Practical application of evidence-based dietary therapy into inflammatory bowel disease care shows high patient satisfaction, compliance, and efficiency. the delectable program

Abstract Background Diet is an accepted therapy for Inflammatory Bowel Disease (IBD). Controlled trials have demonstrated that exclusive enteral nutrition (EEN) and the Crohn’s Disease Exclusion Diet (CDED) induce remission in Crohn’s disease. Low sulphur and plant-based diets are being investigated in ulcerative colitis (UC). Reducing ultra-processed, additive-containing food intake is emerging as important, given its role in initiating and perpetuating disease. IBD patients believe in the value of the diet, but there is no evidence for diet tolerability and benefit outside of clinical trials. The DELECTABLE program, a dietitian-led telehealth service, aims to evaluate structured, evidence-based dietary therapy as part of routine clinical care. Here we present satisfaction, compliance and efficacy results. Methods In this open-label, prospective, observational program, Crohn’s disease and pouchitis patients were offered the CDED or a wholefood additive-free diet, UC patients were offered a low-sulphur plant-based diet or wholefood diet, and patients with microscopic colitis were offered the wholefood diet. The primary outcome was diet satisfaction (modified DSAT-28; possible range: 28 to 140). Dietitian-rated compliance, patient-rated compliance, disease activity score (CDAI, partial Mayo score), CRP, and faecal calprotectin were secondary outcomes. Baseline to week 12 differences were assessed using the Mann-Whitney-U-test or Wilcoxon-sign-test for continuous variables and McNemar’s test for categorical variables. Results Of 165 patients referred, 79 enrolled in the program. Fifty-seven (72%) enrolled patients have completed 12 weeks of diet therapy. Across all diet arms combined, diet satisfaction score increased from week 1 (89.3) to week 12 (93.7; P<0.001). Dietitian and patient-rated compliance were 4/6 and 3/5, respectively, at week 1 and did not change at week 12. CDAI was reduced on all diet arms combined (60.0 to 41.5, P=0.003) and on the CDED (128.9 to 46.6, P=0.004), with a trend for reduced CDAI on the wholefood diet. There was a trend towards reduced CRP across all diet arms and on the wholefood diet (49.5 to 25.3, P=0.363). The proportion of patients in remission, based on CDAI, increased when all diet arms were combined and on the CDED and wholefood diet (P<0.001). Faecal calprotectin was numerically reduced on the CDED (95.0 ug/g to 53.5 ug/g) and UC diet (184.0 ug/g to 159.0 ug/g), but these results did not reach statistical significance. Conclusion Half of the referred patients are interested in pursuing a supervised, long-term diet program. Implementation of well-balanced, effective diet therapies is feasible and well-accepted by patients, with a promising impact on disease activity.