary restrictions, medication side effects, and rapid weight loss.
• Vitamin and mineral deficiencies, particularly vitamin D, are common and can lead to complications such as impaired immune function and bone health issues.

3. **Dietary Interventions**:

• **Low-FODMAP Diet**: Combining a low-FODMAP diet with enteral nutrition has been shown to reduce inflammation (e.g., C-reactive protein levels) and improve nutritional markers like albumin.
• **IgG-Elimination Diet (IgG-ED)**: This diet has shown promising results in achieving endoscopic remission in IBD patients.
• **Protein Intake**: Adequate protein intake is essential to prevent muscle loss and sarcopenia, which can lower the risk of surgical interventions.
• **Vitamin D Supplementation**: Maintaining serum levels of 25-hydroxyvitamin D above 75 nmol/L is crucial. Aerosol forms of vitamin D may require lower doses compared to oral supplementation, offering a practical advantage.

4. **Nutritional Risk and Socioeconomic Factors**:

• Malnutrition is prevalent in over one-third of IBD patients, with socioeconomic factors such as lower income contributing to higher disease activity.
• Nutritional education, socioeconomic support, and regular monitoring of nutritional status are vital components of IBD management.

5. **Preventive and Therapeutic Role of Nutrition**:

• Early implementation of enteral nutrition, anti-inflammatory diets, and personalized nutritional strategies can prevent disease progression and alleviate symptoms.
• Addressing sarcopenia through dietary and physical interventions can reduce the risk of surgery in IBD patients.

6. **Tailored Nutrition**:

• There is no universal diet for IBD, as different clinical goals (e.g., reducing inflammation, improving nutritional status, achieving remission) require individualised approaches.
• Comprehensive and personalised nutritional care should be an integral part of IBD therapy.