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Food and Inflammatory Bowel Diseases: A scoping review on the impact of food on patients’ psychosocial quality of life

2022; Wiley; Volume: 30; Issue: 5 Linguagem: Inglês

10.1111/hsc.13755

1365-2524

Lorenzo Palamenghi, Polina Figliuc, S. Leone, Guendalina Graffigna,

Eosinophilic Esophagitis

Health & Social Care in the CommunityEarly View REVIEW ARTICLEOpen Access Food and Inflammatory Bowel Diseases: A scoping review on the impact of food on patients’ psychosocial quality of life Lorenzo Palamenghi M.Sc., Corresponding Author Lorenzo Palamenghi M.Sc. lorenzo.palamenghi@unicatt.it orcid.org/0000-0002-8222-3915 EngageMinds HUB – Consumer, Food & Health Engagement Research Center, Università Cattolica del Sacro Cuore, Milan, Italy Department of Psychology, Università Cattolica del Sacro Cuore, Milan, Italy Faculty of Agriculture, Food and Environmental Sciences, Università Cattolica del Sacro Cuore, Cremona, Italy Correspondence Palamenghi, Lorenzo, EngageMinds HUB – Consumer, Food & Health Engagement Research Center, Università Cattolica del Sacro Cuore, 20123 Milan, Italy. Email: lorenzo.palamenghi@unicatt.itSearch for more papers by this authorPolina Figliuc M.Sc., Polina Figliuc M.Sc. EngageMinds HUB – Consumer, Food & Health Engagement Research Center, Università Cattolica del Sacro Cuore, Milan, ItalySearch for more papers by this authorSalvatore Leone BBA, Salvatore Leone BBA orcid.org/0000-0003-1690-8147 AMICI Onlus, Associazione nazionale per le Malattie Infiammatorie Croniche dell’Intestino, Milano, ItalySearch for more papers by this authorGuendalina Graffigna PhD, Guendalina Graffigna PhD orcid.org/0000-0003-4378-7467 EngageMinds HUB – Consumer, Food & Health Engagement Research Center, Università Cattolica del Sacro Cuore, Milan, Italy Department of Psychology, Università Cattolica del Sacro Cuore, Milan, Italy Faculty of Agriculture, Food and Environmental Sciences, Università Cattolica del Sacro Cuore, Cremona, ItalySearch for more papers by this author Lorenzo Palamenghi M.Sc., Corresponding Author Lorenzo Palamenghi M.Sc. lorenzo.palamenghi@unicatt.it orcid.org/0000-0002-8222-3915 EngageMinds HUB – Consumer, Food & Health Engagement Research Center, Università Cattolica del Sacro Cuore, Milan, Italy Department of Psychology, Università Cattolica del Sacro Cuore, Milan, Italy Faculty of Agriculture, Food and Environmental Sciences, Università Cattolica del Sacro Cuore, Cremona, Italy Correspondence Palamenghi, Lorenzo, EngageMinds HUB – Consumer, Food & Health Engagement Research Center, Università Cattolica del Sacro Cuore, 20123 Milan, Italy. Email: lorenzo.palamenghi@unicatt.itSearch for more papers by this authorPolina Figliuc M.Sc., Polina Figliuc M.Sc. EngageMinds HUB – Consumer, Food & Health Engagement Research Center, Università Cattolica del Sacro Cuore, Milan, ItalySearch for more papers by this authorSalvatore Leone BBA, Salvatore Leone BBA orcid.org/0000-0003-1690-8147 AMICI Onlus, Associazione nazionale per le Malattie Infiammatorie Croniche dell’Intestino, Milano, ItalySearch for more papers by this authorGuendalina Graffigna PhD, Guendalina Graffigna PhD orcid.org/0000-0003-4378-7467 EngageMinds HUB – Consumer, Food & Health Engagement Research Center, Università Cattolica del Sacro Cuore, Milan, Italy Department of Psychology, Università Cattolica del Sacro Cuore, Milan, Italy Faculty of Agriculture, Food and Environmental Sciences, Università Cattolica del Sacro Cuore, Cremona, ItalySearch for more papers by this author First published: 17 February 2022 https://doi.org/10.1111/hsc.13755 Funding information: This work was part of a broader project regarding the relationship between food, IBD and psychosocial wellbeing of patients (project ‘Crohnviviamo’), funded by Nestlé Health Science. This funding source had no role in the design of this study, in its execution, in the writing of this report or in the decision to submit the results. AboutSectionsPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL Share a linkShare onFacebookTwitterLinked InRedditWechat Abstract Growing bodies of literature show that a controlled diet is important in controlling the symptoms of Inflammatory Bowel Diseases (IBD). This leads patients to avoid foods considered potentially harmful. However, food is not just a nutrient but entails a series of hedonistic, cultural and social values. Thus, there is the concern that having to renounce certain foods might exert an impact on patients’ psychosocial quality of life, particularly in younger patients. The aim of this paper is to review the existing literature to address which aspects of the patients’ quality of life are affected by food restrictions. A scoping review was carried out. Five different databases were searched in January 2021. Retrieved papers were then screened to only include the relevant studies. Data were extracted and the main results of the studies were charted. A thematic analysis was carried out on the main results to identify the areas of psychosocial quality of life more often impacted by the food restrictions. From the initially identified 1967 unique entries, 14 studies were included. Results show that the perceived importance of food in controlling symptoms is confirmed by patients’ accounts. The most common strategy adopted was, thus, the avoidance of trigger foods. The thematic analysis revealed three domains that are impacted by these restrictions: psychological quality of life, social life, family sphere. This study highlights the impact that food restrictions exert on IBD patients’ quality of life, and warrants further studies to fill existing gaps, in particular regarding younger patients. What is known about this topic? Food is a known an important factor in determining IBD symptoms; Patients with Inflammatory Bowel Diseases have to avoid certain foods which they believe could worsen their symptoms; Little guidance is provided in helping patients understand which foods should be avoided. What this paper adds? The psychosocial consequences of food restrictions have been investigated by a number of studies, both qualitative and quantitative; The necessity to control diet and avoid certain foods exerts an impact on three different aspects of patients’ lives: personal and psychological wellbeing, social life, and family sphere; Several gaps exist however regarding the psychosocial impact of food restriction on younger patients. 1 INTRODUCTION Inflammatory Bowel Diseases (IBD) are a group of chronic conditions affecting the gastrointestinal system. These diseases include patients affected by Crohn's Disease (CD) and Ulcerative Colitis (UC), as well as a minority of patients with Indeterminate Colitis (IC). These diseases cause a variety of symptoms, even though the severity and frequency of symptoms vary across individuals and in time, and can exert a strong impact on patients’ quality of life. A recent review found that the highest reported prevalence and incidence of IBD were in European countries and in North America (Ng et al., 2017), even though since 1990 the incidence has been rising even in other continents, as industrialisation increased. Indeed, in 2008 the total economic burden of Crohn's Disease alone has been estimated at 10.9–15.5 billion dollars in the US, and between 2.1–16.7 billion euros in Europe (Yu et al., 2008). The relevance of these diseases for public health led to growing bodies of research focused on identifying the underlying causes that lead to a worsening in the frequency and severity of IBD patients’ symptoms: among the various factors that might impact patients’ symptoms, several studies highlighted the role of food and diet (Hou et al., 2014; Kinsey & Burden, 2016; Mehrabani et al., 2017). Indeed, the management of IBD symptoms through the implementation of dietary therapies aimed at modulating the intestinal microbiome is becoming a rather common method (Green et al., 2019). Patients themselves seem to frequently report an association between food and symptoms (Cohen et al., 2013). Nevertheless, even though the implementation of diets and food restrictions might help the patients to relieve their symptoms, this might actually come to a cost: from a psychological perspective, food is not only a nutrient but has several implications for people's identity and social life (Fischler, 1988; Lupton, 1994), though more marked in certain cultures (Rozin, 2005). Eating, indeed, is a fundamental part of our lives not only because it allows us to introduce nutrients and sustain our bodies, but also determines our own cultural identity (‘Tell me what you eat, and I will tell you who you are’) and is oftentimes a central activity in many important gatherings (Caplan, 1997). Thus, the dietary restrictions imposed by IBD might impact patients’ possibility to both enjoy food and the social dimension it entails. This might be particularly relevant and worrying for younger patients (children and adolescents), as the potentially impoverished social life might compromise their psychosocial development; additionally, the very fact that they cannot behave (in relationships to food) like their peers might pose a threat to their own self-representation and self-esteem. Thus, it is important to assess the impact that dietary restrictions might exert on IBD patients’ quality of life and psychosocial wellbeing, particularly regarding younger patients, as this will allow to highlight potential sources of social and psychological distress and ultimately address the more critical areas to reduce patients’ burden and to sustain their engagement in self-management. The aim of the present paper is to map the scientific literature in order to map the existing evidence regarding the aspects of food that impact on the psychosocial wellbeing and the quality of life of patients with Inflammatory Bowel Disease. 2 MATERIALS AND METHODS In order to answer our research question, we conducted a scoping review, as defined by Armstrong et al. (2011). We preferred a scoping review instead of a systematic review as this is a type of literature review that allows a broader exploration of a certain topic of interest, and a less focused research question. Since we were interested in exploring the ‘state of art’ of the knowledge regarding how food restrictions and diets in IBD impact on the psychosocial wellbeing and the quality of life of patients, we decided that a scoping review was preferable. To carry out our study in a rigorous, though flexible, way, we referred to a framework describing a 4-step process (Arksey & O’Malley, 2005): identification of the possibly relevant studies by consulting a selection of the most relevant scientific citation databases; selection of the potentially relevant studies by screening the titles and abstracts of the candidate articles identified in the databases; data extraction and analysis from the eligible papers, and finally. data charting and report. 2.1 Identification of the possibly relevant studies To identify all the potentially relevant articles to be included in our review, we interrogated the most important scientific databases in the medical and psychological field, namely: Scopus, Web of Science Core Collection, Pubmed, EBSCO_ Cochrane Central Register of Controlled Trials, and PsycINFO. The search was conducted on January 7, 2021, including only articles written in English. The research string was composed of three main queries, each composed of different synonyms (connected with ‘OR’), and queries were connected to each other with ‘AND’ connectors. The three queries regarded, respectively: ‘Inflammatory Bowel Disease’, ‘Food’, and ‘psychosocial wellbeing’. All the identified studies were then imported into a reference manager (Mendeley) and checked for duplicates. 2.2 Screening and selection of relevant studies The identified articles were then screened applying the following inclusion/exclusion criteria to the title and abstract of each publication; to be included, the article had to: 1) discuss the perception of the disease-food relationship in IBD patients, its psychosocial outcomes, and the quality of life derived from such relationship (clinical trials and publications that evaluated specific dietary or medical treatments efficacy, and articles that considered merely the nutrients and chemical characteristics of food, were excluded); 2) be in English and available; 3) be an original article (non-peer-reviewed articles, opinions, letters and reviews were excluded). Two researchers of the team (LP and PF) screened the identified articles by reading titles and abstracts. Conflicts regarding inclusion or exclusion were resolved by consensus. 2.3 Data extraction, collation and analysis From the included studies we extracted three types of data: Bibliometric data regarding the paper (reference, year of publication, journal and subject area of the journal); Methodological data (quantitative or qualitative research, tools used, sample characteristics, nationality); Main results of the studies. In particular, regarding the results of the included study, we conducted a qualitative thematic analysis to identify the main themes that emerged from qualitative studies and/or were investigated in the quantitative studies. Thus, results from the included studies are reported inside the specific categories that were identified in our thematic analysis. 3 RESULTS 3.1 Identification and selection of relevant studies Figure 1 shows the results of the screening procedure. 2782 records were identified through the database search and exported into the citation manager (Mendeley). After removing duplicates (via automatic tools and manual check), 1967 publications remained. FIGURE 1Open in figure viewerPowerPoint PRISMA flow chart After the first screening (title & abstract), 14 articles were included as potentially relevant and screened in full text. 3 of these papers were then excluded as they did not match the inclusion criteria. However, 3 additional papers—which were not found by our research string but retrieved by the inspection of included papers’ reference lists—were later included, as relevant. The total number of papers included for data extraction was then 14. 3.2 Characteristics of the included studies The bibliometric data and principal characteristics of the 14 articles included in the review are summarised in Table 1. The oldest included article that investigates the impact of food in IBD patients is that from Jowett and colleagues from 2004 (Jowett et al., 2004), while the most recent is from 2021 (Crooks et al., 2021). All the included studies have been published in journals focused on the health sciences area: in particular, 3 articles were published in journals focused on gastroenterology (Crooks et al., 2021; Palant et al., 2015; De Vries et al., 2019), and an additional two in journals specifically dedicated to IBD (Limdi et al., 2016; Zallot et al., 2013). The remaining articles are from journals dedicated to medicine in general, nursing, or quality of life. TABLE 1. Bibliometric characteristics of the included papers Autor(s) Title Year Journal Journal subject areaa a Journal subject area was retrieved from: Scimago (https://www.scimagojr.com/) Alexakis, C.; Nash, A.; Lloyd, M.; Brooks, F.; Lindsay, J. O.; Poullis, A. Inflammatory bowel disease in young patients: challenges faced by black and minority ethnic communities in the UK 2015 Health & Social Care in the Community Medicine: Health Policy; Public Health, Environmental and Occupational Health. Social Sciences: Social Sciences (miscellaneous); Social Work; Sociology and Political Science. Chuong, K. H.; Haw, J.; Stintzi, A.; Mack, D. R.; O'Doherty, K. C. Dietary strategies and food practices of paediatric patients, and their parents, living with inflammatory bowel disease: a qualitative interview study 2019 International journal of qualitative studies on health and wellbeing Medicine: Health Policy. Nursing: Fundamentals and Skills; Gerontology; Issues, Ethics and Legal Aspects. Crooks, B.; McLaughlin, J.; Matsuoka, K.; Kobayashi, T.; Yamazaki, H.; Limdi, J. K. The dietary practices and beliefs of people living with inactive ulcerative colitis 2021 European Journal of Gastroenterology & Hepatology Medicine: Gastroenterology; Hepatology. Czuber-Dochan, W.; Morgan, M.; Hughes, L. D.; Lomer, M. C. E.; Lindsay, J. O.; Whelan K., Perceptions and psychosocial impact of food, nutrition, eating and drinking in people with inflammatory bowel disease: a qualitative investigation of food-related quality of life 2020 Journal of Human Nutrition and Dietetics Medicine: Medicine (miscellaneous). Nursing: Nutrition and Dietetics. De Vries J. H.M.; Dijkhuizen, M.; Tap, P.; Witteman, B. J.M. Patient's Dietary Beliefs and Behaviours in Inflammatory Bowel Disease 2019 Digestive Diseases Medicine: Gastroenterology; Medicine (miscellaneous). Fletcher, P. C.; Schneider, M. A. Is There Any Food I Can Eat? Living With Inflammatory Bowel Disease and/or Irritable Bowel Syndrome 2006 Clinical Nurse Specialist Nursing: Advanced and Specialised Nursing; Assessment and Diagnosis; Leadership and Management; LPN and LVN Guadagnoli, L.; Mutlu, E. A.; Doerfler, B.; Ibrahim A.; Brenner, D.; Taft, T. H. Food-related quality of life in patients with inflammatory bowel disease and irritable bowel syndrome 2019 Quality of Life Research Medicine: Public Health, Environmental and Occupational Health Jowett, S. L.; Seal, C. J.; Phillips, E.; Gregory, W.; Barton, J. R.; Welfare, M. R. Dietary beliefs of people with ulcerative colitis and their effect on relapse and nutrient intake 2004 Clinical Nutrition Medicine: Endocrinology, Diabetes and Metabolism. Nursing: Nutrition and Dietetics. Limdi, J. K.; Aggarwal, D.; McLaughlin, J. T. Dietary Practices and Beliefs in Patients with Inflammatory Bowel Disease 2016 Inflammatory Bowel Diseases Medicine: Gastroenterology; Immunology and Allergy. Marsh A.; Kinneally J.; Robertson T.; Lord A.; Young A.; Radford–Smith G. Food avoidance in outpatients with Inflammatory Bowel Disease – Who, what and why 2019 Clinical Nutrition ESPEN Medicine: Endocrinology; Diabetes and Metabolism. Nursing: Nutrition and Dietetics. Palant A.; Koschack J.; Rassmann S.; Lucius-Hoene G.; Karaus M.; Himmel W. ‘And then you start to loose it because you think about Nutella’: The significance of food for people with inflammatory bowel disease - a qualitative study 2015 BMC Gastroenterology Medicine: Gastroenterology; Medicine (miscellaneous). Pituch-Zdanowska A.; Kowalska-Duplaga K.; Jarocka-Cyrta E.; Stawicka A.; Dziekiewicz M.; Banaszkiewicz A. Dietary Beliefs and Behaviours Among Parents of Children with Inflammatory Bowel Disease 2019 Journal of Medicinal Food Medicine: Medicine (miscellaneous). Nursing: Nutrition and Dietetics. Schneider Margaret A.; Jamieson A.; Fletcher P. C. ‘One sip won't do any harm...’: Temptation among women with inflammatory bowel disease/ irritable bowel syndrome to engage in negative dietary behaviours, despite the consequences to their health 2009 International Journal of Nursing Practice Nursing: Nursing (miscellaneous). Zallot C.; Quilliot D.; Chevaux J. B.; Peyrin-Biroulet C.; Guéant-Rodriguez R. M.; Freling E.; Collet-Fenetrier B.; Williet N.; Ziegler O.; Bigard M. A.; Guéant J. L.; Peyrin-Biroulet L. Dietary Beliefs and Behaviour Among Inflammatory Bowel Disease Patients 2013 Inflammatory Bowel Diseases Medicine: Gastroenterology; Immunology and Allergy. a Journal subject area was retrieved from: Scimago (https://www.scimagojr.com/) Regarding methodology, 6 articles describe qualitative research (Alexakis et al., 2015; Chuong et al., 2019; Czuber-Dochan et al., 2020; Fletcher & Schneider, 2006; Palant et al., 2015; Schneider et al., 2009), 7 provide quantitative data (Crooks et al., 2021; Guadagnoli et al., 2019; Limdi et al., 2016; Marsh et al., 2019; Pituch-Zdanowska et al., 2019; De Vries et al., 2019; Zallot et al., 2013) and the remaining one used a mixed methodology (Jowett et al., 2004). Three articles that were included in the review featured a sample with both IBD and IBS (Inflammatory Bowel Syndrome) patients (Fletcher & Schneider, 2006; Guadagnoli et al., 2019; Schneider et al., 2009). We decided to include these studies too, as the authors themselves considered IBD and IBS patients similar for what concerns the food and disease and the way food restrictions impact on their psychosocial wellbeing. Regardless, whenever it was possible, only results pertaining IBD patients were extracted and summarised from these studies. Only a minority of the included studies regarded young patients: in particular, 2 articles included adolescents (over 16 years old) along with adults (Alexakis et al., 2015; Czuber-Dochan et al., 2020); in one study participants were children between 9 and 17 years old (along with their parents) (Chuong et al., 2019); finally, one study used the parents of young IBD patients as a proxy (Pituch-Zdanowska et al., 2019). All the remaining 10 studies concerned only adult patients. All the studies were conducted in western countries; one article focused on black and minority ethnic communities in the UK (Alexakis et al., 2015). Table 2 describes the included studies’ methods and methodologies. TABLE 2. included studies’ methodology, methods and sample Reference Methodology Research methods Sample size Sample IBD type Sample Age/Age groups Sample Country Alexakis et al., 2015 Qualitative study Semi-structured interviews with young people with IBD from black and minority ethnic groups 20 CD (13), UC (6), other (1) 16–24 UK Chuong et al., 2019 Qualitative study Semi-structured interviews with children and their parents or grandparents 28 CD (23), UC (5) Children and adolescents (9–17) Canada Crooks et al., 2021 Quantitative study Questionnaire developed by the authors (27 questions) 208 UC ≥18 UK Czuber-Dochan et al., 2020 Qualitative study Semi-structured interviews conducted with people with IBD 28 CD (16), UC (12) ≥ 16 UK De Vries et al., 2019 Quantitative study Questionnaire developed by the authors (37 close-ended questions) 294 CD (146), UC (148) 18–79 Netherlands Fletcher & Schneider, 2006 Qualitative study Semi-structured interviews with women with IBD or IBS 8 2 UC, 1 UC+IBS, 5 IBS 18–22 Canada Guadagnoli et al., 2019 Quantitative study Survey including measures of Food-Related Quality of Life, Health-Related Quality of Life, disease activity, anxiety and depression 175 IBD (95), IBS (80) 18–70 USA Jowett et al., 2004 Mixed method: qualitative assessment of nutritional beliefs and a quantitative assessment of nutritional intake Interview at recruitment (beliefs) + food frequency questionnaire (nutritional intake) at recruitment and once a week for 1 year +validated disease activity index at recruitment and once a week for 1 year 191 (follow-up complete in 183 patients) UC 18–70 UK Limdi et al., 2016 Quantitative study Questionnaire developed by the authors (demographics +18 questions relating to dietary beliefs and food-related behaviour) 400 CD (156), UC (205), not sure or no response (53) >18 UK Marsh et al., 2019 Quantitative study Structured interviews with patients with IBD including nutritional assessment and evaluation of medical records 117 CD (50), UC (61), unspecified (6) >18 Australia Palant et al., 2015 Qualitative study (grounded theory) Open-end narrative interviews conducted with people with different IBD types, disease activities, and prior surgeries 42 CD (25), UC (15), IC (2) Young adults, Middle aged and Aged people Germany Pituch-Zdanowska et al., 2019 Quantitative study Questionnaire developed by the authors administered to parents of children with IBD (demographics and disease characteristics +13 questions about dietary beliefs and practices +list of products avoided or that should be avoided) 155 CD (104), UC (51) 4–8 Poland Schneider et al., 2009 Qualitative study (phenomenological study guided by heuristic inquiry) Semi-structured interviews with women with IBD or IBS +background questionnaire +food diary 3 IBD and 5 IBS 3 IBD (1 CD, 1 UC, 1 CD+UC), 5 IBS 18–23 Canada Zallot et al., 2013 Quantitative study Questionnaire developed by the authors (14 questions relating to dietary beliefs and dietary behaviour) 244 CD (177), UC (67) >17 France 3.3 Main results The studies included in our literature review confirm that patients perceive the diet as an important element to control the disease. Some studies reported that a large part of participants (31%–48%) believe that diet is a potential cause of their IBD (Crooks et al., 2021; Limdi et al., 2016), even though other studies reported lower percentages of patients who shared this point of view (13%–16%) (De Vries et al., 2019; Zallot et al., 2013). Nevertheless, the number of participants who believe that food habits could trigger a relapse is higher (between 33% and 58%) (De Vries et al., 2019; Zallot et al., 2013). In particular, the belief that certain foods can be the cause of relapses seems to be more prevalent in parents of children with IBD when compared with adults (Pituch-Zdanowska et al., 2019). The authors also found that dietary beliefs seem to be perceived differently by parents depending on age and illness duration: parents of children with a longer history of IBD tended to respond more frequently that food could be a cause of the illness, and parents of older children expressed greater concern that dietary habits could trigger an IBD flare (Pituch-Zdanowska et al., 2019). Hence, many patients considered adapting their dietary intake to control the symptoms, prevent, or end the relapses faster; a large number of patients (21%–59%) reported diet as equally or more important than medicines in the management of the disease (Limdi et al., 2016; Marsh et al., 2019; De Vries et al., 2019). Furthermore, one study revealed that almost one patient in three is convinced that consuming nutritional supplements or specific food or drinks could prevent a relapse (Crooks et al., 2021). In accordance with these results, one qualitative study reported that many patients perceived a bi-directional relationship between IBD and food: on the one hand, the disease could affect their dietary habits, on the other hand, dietary strategies could be considered an efficient way to manage the symptoms. Although in this study food was not reported as the direct reason for IBD flares, most patients believed that certain foods or food categories could worsen their symptoms, especially during active disease (Czuber-Dochan et al., 2020). The strategies more frequently reported are the avoidance of foods believed to be ‘triggers’, the assumption of ‘beneficial’ alimentary products, and the use of specific dietary treatments. Most of the included studies reported that IBD patients tend to avoid or reduce the intake of certain foods to reduce symptoms or prevent a relapse (Crooks et al., 2021; Limdi et al., 2016; Marsh et al., 2019; Pituch-Zdanowska et al., 2019; De Vries et al., 2019; Zallot et al., 2013), even though it is not always easy to completely avoid these foods, which sometimes results in ‘cheating’, particularly in children (Chuong et al., 2019; Fletcher & Schneider, 2006; Palant et al., 2015; Schneider et al., 2009). The strategy of food avoidance is adopted by 59%–90% of participants and many of them avoid more than one dietary product, especially during relapses. Patients with CD tend to avoid significantly more foods than patients with UC both during active phases and remissions (Marsh et al., 2019). The results of almost all studies agree that the most omitted food categories are very common food categories, such as spicy foods (44%–81%), fat or strongly seasoned foods (32%–70%), food containing lactose, carbonated drinks, milk and other dairy products, raw vegetables, raw fruits, and fibres (Jowett et al., 2004; Marsh et al., 2019; De Vries et al., 2019; Zallot et al., 2013). De Vries et al. (2019) also reported a list of foods, consumed by the participants, which were believed to be beneficial: wholemeal bread, tea, leafy vegetables, fatty fish, and poultry. Also, the use of dietary supplements, as well as the adoption of specific food exclusion diets, is reported by most studies as common in patients with IBD, especially during relapses (Crooks et al., 2021; Guadagnoli et al., 2019; De Vries et al., 2019). The main reasons for the use of supplements were to improve health and reduce fatigue (De Vries et al., 2019). Marsh and colleagues, conversely, reported that the majority of their participants did not follow any specific dietary pattern (Marsh et al., 2019). Crooks and colleagues reported that almost a quarter of the patients with UC that took part in their study had tried a specific whole food exclusion diet and 12% had tried more than one; the most followed were gluten-free diet and lactose-free diet (Crooks et al., 2021). Zallot et al. found that only 25% of their sample maintained a normal diet during relapse; more than half of the participants followed a low-residue diet (Zallot et al., 2013). Other strategies to prevent symptoms emerged from the interviews were changing food preparation making dishes easier to digest, replacing ‘bad foods’ with ‘good foods’, eating slowly and moderating the intake of certain products without complete exclusion (Czuber-Dochan et al., 2020; Fletcher & Schneider, 2006). Regardless of this, there are some accounts