Personalizing nutrition therapy in inflammatory bowel disease: Practical applications and review of the latest...

Inflammatory bowel disease (IBD), encompassing Crohn's disease (CD) and ulcerative colitis (UC), is a chronic condition influenced by genetic and environmental factors, including diet. Dietary interventions modulate IBD pathophysiology through microbiome reshaping, short-chain fatty acid production, and immune regulation. While pharmacologic therapies remain central, dietary interventions have emerged as evidence-based adjunctive strategies for inducing and maintaining remission. In UC, the Mediterranean diet (MED) demonstrates consistent improvements in clinical symptoms and inflammatory markers in mild-to-moderate disease, with emerging evidence supporting benefit in moderate-to-severe UC when combined with pharmacotherapy. The ulcerative colitis exclusion diet (UCED) shows preliminary promise, though larger trials are needed. For maintenance, anti-inflammatory whole-food patterns reduce fecal calprotectin and promote favorable microbiota shifts. In CD, exclusive enteral nutrition (EEN) remains the gold standard for induction, primarily in pediatric Crohn's disease, while the Crohn's disease exclusion diet (CDED) with partial enteral nutrition offers a well-tolerated food-based alternative. Notably, enteral nutrition combined with biologics enhances drug bioavailability and clinical outcomes. Across interventions, microbiome modulation, including increased SCFA-producing bacteria and enhanced microbial diversity, represents a unifying therapeutic mechanism. Future research priorities include trials with endoscopic endpoints, identification of predictive biomarkers, and development of precision nutrition approaches tailored to individual disease characteristics.