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The overall quality of evidence of recommendations surrounding nutrition and diet in inflammatory bowel disease

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Abstract

Background and aim

Recently, there has been an increased focus on the role nutrition and diet play in maintaining health in inflammatory bowel disease (IBD). We aimed to assess the overall quality, strength, and transparency of conflicts among guidelines on nutrition/diet in IBD.

Methods

A systematic search was performed on multiple databases from inception until January 1, 2021, to identify guidelines pertaining to nutrition or diet in IBD. All guidelines were reviewed for disclosure of conflicts of interest (COI) and funding, recommendation quality and strength, external document review, patient representation, and plans for update—as per Institute of Medicine (IOM) standards. In addition, recommendations and their quality were compared between guidelines/societies.​

Results

Seventeen distinct societies and a total of 228 recommendations were included. Not all guidelines provided recommendations on key aspects of diet—such as the role of supplements or the appropriate micro/macro nutrition in IBD. Fifty-nine percent of guidelines reported on COI, 24% underwent external review, and 41% included patient representation. 18.4%, 25.9%, and 55.7% of recommendations were based on high-, moderate-, and low-quality evidence, respectively. 10.5%, 24.6%, and 64.9% of recommendations were strong, weak/conditional, and did not provide a strength, respectively. The proportion of high-quality evidence (p = 0.12) and strong recommendations (p = 0.83) did not significantly differ across societies.

Conclusions

Many guidelines do not provide recommendations on key aspects of diet/nutrition in IBD. As over 50% of recommendations are based on low-quality evidence, further studies on nutrition/diet in IBD are warranted to improve the overall quality of evidence.

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Data availability

All data generated or analyzed during this study can be obtained from the corresponding author upon request.

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Authors and Affiliations

  1. Department of Medicine, Hackensack Meridian Health Palisades Medical Center, North Bergen, NJ, USA

    Simcha Weissman, Ayrton Bangolo, Atif Rashid, Badar F. Khan, Aditya K. Gudimella Tirumala, Sneha Nagpaul, Samuel Cornwell, Praveena Karamthoti, Vignesh Murugan, Ihsan S. Taranichi, Maksim Kalinin, Annetta Wishart, Ibtihal Khalaf, Naga A. Kodali, Pruthvi S. C. Aluri, Yabets Kejela, Rub Abdul, Feba M. Jacob, Advaith Manoharasetty, Aparna Sethi, Preethi M. Nadimpallli, Natalia P. Ballestas, Aarushi Venkatraman, Avinash Chirumamilla & Vignesh K. Nagesh

  2. Division of Gastroenterology and Hepatology, University of Arizona College of Medicine–Phoenix, Phoenix, AZ, USA

    Brian M. Fung

  3. Department of Medicine, Toledo University Medical Center, Toledo, OH, USA

    Manesh K. Gangwani

  4. Department of Medicine, Section of Digestive Diseases, Cedars-Sinai Medical Center, Los Angeles, CA, USA

    Kelly Issokson

  5. Division of Gastroenterology, Toledo University Medical Center, Toledo, OH, USA

    Muhammad Aziz

  6. Division of Gastroenterology, Inflammatory Bowel Disease Program, Lenox Hill Hospital, New York, NY, USA

    Arun Swaminath

  7. Division of Gastroenterology, Hepatology, and Nutrition, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA

    Joseph D. Feuerstein

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  1. Simcha Weissman
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Contributions

Simcha Weissman, Brian M. Fung, and Ayrton Bangolo searched the literature, wrote, and revised the manuscript. Atif Rashid, Badar F. Khan, Aditya K. Gudimella Tirumala, Sneha Nagpaul, Samuel Cornwell, Praveena Karamthoti, Vignesh Murugan, Ihsan S. Taranichi, Maksim Kalinin, Annetta Wishart, Ibtihal Khalaf, Naga A. Kodali, Pruthvi S.C. Aluri, Yabets Kejela, Rub Abdul, Feba M. Jacob, Advaith Manoharasetty, Aparna Sethi, Preethi M. Nadimpallli, Natalia P. Ballestas, Aarushi Venkatraman, Avinash Chirumamilla, Vignesh K. Nagesh, Manesh K. Gangwani, Kelly Issokson, Muhammad Aziz, and Arun Swaminath revised and edited the manuscript. Joseph D. Feuerstein revised and approved the final version and is the article’s guarantor. All authors certify that they contributed sufficiently to the intellectual content and data analysis. Each author has reviewed the final version of the manuscript and approves it for publication.

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Correspondence to Ayrton Bangolo.

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384_2023_4404_MOESM1_ESM.tif

Supplementary Fig. 1. Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement diagram delineating the process by which manuscripts were screened and ultimately included in this study (DOC 86 KB)

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Weissman, S., Fung, B.M., Bangolo, A. et al. The overall quality of evidence of recommendations surrounding nutrition and diet in inflammatory bowel disease. Int J Colorectal Dis 38, 98 (2023). https://doi.org/10.1007/s00384-023-04404-x

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