Alicia Sandall  © ECCO

What are ultra-processed foods?

Recent interest has focused on the role of ultra-processed foods (UPFs) in IBD. UPFs are foods whose constituent ingredients are of exclusive industrial availability [1]. Across Europe, 30%–60% of energy intake in the diet is from UPFs [2, 3].

What is the research on ultra-processed foods and IBD?

Higher intakes of UPFs (especially through consumption of soft drinks, processed meat, salty snacks and refined sweetened foods) are associated with a greater risk of developing IBD [4], although a meta-analysis demonstrated an increased risk for Crohn’s Disease (CD) but not Ulcerative Colitis (UC) [5]. Once a person has been diagnosed with IBD, higher intakes of UPFs are associated with a greater incidence of IBD-related surgery [6] and a higher number of episodes of active disease in UC [7]. 

Emma Halmos © ECCO

Hannah Gordon © ECCO

Richard Hansen © ECCO

Diet in Inflammatory Bowel Disease has become a hot topic in recent years, pushed forward by advances in our understanding of the microbiome and the promise of nutrition as therapy, particularly in Crohn’s Disease. One of the most important questions in clinic (and yet the hardest to answer) remains “What can I eat?” or variations of the same. The reason this question is so difficult to answer is the enormous complexity in how diet overlays IBD and also the lack of high-quality scientific studies addressing this specific problem.

Chen Sarbagili Shabat  © ECCO

We were in Stockholm for the 9^th D-ECCO Workshop! The workshop was full, with 162 attendees including not only dietitians but also a great mix of specialists from all over the world. Lihi Godny, the D-ECCO Chair, opened the workshop by presenting the various opportunities available to all IBD Dietitian Members, including the D-ECCO Grant and four Travel Awards.

Chen Sarbagili Shabat  © ECCO

The D-ECCO Committee would like to express gratitude to Lihi Godny, the retiring D-ECCO Chair, for her invaluable contribution in formulating and promoting a variety of opportunities for all IBD Dietitians.

As a D-ECCO Committee Member, it is my mission, along with my fellow D-ECCO’ers, to educate and train other dietitians and healthcare professionals in the field of IBD. Also, with dietary therapies and beliefs still growing and consolidating their place in the prevention and treatment of IBD, there is an emerging need for skilled dietitians to guide our patients in the different nutritional pathways throughout their disease. But what makes a dietitian skilled in the field of IBD?

Up to one-third of patients with Inflammatory Bowel Disease (IBD) have persistent bowel symptoms despite apparent control of intestinal inflammation [1]. These symptoms fit with irritable bowel syndrome (IBS), a type of disorder of gut–brain interactions (DGBI). DGBI respond poorly to the pharmacological agents that are typically used to target inflammation in IBD. Thus, as clinicians, our challenges are to identify IBS-like symptoms, which is more easily achieved in those with quiescent disease, and to find suitable treatments for control of non-inflammatory symptoms.

Inflammatory Bowel Disease (IBD) can affect women during their reproductive years. Prenatal, perinatal and postnatal factors may be associated with adverse pregnancy outcomes and can also affect the long-term health of the infant. The perinatal period raises many concerns for the patient with IBD beyond medical therapy that can be addressed by the IBD multidisciplinary team (MDT). However, there is a lack of robust evidence on perinatal holistic management in IBD, and guidelines usually do not address non-medical and nutritional management. Therefore, D-ECCO initiated a collaborative Topical Review with the aim of assessing the scientific evidence and providing expert opinion on nutritional, psychological and supportive care for women with IBD and their infants throughout the perinatal period [1].

Chen Sarbagili Shabat  © ECCO

After a long hiatus, the 18^th ECCO Congress finally took place in person and face-to-face, which was very exciting. The 8^th D-ECCO Workshop was full, with attendees including not only dietitians but also a great mix of specialists from all around the world. There were three Workshop sessions, on “Food science: there is more than EEN for Crohn’s Disease”, “Practical and clinical advice for the IBD dietitian” and “Psychological aspects of dietary management in IBD”. Apart from these sessions, great discussions were hosted and participated in by D-ECCO Committee Members and external speakers, and the D-ECCO Grant and Travel Awards were handed out.

Dearbhaile O'Hanlon  © ECCO

Exclusive enteral nutrition (EEN) is well established as first-line management for children with luminal Crohn’s Disease (CD) [1]. Its use in paediatrics was covered in the 2017 ECCO e-Learning Activity “Use of exclusive enteral nutrition in CD”.

The use of EEN in adults with CD is not as well established. It is often overlooked as a management tool but can be an effective therapy for adults in many scenarios. Catherine Wall and I designed an e-Learning Activity specifically covering EEN in adults with CD, and this was launched on the e-CCO Learning Platform in May 2022. The course was developed for gastroenterologists, surgeons, dietitians, nurses and other interdisciplinary medical experts interested in Inflammatory Bowel Disease(s) (IBD).

Emma Halmos  © Emma Halmos

It has long been acknowledged that Inflammatory Bowel Disease (IBD) carries a risk of malnutrition, leading to fatigue, infection, poor wound healing and poor health-related quality of life [1]. Historically, most attention has been devoted to undernutrition; however, there is now evidence that overnutrition in the form of visceral fat is associated with raised tumour necrosis factor (TNF) and poorer responses to anti-TNF agents [2], indicating that central adiposity can be just as detrimental to disease outcomes as undernutrition. Furthermore, under- and overnutrition are not mutually exclusive and nutrient deficiencies and excesses often co-exist. In the last few years, there has been a shift away from the historical approach of using rudimentary markers of malnutrition, such as weight or body mass index (BMI), which can often be misleading as assessment tools in that they may falsely detect abnormalities or miss them completely, towards more detailed body composition measures of muscle and fat mass, which reflect nutritional abnormalities more sensitively. Indeed, GLIM (Global Leadership Initiative on Malnutrition) recognises the importance of body composition in the diagnosis of malnutrition [3]. The key question now is how should we best assess our IBD patients for nutritional status in order to identify risk of poor clinical outcomes?