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Dietary Patterns and Practices Among Patients With Inflammatory Bowel Disease and Their Associations With Gastrointestinal Symptoms and Disease Activity: A Systematic Review

Year: 2026

Type: review

Abstract: Patients with inflammatory bowel disease (IBD) often report food avoidance, restrictive eating, and dietary modification, although the association of these dietary behaviours with gastrointestinal symptoms and objective measures of inflammatory activity remains unclear. Clinically, it is important to distinguish dietary behaviours for symptom relief from dietary exposures associated with underlying inflammation. The aim of this systematic review was to synthesise evidence on habitual dietary patterns and patient-adopted dietary practices among patients with Crohn's disease, ulcerative colitis, or IBD-unclassified and to evaluate their associations with gastrointestinal symptoms and clinical, biochemical, endoscopic, or histological disease activity. PubMed/MEDLINE, Scopus, and Web of Science Core Collection were searched for English-language observational studies published between January 1, 2016, and August 4, 2026. Eligible studies provided information on habitual dietary intake or diets used by patients in their daily practice or real-world situations. Prescribed therapeutic dietary interventions, supplementation studies, reviews, case reports, animal studies, and studies without IBD-specific outcome measures were excluded. The review was performed in accordance with Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) 2020, and methodological quality was evaluated using the Joanna Briggs Institute checklists for each design. Findings were synthesised narratively. Eleven studies were included in this review, with 2,242 participants who had IBD. Across disease states, food avoidance, dietary restriction, meal skipping, and symptom-driven dietary modification were common. Three studies reported positive screening rates for avoidant/restrictive food intake disorder (10.2% to 32.5%). Dietary practices were restrictive and related to malnutrition risk and nutritional inadequacy, and low appetite and reduced food-related quality of life were also reported. Associations with dietary behaviours were more consistent for gastrointestinal symptoms than for objective measures of inflammatory activity, including C-reactive protein, faecal calprotectin, endoscopic activity, and validated disease-activity indices. No single dietary pattern or dietary total score was consistently associated with inflammatory activity. Dietary patterns and practices in IBD were more consistently associated with gastrointestinal symptom burden than with objective measures of inflammatory activity. Self-imposed dietary restrictions may be associated with nutritional and psychosocial consequences. Patients with substantial dietary restriction should undergo assessment of inflammatory activity and nutritional status, with referral to an IBD-experienced dietitian when appropriate. Future studies using validated dietary instruments and standardised clinical, biochemical, endoscopic, and patient-reported outcomes are needed to clarify temporal and causal relationships.

Source: Cureus

DOI: 10.7759/cureus.117475