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

Published:January 20, 2021DOI:



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


      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.


      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.


      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.


      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.


      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'


      Subscribe to Journal of the Academy of Nutrition and Dietetics
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect


        • Racine A.
        • Carbonnel F.
        • Chan S.S.
        • et al.
        Dietary patterns and risk of inflammatory bowel disease in Europe: results from the EPIC study.
        Inflamm Bowel Dis. 2016; 22: 345-354
        • Ananthakrishnan A.N.
        • Khalili H.
        • Konijeti G.G.
        • et al.
        A prospective study of long-term intake of dietary fiber and risk of Crohn’s disease and ulcerative colitis.
        J Gastroenterol. 2013; 145: 970-977
        • Jowett S.L.
        • Seal C.J.
        • Phillips E.
        • Gregory W.
        • Barton J.R.
        • Welfare M.R.
        Dietary beliefs of people with ulcerative colitis and their effect on relapse and nutrient intake.
        Clin Nutr. 2004; 23: 161-170
        • Levine A.
        • Sigall Boneh R.
        • Wine E.
        Evolving role of diet in the pathogenesis and treatment of inflammatory bowel diseases.
        Gut. 2018; 67: 1726-1738
        • Jowett S.L.
        • Seal C.J.
        • Pearce M.S.
        • et al.
        Influence of dietary factors on the clinical course of ulcerative colitis: a prospective cohort study.
        Gut. 2004; 53: 1479-1484
        • Valcheva R.
        • Koleva P.
        • Martínez I.
        • Walter J.
        • Gänzle M.G.
        • Dieleman L.A.
        Inulin-type fructans improve active ulcerative colitis associated with microbiota changes and increased short-chain fatty acids levels.
        Gut Microbes. 2019; 10: 334-357
        • Levine A.
        • Wine E.
        • Assa A.
        • et al.
        Crohn’s disease exclusion diet plus partial enteral nutrition induces sustained remission in a randomized controlled trial.
        Gastroenterology. 2019; 157: 440-450
        • Cohen A.B.
        • Lee D.
        • Long M.D.
        • et al.
        Dietary patterns and self-reported associations of diet with symptoms of inflammatory bowel disease.
        Dig Dis Sci. 2013; 58: 1322-1328
        • Roediger W.
        Decreased sulphur amino acid intake in ulcerative colitis.
        Lancet. 1998; 351: 1555
        • Haskey N.
        • Gibson D.L.
        An examination of diet for the maintenance of remission in inflammatory bowel disease.
        Nutrients. 2017; 9: 259
        • Holt D.Q.
        • Strauss B.J.
        • Moore G.T.
        Patients with inflammatory bowel disease and their treating clinicians have different views regarding diet.
        J Hum Nutr Diet. 2017; 30: 66-72
        • Halmos E.P.
        • Gibson P.R.
        Dietary management of IBD: insights and advice.
        Nat Rev Gastroenterol Hepatol. 2015; 12: 133-146
        • de Vries J.H.M.
        • Dijkhuizen M.
        • Tap P.
        • Witteman B.J.M.
        Patient's dietary beliefs and behaviours in inflammatory bowel disease.
        Dig Dis. 2019; 37: 131-139
        • Opstelten J.L.
        • de Vries J.H.M.
        • Wools A.
        • Siersema P.D.
        • Oldenburg B.
        • Witteman B.J.M.
        Dietary intake of patients with inflammatory bowel disease: a comparison with individuals from a general population and associations with relapse.
        Clin Nutr. 2019; 38: 1892-1898
        • Svolos V.
        • Hansen R.
        • Nichols B.
        • et al.
        Treatment of active Crohn's Disease with an ordinary food-based diet that replicates exclusive enteral nutrition.
        Gastroenterology. 2019; 156: 1354-1367
        • Eswaran S.
        • Muir J.
        • Chey W.D.
        Fiber and functional gastrointestinal disorders.
        Am J Gastroenterol. 2013; 108: 718-727
        • Macfarlane G.T.
        • Macfarlane S.
        Bacteria, colonic fermentation, and gastrointestinal health.
        J AOAC Int. 2012; 95: 50-60
        • Andersen V.
        • Chan S.
        • Luben R.
        • et al.
        Fibre intake and the development of inflammatory bowel disease: a European prospective multi-centre cohort study (EPIC-IBD).
        J Crohns Colitis. 2018; 12: 129-136
        • Halmos E.P.
        • Christophersen C.T.
        • Bird A.R.
        • Shepherd S.J.
        • Gibson P.R.
        • Muir J.G.
        Diets that differ in their FODMAP content alter the colonic luminal microenvironment.
        Gut. 2015; 64: 93
        • Wedlake L.
        • Slack N.
        • Andreyev H.J.
        • Whelan K.
        Fiber in the treatment and maintenance of inflammatory bowel disease: a systematic review of randomized controlled trials.
        Inflamm Bowel Dis. 2014; 20: 576-586
        • Council NHaMR
        Nutrient Reference Values.
        Australian Government, 2014
        • Vanhauwaert E.
        • Matthys C.
        • Verdonck L.
        • De Preter V.
        Low-residue and low-fiber diets in gastrointestinal disease management.
        Adv Nutr. 2015; 6: 820-827
        • Moher D.
        • Liberati A.
        • Tetzlaff J.
        • Altman D.G.
        Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement.
        PLoS Med. 2009; 6: e1000097
        • Schardt C.
        • Adams M.B.
        • Owens T.
        • Keitz S.
        • Fontelo P.
        Utilization of the PICO framework to improve searching PubMed for clinical questions.
        BMC Med Inform Decis Mak. 2007; 7 (16-16)
      1. Evidence Analysis Manual: Steps in the Academy Evidence Analysis Process. Academy of Nutrition and Dietetics, 2016
        • Anderson J.L.
        • Hedin C.R.
        • Benjamin J.L.
        • et al.
        Dietary intake of inulin-type fructans in active and inactive Crohn's disease and healthy controls: a case-control study.
        J Crohns Colitis. 2015; 9: 1024-1031
        • Pieczynska J.
        • Prescha A.
        • Zablocka-Slowinska K.
        • et al.
        Occurrence of dietary risk factors in inflammatory bowel disease: influence on the nutritional status of patients in clinical remission.
        Adv Clin Exp Med. 2019; 28: 587-592
        • Principi M.
        • Losurdo G.
        • Iannone A.
        • et al.
        Differences in dietary habits between patients with inflammatory bowel disease in clinical remission and a healthy population.
        Ann Gastroenterol. 2018; 31: 469-473
        • Brotherton C.S.
        • Martin C.A.
        • Long M.D.
        • Kappelman M.D.
        • Sandler R.S.
        Avoidance of fiber is associated with greater risk of Crohn's disease flare in a 6-month period.
        Clin Gastroenterol Hepatol. 2016; 14: 1130-1136
        • Lim H.S.
        • Kim S.K.
        • Hong S.J.
        Food elimination diet and nutritional deficiency in patients with inflammatory bowel disease.
        Clin Nutr Res. 2018; 7: 48-55
        • Wada Y.
        • Hisamatsu T.
        • Naganuma M.
        • et al.
        Risk factors for decreased bone mineral density in inflammatory bowel disease: a cross-sectional study.
        Clin Nutr. 2015; 34: 1202-1209
        • Tanaka M.
        • Shibayama T.
        • Sato E.
        • Sasaki S.
        • Kazuma K.
        Dietary intake and body composition of Japanese ulcerative colitis patients in remission.
        Gastroenterol Nurs. 2007; 30: 357-362
        • Brauer P.M.
        • Gee M.I.
        • Grace M.
        • Thomson A.B.
        Diet of women with Crohn's and other gastrointestinal diseases.
        J Am Diet Assoc. 1983; 82: 659-664
        • Rosman-Urbach M.
        • Niv Y.
        • Birk Y.
        • Morgenstern S.
        • Schwartz B.
        Relationship between nutritional habits adopted by ulcerative colitis relevant to cancer development patients at clinical remission stages and molecular-genetic parameters.
        Br J Nutr. 2006; 95: 188-195
        • Keshteli A.H.
        • van den Brand F.F.
        • Madsen K.L.
        • et al.
        Dietary and metabolomic determinants of relapse in ulcerative colitis patients: a pilot prospective cohort study.
        World J Gastroenterol. 2017; 23: 3890-3899
        • Wardle R.A.
        • Thapaliya G.
        • Nowak A.
        • et al.
        An examination of appetite and disordered eating in active Crohn’s disease.
        J Crohns Colitis. 2018; 12: 819-825
        • Lim H.
        • Kim H.J.
        • Hong S.J.
        • Kim S.
        Nutrient intake and bone mineral density by nutritional status in patients with inflammatory bowel disease.
        J Bone Metab. 2014; 21: 195-203
        • D’Odorico A.
        • Bortolan S.
        • Cardin R.
        • et al.
        Reduced plasma antioxidant concentrations and increased oxidative DNA damage in inflammatory bowel disease.
        Scand J Gastroenterol. 2001; 36: 1289-1294
        • Filippi J.
        • Al-Jaouni R.
        • Wiroth J.B.
        • Hebuterne X.
        • Schneider S.M.
        Nutritional deficiencies in patients with Crohn's disease in remission.
        Inflamm Bowel Dis. 2006; 12: 185-191
        • Guerreiro C.
        • Cravo M.
        • Costa A.R.
        • et al.
        A comprehensive approach to evaluate nutritional status in Crohn's patients in the era of biologic therapy: a case-control study.
        Am J Gastroenterol. 2007; 102: 2551-2556
        • Kawakami Y.
        • Okada H.
        • Murakami Y.
        • et al.
        Dietary intake, neutrophil fatty acid profile, serum antioxidant vitamins and oxygen radical absorbance capacity in patients with ulcerative colitis.
        J Nutr Sci Vitaminol (Tokyo). 2007; 53: 153-159
        • Dhingra R.
        • Kedia S.
        • Mouli V.P.
        • et al.
        Evaluating clinical, dietary, and psychological risk factors for relapse of ulcerative colitis in clinical, endoscopic, and histological remission.
        J Gastroenterol Hepatol. 2017; 32: 1698-1705
        • Ripoli J.
        • Miszputen S.J.
        • Ambrogini Jr., O.
        • Carvalho L.
        Nutritional follow-up of patients with ulcerative colitis during periods of intestinal inflammatory activity and remission.
        Arq Gastroenterol. 2010; 47: 49-55
        • Lomer M.C.
        • Hutchinson C.
        • Volkert S.
        • et al.
        Dietary sources of inorganic microparticles and their intake in healthy subjects and patients with Crohn's disease.
        Br J Nutr. 2004; 92: 947-955
        • Vidarsdottir J.B.
        • Johannsdottir S.E.
        • Thorsdottir I.
        • Bjornsson E.
        • Ramel A.
        A cross-sectional study on nutrient intake and -status in inflammatory bowel disease patients.
        Nutr J. 2016; 15: 61
        • Walton M.
        • Alaunyte I.
        Do patients living with ulcerative colitis adhere to healthy eating guidelines? A cross-sectional study.
        Br J Nutr. 2014; 112: 1628-1635
        • Aghdassi E.
        • Wendland B.E.
        • Stapleton M.
        • Raman M.
        • Allard J.P.
        Adequacy of nutritional intake in a Canadian population of patients with Crohn's disease.
        J Am Diet Assoc. 2007; 107: 1575-1580
        • Głąbska D.
        • Guzek D.
        • Zakrzewska P.
        • Lech G.
        Intake of lutein and zeaxanthin as a possible factor influencing gastrointestinal symptoms in caucasian individuals with ulcerative colitis in remission phase.
        J Clin Med. 2019; 8: 77
        • Brotherton A.M.
        • Judd P.A.
        Quality of life in adult enteral tube feeding patients.
        J Hum Nutr Diet. 2007; 20: 513-522
        • Government of Canada
        Dietary reference intakes.
        Government of Canada, 2006
        • Hou J.K.
        • Lee D.
        • Lewis J.
        Diet and inflammatory bowel disease: review of patient-targeted recommendations.
        Clin Gastroenterol Hepatol. 2014; 12: 1592-1600
        • Halpin S.J.
        • Ford A.C.
        Prevalence of symptoms meeting criteria for irritable bowel syndrome in inflammatory bowel disease: systematic review and meta-analysis.
        Am J Gastroenterol. 2012; 107: 1474-1482
        • Barrett J.S.
        • Gibson P.R.
        Development and validation of a comprehensive semi-quantitative food frequency questionnaire that includes FODMAP intake and glycemic index.
        J Am Diet Assoc. 2010; 110: 1469-1476
        • Stephen A.M.
        • Champ M.M.
        • Cloran S.J.
        • et al.
        Dietary fibre in Europe: current state of knowledge on definitions, sources, recommendations, intakes and relationships to health.
        Nutr Res Rev. 2017; 30: 149-190
      2. Davis R, Day A, Barrett J, et al. Habitual dietary fibre and prebiotic intake is inadequate in patients with inflammatory bowel disease: findings from a multicentre cross-sectional study. J Hum Nutr Dietetics. Published online September 21, 2020.

        • Yao C.K.
        • Rotbart A.
        • Ou J.Z.
        • Kalantar-zadeh K.
        • Muir J.G.
        • Gibson P.
        Modulation of colonic hydrogen sulfide production by diet and mesalazine utilizing a novel gas-profiling technology.
        Gut Microbes. 2018; 9: 510-522
        • Gibson P.R.
        Use of the low-FODMAP diet in inflammatory bowel disease.
        J Gastroenterol Hepatol. 2017; 32: 40-42
        • Barrett J.S.
        • Muir J.G.
        • Gibson P.R.
        Prebiotics and probiotics.
        Med Today. 2010; 11: 75-76
        • Pedersen N.
        • Ankersen D.V.
        • Felding M.
        • et al.
        Low-FODMAP diet reduces irritable bowel symptoms in patients with inflammatory bowel disease.
        World J Gastroenterol. 2017; 23: 3356
        • Barbalho S.M.
        • Goulart RdA.
        • Aranão ALdC.
        • de Oliveira P.G.C.
        Inflammatory bowel diseases and fermentable oligosaccharides, disaccharides, monosaccharides, and polyols: an overview.
        J Med Food. 2018; 21: 633-640
        • Gidley M.J.
        • Yakubov G.E.
        Functional categorisation of dietary fibre in foods: beyond ‘soluble’ vs ‘insoluble.
        Trends in Food Science & Technology. 2019; 86: 563-568
        • Prince A.C.
        • Myers C.E.
        • Joyce T.
        • Irving P.
        • Lomer M.
        • Whelan K.
        Fermentable carbohydrate restriction (low FODMAP diet) in clinical practice improves functional gastrointestinal symptoms in patients with inflammatory bowel disease.
        Inflamm Bowel Dis. 2016; 22: 1129-1136
        • Moher D.
        • Tricco A.C.
        Issues related to the conduct of systematic reviews: a focus on the nutrition field.
        Am J Clin Nutr. 2008; 88: 1191-1199
        • Sigall Boneh R.
        • Sarbagili Shabat C.
        • Yanai H.
        • et al.
        Dietary therapy with the Crohn’s disease exclusion diet is a successful strategy for induction of remission in children and adults failing biological therapy.
        J Crohns Colitis. 2017; 11: 1205-1212
        • Sigall-Boneh R.
        • Levine A.
        • Lomer M.
        • et al.
        Research gaps in diet and nutrition in inflammatory bowel disease. a topical review by D-ECCO Working Group [Dietitians of ECCO].
        J Crohns Colitis. 2017; 11: 1407-1419
        • Hart A.L.
        • Lomer M.
        • Verjee A.
        • et al.
        What are the top 10 research questions in the treatment of inflammatory bowel disease? a priority setting partnership with the James Lind Alliance.
        J Crohns Colitis. 2017; 11: 204-211
        • Shim J.S.
        • Oh K.
        • Kim H.C.
        Dietary assessment methods in epidemiologic studies.
        Epidemiol Health. 2014; 36: e2014009
        • Rebro S.M.
        • Patterson R.E.
        • Kristal A.R.
        • Cheney C.L.
        The effect of keeping food records on eating patterns.
        J Am Diet Assoc. 1998; 98: 1163-1165


      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.


      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.


      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.


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


      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.


      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.