Nutritional Assessment and Impact of the Mediterranean Diet on Patients With Inflammatory Bowel Disease
Nutritional Assessment and Impact of the Mediterranean Diet on Patients With Inflammatory Bowel Disease
1. Assessment of nutritional status among patients with inflammatory bowel disease using
 different nutritional assessment tools.

 2. Assessment of correlation between nutritional status and disease severity.

 3. Assessment of the impact of the Mediterranean diet on the nutritional status of the
 patients after 3 months.
Inflammatory bowel diseases (IBD) comprise a variety of disorders that result from the
 continuous activation of the immunoinflammatory cascade, whose etiology has not been defined
 in some cases. Classical IBD include Crohn's disease (CD), ulcerative colitis (UC), and
 indeterminate colitis. These diseases are chronic and are characterized by alternating
 periods of recurrence and remission.

 The European Society of Clinical Nutrition and Metabolism (ESPEN) defined malnutrition as a
 state resulting from lack of uptake or intake of nutrition leading to altered body
 composition (decreased fat-free mass and body cell mass), resulting in diminished physical
 and mental function and impaired clinical outcome from disease.

 The prevalence of Malnutrition in patients with inflammatory bowel disease (IBD) is very
 high. it presents in up to 70% of patients with active disease and up to 38% in patients with
 remission.

 Several factors contribute to the malnutrition in IBD including insufficient nutrient intake
 as a consequence of impaired appetite (anorexia, stomachache), short bowel syndrome, impaired
 nutrient absorption (diarrhea, villus atrophy, bowel resection, intestinal flora overgrowth),
 increased nutrient losses (bleeding, fistulae), and food-drug interaction.

 Malnutrition in IBD has been associated with several adverse clinical outcomes. IBD patients
 with nutritional deficiencies may present with higher mortality rate, length of stay in the
 hospital, infectious rate, and even thromboembolic events than those without nutritional
 deficiencies. Furthermore, undernutrition in patients with postoperative conditions has been
 associated with increased complications such as anastomotic leakage and breakdown, infection
 including sepsis and pneumonia, prolonged hospitalization, and increased mortality.

 IBD is clearly associated with intestinal dysbiosis. Changes in the microbiome have a pivotal
 role in determining the onset of the pathology, when the genetic background of the individual
 makes him/her predisposed and other concomitant environmental factors intervene. Results of
 studies aimed at characterizing the microbiota of patients suffering from IBD, even sometimes
 with checkered results, indicate a generalized decrease in biodiversity, measured by an
 appropriate parameter-alpha-as well as a reduction in specific taxa including Firmicutes and
 Bacteroidetes, Lactobacillus and Eubacterium. IBD patients also present a reduction in
 species producing butyrate, a short chain fatty acid positively modulating intestinal
 homeostasis and reducing inflammation.

 Regarding environmental factors, accumulating data have proven that various nutritional
 components in diet can play a significant role in the development and clinical course of IBD.
 Dietary nutrients alter the composition of the gut microbiota and intestinal permeability,
 influencing the interaction between the host and gut microbiota.

 The Mediterranean diet (MedDiet) is a nutritional model inspired by the traditional dietary
 pattern of some of the countries of the Mediterranean basin. Mediterranean dietary pattern
 (MDP) gather the following characteristics: abundant consumption of olive oil and high
 consumption of fruits, vegetables, cereals (preferably as whole grain), legumes, nuts and
 seeds. The MDP also includes moderate consumption of fish and shellfish, white meat, eggs,
 and fermented dairy products (cheese and yogurt), as well as relatively small amounts of red
 meat, processed meats, and foods rich in sugars. Frequent but moderate intake of wine,
 especially red wine with meals is also recommended.

 Results from clinical and translational research on the Mediterranean diet point to its
 possible meaningful use in managing IBD, and thus additional studies could have the potential
 to add further insights to the field. Concerning published data, it was observed that 153
 Italian healthy subjects were investigated for their dietary habits and their gut microbiota
 was assessed, and high-level adherence to a Mediterranean diet was found to beneficially
 impact the gut microbiota and associated metabolome. These studies provided the first
 concrete evidence for the interconnection between Mediterranean dietary patterns, gut
 microbiota and microbial metabolites as they observed that the consumption of fruit,
 vegetables and legumes by subjects with satisfactory adherence to the Mediterranean diet was
 associated with an increase in fecal SCFA levels, an effect that was likely boosted by
 bacteria belonging to both the Firmicutes and Bacteroidetes capable of degrading
 carbohydrates not digestible by the host. When eight adult patients suffering from CD
 followed the Mediterranean diet for 6 weeks, their transcriptome analysis showed a change in
 expression of more than 3000 genes; changes in the intestinal microbiota, although not
 significant, showed a trend towards normalization with an increase in the expression of
 Bacteroidetes (17.89% to 18.74%), Clostridium cluster IV (19.2% to 21.86%) and Clostridium
 cluster XIVa (26.78% to 28.79%) and a decrease in the abundance of Proteobacteria (5.93% to
 5.48%) and Bacillaceae (4.65% to 4.21%).
Inclusion Criteria:

 -  patients with inflammatory bowel disease between 18 to 55 years

 Exclusion Criteria:

 -  presence of other diseases that affect the nutritional status of the patients like
 diabetes mellitus, liver cirrhosis, chronic kidney disease, and malignancy