Colon to Rectum
J Crohns Colitis. 2023;17(10):1569–78
A Mediterranean Diet Pattern improves intestinal inflammation concomitant with reshaping of the bacteriome in ulcerative colitis: A randomized controlled trial
Background and aims: Dietary patterns are important in managing ulcerative colitis (UC), given their influence on gut microbiome-host symbiosis and inflammation. The authors investigated whether the Mediterranean Diet Pattern (MDP) versus the Canadian Habitual Diet Pattern (CHD) would affect disease activity, inflammation, and the gut microbiome in patients with quiescent UC.
Methods: They performed a prospective, randomized, controlled trial in adults (65% female; median age, 47 years) with quiescent UC in an outpatient setting from 2017 to 2021. Participants were randomized to a MDP (n = 15) or CHD (n = 13) for 12 weeks. Disease activity (Simple Clinical Colitis Activity Index) and fecal calprotectin (FC) were measured at baseline and week 12. Stool samples were analyzed by 16S rRNA gene amplicon sequencing.
Results: The diet was well tolerated by the MDP group. At week 12, 75% of participants (9/12) in the CHD group had an FC > 100 μg/g, versus 20% of participants (3/15) in the MDP group. The MDP group had higher levels of total fecal short-chain fatty acids (SCFAs) (p = 0.01), acetic acid (p = 0.03), and butyric acid (p = 0.03) compared with the CHD group. Furthermore, the MDP induced alterations in microbial species associated with a protective role in colitis (Alistipes finegoldii and Flavonifractor plautii), as well as the production of SCFAs (Ruminococcus bromii).
Conclusions: A Mediterranean Diet Pattern (MDP) induces gut microbiome alterations associated with the maintenance of clinical remission and reduced fecal calprotectin in patients with quiescent ulcerative colitis (UC). The data support that the MDP is a sustainable diet pattern that could be recommended as a maintenance diet and adjunctive therapy for UC patients in clinical remission.