Dietary interventions for induction and maintenance of remission in inflammatory bowel disease.

Systematic review of randomized controlled trials in inflammatory bowel disease. Participants were mainly adults with Crohn's disease or ulcerative colitis, with one study including children, and studies enrolled people with either active disease or remission/maintenance settings.

The review evaluated a range of exclusion and restriction diets rather than one standardized regimen, including high-fiber low refined carbohydrate diets, low microparticle diets, sequential elimination diets, low fiber diets, low refined carbohydrate diets, sugar-free diets, cow's milk protein elimination, and low calcium plus low microparticle diets. These dietary interventions were compared with usual diet, conventional nutritional advice, or other control diets; no consistent dose standardization was reported across studies.

Overall, dietary interventions did not show clear, reliable benefit for inducing or maintaining remission in Crohn's disease or ulcerative colitis. Some individual trials reported favorable remission or symptom results, such as low microparticle diets in Crohn's disease and elimination diets in ulcerative colitis, but the evidence was very low certainty and inconsistent. Reported effects included 44% remission with low microparticle diet versus 25% with control at 16 weeks, 50% versus 0% remission with sequential elimination diets at 6 weeks, and 36% versus 0% remission with a symptom-guided diet in ulcerative colitis. The authors concluded that no firm conclusions about benefits or harms can be drawn because data were sparse, heterogeneous, and methodologically limited.

Evidence certainty was very low, with sparse event data, small studies, heterogeneous dietary interventions, and methodological flaws. Outcomes were inconsistent across trials and conditions, and some findings were based on single studies or incomplete follow-up, limiting confidence and generalizability.