Potential Impact of Diet on Treatment Effect from Anti-TNF Drugs in Inflammatory Bowel Disease

Abstract

We wanted to investigate the current knowledge on the impact of diet on anti-TNF response in inflammatory bowel diseases (IBD), to identify dietary factors that warrant further investigations in relation to anti-TNF treatment response, and, finally, to discuss potential strategies for such investigations. PubMed was searched using specified search terms. One small prospective study on diet and anti-TNF treatment in 56 patients with CD found similar remission rates after 56 weeks among 32 patients with good compliance that received concomitant enteral nutrition and 24 with poor compliance that had no dietary restrictions (78% versus 67%, p = 0.51). A meta-analysis of 295 patients found higher odds of achieving clinical remission and remaining in clinical remission among patients on combination therapy with specialised enteral nutrition and Infliximab (IFX) compared with IFX monotherapy (OR 2.73; 95% CI: 1.73–4.31, p < 0.01, OR 2.93; 95% CI: 1.66–5.17, p < 0.01, respectively). In conclusion, evidence-based knowledge on impact of diet on anti-TNF treatment response for clinical use is scarce. Here we propose a mechanism by which Western style diet high in meat and low in fibre may promote colonic inflammation and potentially impact treatment response to anti-TNF drugs. Further studies using hypothesis-driven and data-driven strategies in prospective observational, animal and interventional studies are warranted.

Meat and fiber intake and interaction with pattern recognition receptors (TLR1, TLR2, TLR4, and TLR10) in relation to colorectal cancer in a Danish prospective, case-cohort study

“…adherent layer, prevents large particles and intact microbes from coming into direct contact with the underlying epithelium; thus, the lower adherent layer is generally free from microbes (63). Low levels of fiber may change the gut microbial metabolism from primarily using microbial derived SCFAs to mucinous carbohydrates as the main energy source, thereby degrading the mucus (64,65). It has been suggested that plant fiber may be important for restoring the mucus layer (63).…”

“…It has been suggested that plant fiber may be important for restoring the mucus layer (63). In addition, high intake of meat containing organic sulfur may increase the amount of sulfate for microbially produced hydrogen sulfide (66,67) that may then reduce the disulfide bonds in the mucus network, rendering the mucus layer penetrable to bacteria (65,68,69). Bacteria may then reach the epithelium and activate the TLR-induced gut inflammation.…”

Inflammation: a highly conserved, Janus-like phenomenon—a gastroenterologist’ perspective

“…In the last decade, the attention of investigators was necessarily re-directed towards studying the reasons for the erratic response of IBD to the various anti-TNF antagonists, and one of the main questions asked whether simultaneous treatment of the patient with biologic drugs and a special diet could improve effectiveness. Most of the studies were drawn in CD [52]. Two main designs were used: 1) Investigation of the effects of 9 superimposing an elemental diet; 2) Study of the effects of diet modification in the course of treatment, using a Food Frequency Questionnaire (FFQ).…”

“…In this chain of events, the prime mover is the shortage of fibre, which boosts growth of mucin-degrading strains, such as the various Ruminococci that are found abundant in UC; degradation of mucus would then make available sulphate for degradation by noxious bacteria such as Bilephila Wadsworthi, capable to induce gut membrane ulceration. Large breaches in the mucus shield would allow antigenic luminal contents to be intercepted by TLR sensors, which, responding to bacterial antigenic motifs, can activate the pro-inflammatory chain down to TNF-α production with local and systemic inflammation [52].…”

Degradation of the extracellular matrix is part of the pathology of ulcerative colitis

“…7 Additionally, a westernized lifestyle and environmental impact is associated with increased risk of IBD, which may be linked to changes in the gut microbiome. 8 Accordingly, the prevalence in the West is increasing. 9 Cigarette smoking also affects the risk of IBD and gene-smoking interactions have been identified.…”