The Adequacy of Habitual Dietary Fiber Intake in Individuals With Inflammatory Bowel Disease: A Systematic Review

Published:January 20, 2021DOI:https://doi.org/10.1016/j.jand.2020.12.001

      Abstract

      Background

      Dietary fiber may influence disease course in individuals with inflammatory bowel disease (IBD), yet there is a paucity of understanding of habitual fiber intakes.

      Objectives

      To identify studies measuring fiber intakes of individuals with IBD, compare the adequacy of fiber intakes with that of control groups or respective national dietary guidelines, and examine factors associated with fiber consumption.

      Methods

      Five electronic databases—MEDLINE, CINAHL, SCOPUS, PROQUEST, and COCHRANE LIBRARY—were systematically searched, using search terms inflammatory bowel disease, Crohn’s disease, ulcerative colitis, dietary intake, and fiber, until December 2019, with hand searching of reference lists. Primary studies were included if fiber intakes were measured in participants 18 years of age or older, with confirmed IBD, with or without comparison to a control.

      Results

      A total of 2105 publications were identified, and 26 met inclusion criteria. Total fiber intake of 4164 participants with IBD ranged broadly (9.9 ± 7.8 g/day to 21.0 ± 10.5 g/day). Most (18/26) used cross-sectional study design, with a large degree of heterogeneity in tools measuring fiber intake. Sixty-six percent of studies comparing participants with IBD with control groups found that participants with IBD consumed significantly less fiber than control subjects. Four studies reported that less than 10% to 21% of IBD participants met their national fiber recommendations. Data conflicted regarding an association between disease type, disease activity, or rate of relapse and fiber intake.

      Conclusions

      Individuals with IBD consume less fiber than healthy populations. Fiber intakes are inadequate compared with respective national fiber guidelines. Interpretation of factors associated with fiber intakes were limited by data quality and conflicting results. Future research is required into factors associated with fiber intake and whether increasing fiber intakes can influence disease course and behavior.

      Keywords

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      Biography

      A. S. Day is a Senior Academic Dietitian & PhD Candidate, Inflammatory Bowel Disease Services, Department of Gastroenterology and Hepatology, The Queen Elizabeth Hospital, Woodville South, and the School of Medicine, Faculty of Health Sciences, University of Adelaide, Frome Road, Adelaide, South Australia, Australia.

      Biography

      R. Davis is a Clinical Dietitian, Inflammatory Bowel Disease Services, Department of Gastroenterology and Hepatology, The Queen Elizabeth Hospital, Woodville South, and Discipline of Nutrition and Dietetics, College of Nursing and Health Sciences, Flinders University, Adelaide, South Australia, Australia.

      Biography

      S. P. Costello is a Staff Specialist Gastroenterologist, Inflammatory Bowel Disease Services, Department of Gastroenterology and Hepatology, The Queen Elizabeth Hospital, Woodville South, and the School of Medicine, Faculty of Health Sciences, University of Adelaide, Frome Road, Adelaide, South Australia, Australia.

      Biography

      C. K. Yao is a Post-doctoral Research Fellow, Translational Nutritional Sciences, Department of Gastroenterology, Monash University & Alfred Hospital, Melbourne, Victoria, Australia.

      Biography

      J. M. Andrews is a Medical Lead S3 Gastroenterology, General & GI Surgery, Clinical Professor of Medicine, School of Medicine, Faculty of Health Sciences, University of Adelaide, and the Inflammatory Bowel Disease Service, Department of Gastroenterology and Hepatology, Royal Adelaide Hospital, Adelaide, South Australia, Australia.

      Biography

      R. V. Bryant is a Staff Specialist Gastroenterologist and Head of IBD Services, School of Medicine, Faculty of Health Sciences, University of Adelaide, Adelaide, South Australia, Australia.