The Role of Diet in Crohn's Disease: From Etiology to Evidence-Based Management

Crohn's disease (CD) is a chronic, relapsing inflammatory bowel disease increasingly linked to environmental and dietary factors. This narrative review explores the role of diet in the pathogenesis and management of CD across its clinical spectrum. Emerging evidence implicates Westernized dietary patterns, characterized by high intakes of ultra-processed foods, saturated fats, and low fiber, contributes to intestinal dysbiosis, barrier dysfunction, and inflammation in genetically susceptible individuals. However, dietary patterns rich in minimally processed, plant-based foods, such as the Mediterranean diet, are associated with anti-inflammatory benefits. Nutritional therapies, including exclusive enteral nutrition (EEN) and the Crohn's Disease Exclusion Diet (CDED), have shown efficacy in inducing and maintaining remission, particularly in pediatric populations. The role of specific macronutrients, food additives, and emulsifiers in modulating gut inflammation and microbiota composition is also reviewed. Furthermore, the importance of early malnutrition screening, micronutrient assessment, and individualized dietary counseling is emphasized. Integrating dietary strategies into multidisciplinary CD management may improve clinical outcomes, enhance quality of life, and reduce long-term disease burden. Future research should focus on personalized nutrition approaches and tools to support adherence and sustainability.