Dietary adherence to the Mediterranean diet pattern in a randomized clinical trial of patients with quiescent ulcerative colitis

Natasha Haskey; Rachel C K Shim; Alexander Davidson-Hunt; Jiayu Ye; Sunny Singh; Levinus A Dieleman; Kevan Jacobson; Sanjoy Ghosh; Deanna L Gibson

doi:10.3389/fnut.2022.1080156

Dietary adherence to the Mediterranean diet pattern in a randomized clinical trial of patients with quiescent ulcerative colitis

Front Nutr. 2022 Dec 21:9:1080156. doi: 10.3389/fnut.2022.1080156. eCollection 2022.

Authors

Natasha Haskey¹, Rachel C K Shim², Alexander Davidson-Hunt¹, Jiayu Ye³, Sunny Singh⁴, Levinus A Dieleman⁵, Kevan Jacobson⁶, Sanjoy Ghosh¹, Deanna L Gibson^{1

7}

Affiliations

¹ Department of Biology, University of British Columbia - Okanagan Campus, Kelowna, BC, Canada.
² Department of Public Health Sciences, The Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada.
³ Diabetes Center, University of California, San Francisco, San Francisco, CA, United States.
⁴ Division of Gastroenterology, Department of Medicine, University of British Columbia, Vancouver, BC, Canada.
⁵ Division of Gastroenterology, Department of Medicine, University of Alberta, Edmonton, AB, Canada.
⁶ Division of Gastroenterology, Department of Pediatrics, Hepatology and Nutrition and British Columbia Children's Hospital Research Institute, University of British Columbia, Vancouver, BC, Canada.
⁷ Faculty of Medicine, University of British Columbia - Okanagan Campus, Kelowna, BC, Canada.

Abstract

Background: The Mediterranean diet pattern (MDP) is believed to improve health and promote balanced inflammation and metabolism. While unknown, compelling evidence suggests that MDP could benefit patients with inflammatory bowel disease (IBD). We aimed to evaluate the level of diet adherence, diet quality, and nutritional adequacy of the MDP in patients with Ulcerative Colitis (UC).

Methods: Adult participants (n = 32) with quiescent UC were randomized to follow a MDP (n = 18) or Canadian Habitual Diet (CHD) (n = 14) for 12 weeks. The MDP participants received tailored nutrition education from a Registered Dietitian. Demographic, clinical data, medical history, and quality of life were assessed with the Short Inflammatory Bowel Disease Questionnaire (SIBDQ), dietary adherence with the Mediterranean Diet Serving Score (MDSS), diet quality via the Healthy Eating Index-2015 (HEI-2015), and dietary intake (ASA-24) were completed at baseline and week 12.

Results: Participants' diets were analyzed (MDP n = 15, CHD n = 13). The MDP (n = 10, 67%) achieved a high level of adherence (MDSS score between 16 and 24) vs. CHD (n = 3), (p = 0.030). HEI-2015 significantly increased from baseline to week 12 (p = 0.007) in the MDP and was significantly higher at week 12 compared to the CHD (p = 0.0001). The SIBDQ (bowel domain) showed reductions in the passage of large amounts of gas (p = 0.01) and improvements in tenesmus (p = 0.03) in the MDP. Despite enhanced diet quality and adherence in the MDP, females had inadequate intakes of calcium, iron, vitamin D, vitamin E, and choline and males had inadequate intakes of fiber, vitamin D, vitamin E, and choline. No adverse events were reported.

Conclusion: With nutrition education, high adherence to the MDP was achieved without an increase in bowel symptoms. Following the MDP led to a higher diet quality; however, nutritional inadequacies were identified. Tailored dietary education focusing on nutrients of concern when following the MDP is recommended to ensure nutritional adequacy.

Clinical trial registration: [www.ClinicalTrials.gov], identifier [NCT03053713].

Keywords: Healthy Eating Index-2015; Mediterranean diet; Mediterranean diet serving score; compliance; diet; ulcerative colitis.

Associated data

ClinicalTrials.gov/NCT03053713