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Is Diet Involved in the Etiology of Ulcerative Colitis and Crohn’s Disease? A Review of the Experimental and Epidemiological Literature

Punyanganie de Silva, MBBS, MRCP(UK)1, Elizabeth K Lund, PhD2, Simon Chan, MB BChir, MRCP, PhD1,3, and Andrew R Hart, MD1,3

The consequences of a diagnosis of Crohn’s disease or ulcerative colitis (UC) are well known. They include an impaired quality of life (QoL) and a requirement for regular medication and surgery, together with an increased risk of complications including colorectal cancer [1–3]. The etiology of the two illnesses is unknown, although recognized risk factors are genetics and a family history [4], smoking [5], and appendectomy [6]. Environmental factors are paramount as only changes in these can explain the large increases in incidence during the 20th century and the adoption of the incidence pattern in migrants who move from low to high risk areas [7,8]. One such environmental factor that may be important is diet. Experimental studies have provided key data on how nutrients may be involved, although confirmation of these data in epidemiological studies is required. Such investigations are difficult for several methodological reasons. This review will focus predominantly on diet in the etiology of IBD, but not provide detailed information on dietary manipulation in the clinical treatment of patients. We will describe laboratory-based investigations supporting a role for diet, outline the most robust epidemiological methods for studying diet, and finally review epidemiological etiological studies in IBD.

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