ECCO’25: Key Nutrition Insights for Managing IBD

In February 2025, Nutritional Therapy for IBD attended the 20^th Congress of the European Crohn’s and Colitis Organisation (ECCO’25) in Berlin, Germany. This year, ECCO focused on the REACH goal for sustainability in preventing and treating inflammatory bowel disease (IBD). Find out more about what is new and interesting in nutrition care in IBD.

‍Combining Environment and Genes to Decrease IBD Risk

While some genes have been associated with IBD susceptibility, urban living and westernization of lifestyles are major drivers of the highest number of people diagnosed with IBD ever seen in developed and developing countries. Rupa Banerjee, PhD, MD,director of the IBD clinic at Asian Institute of Gastroenterology Hospitals in India, highlighted environmental triggers mainly involved in the higher risk of IBD and worst outcomes include short breastfeeding, antibiotics, especially exposure in the first year of life, urbanization, and a Westernized diet with a high intake of red and processed meat, other processed foods, and refined foods, together with a low intake of high-fiber foods (ie, “the S.A.D diet”). These environmental risk factors are now being examined through the lens of the microbiome. Westernization alters environmental exposures that influence the microbiome, which may trigger IBD in genetically susceptible individuals and may help explain why not all people respond favorably to biologics.¹

Genes and lifestyle work together in shaping IBD risk. Some nutrients, such as methionine, folate, choline, and betaine, which are highly found in fruits, green leafy vegetables, and legumes, can act as methyl donors or cofactors for enzymes that shape gene expression. Data from the huge cohort of UK Biobank revealed that people with the highest dietary methyl donor’s intake had a reduced risk of ulcerative colitis (UC) and Crohn’s disease (CD), with the link being stronger for heavy smokers with more than 20 pack-year smoking history and people exposed to high air pollution.² Pollution exposure is a plausible culprit of IBD,³ although it cannot always be avoided. However, the good news is that the above data suggest we can act on diet to partly counteract air pollution and decrease the risk of having IBD. 

New ECCO Consensus on Diet and Nutrition in IBD

Richard Hansen, MD, PhD, from the University of Dundee (United Kingdom), and Vaios Svolos, PhD, MSc, BSc, RD, research fellow at the Lab of Clinical Nutrition and Dietetics, University of Thessaly (Greece), presented a summary of the upcoming ECCO consensus on diet and nutrition in IBD that involves diet for IBD prevention, nutritional assessment and optimization, even in patients with IBD with no risk of malnutrition, diet recommendations for induction and maintenance, and dietary management of quiescent IBD with IBS-like symptoms, IBD-related surgeries, and inflammatory strictures in Crohn’s disease.

Just Because a Diet is Plant-Based Does Not Mean it's Healthy

Promoting or preventing dietary fiber in IBD is still under debate. Emerging findings from the GEM Project, presented by Cathy McShane, PhD, from St. James Hospital in Dublin, showed that a higher intake of fermentable fibers inulin and beta-glucan was associated with a reduced risk of CD development. While individuals with IBD consume less fiber than healthy populations, these findings support the importance of personalizing fiber intake in preventing the onset of IBD.

Chu K Yao, PhD, RD, from Monash University and Alfred Health in Australia, updated emerging hints of changing fiber recommendations in IBD. Observational data show an increased likelihood of IBD relapse in those who restrict fiber. There is also evidence that supplementation with specific fibers (eg, 7-20 g/day psyllium) could reduce relapse rates in ulcerative colitis, although a gradual increase of fiber is key to optimizing tolerability.⁴ Interestingly, gut pH and transit alterations driven by fermentable fiber intake may affect the efficacy-based delivery of mesalamine in patients with quiescent UC.⁵ Fiber intake advice in IBD is not one-size-fits-all and is determined by gut microbial function and individual immune status.⁶ For most patients with active (non-stricturing or penetrating) IBD, the fiber goal aligns with recommendations for the healthy population, incorporating fermentable and poorly fermentable sources, as not all fibers impact the same way on the abundance of the gut microbiome and its metabolites.

One of the paradoxes in fiber and IBD is exclusive enteral nutrition (EEN) that lacks fiber. It is as effective as corticosteroids for CD despite reducing bacterial diversity and worsening the dysbiosis already present in CD. A pilot study in healthy adults presented by Sarah Melton, RD, from Monash University and Alfred Health in Australia, showed that the addition of fiber to EEN (20 g of fiber/day including 6 fibers) normalized basal small intestinal permeability and minimized stress-induced changes to a similar degree as EEN without fiber. The good news was that fiber prevented long colonic transit, enhanced carbohydrate fermentation to the entire colon, and prevented common symptoms seen with no-fiber EEN (eg, headaches and nausea). To what extent the addition of fiber improves the outcomes in patients with CD without compromising small intestinal action of EEN remains to be seen.⁷

Plant-based diets are effective in IBD, but not all plant-based diets are equal. New findings presented by Jie Chen, PhD, of the Department of Gastroenterology at the Third Xiangya Hospital in China, showed evidence across 529,000 participants in the UK Biobank and European Prospective Investigation into Cancer and Nutrition (EPIC) cohorts that unhealthy plant-based diets (refined grains, sugary beverages) are linked to higher IBD risk (hazard ratio = 1.48) and doubled risk of IBD-related surgery (hazard ratio = 2.12). In contrast, emphasizing whole, minimally processed plant foods (fruits, vegetables, whole grains) is associated with a 25% lower IBD risk (hazard ratio = 0.75) and a 50% lower risk of IBD-related surgery (hazard ratio = 0.50).⁸

An Exclusive Whole-Food Diet for Inducing Biologic and Clinical Remission in Children and Adults with Crohn’s Disease

Luba Plotkin, RD, from the Shaare Zedek Medical Center in Jerusalem (Israel), showed that an exclusive whole-food diet* was comparable to an only-liquid diet for inducing clinical (56% in intention-to-treat analyses and 67% in per protocol analyses) and biological remission in children and young adults with mild-moderate uncomplicated CD. The whole-food diet induced a more diverse and healthier fecal microbiome, which was enriched in anti-inflammatory bacteria such as Faecalibacterium prausnitzii, compared to exclusive enteral nutrition, which might partly explain its benefits.⁹

The “ Tasty & Healthy " diet is a whole-foods-exclusive diet that excludes processed and canned foods, gluten, animal fat (except plain yogurt), and deep-fried food. Everything else is allowed with full flexibility and without any need for formula and without mandatory ingredients.

Half of the patients (21/43) who completed the “Tasty & Healthy” diet for 8 weeks and were in clinical remission successfully maintained remission with the whole-food diet over 4 months. These follow-up findings are based on the reintroduction of ingredients based on calprotectin levels and suggest that the diet is feasible in most patients, with good nutrient intake, except calcium and potassium.¹⁰

First Clinical Trial to Show Restricting Food Additive Emulsifiers May Improve Crohn’s Disease

Higher consumption of ultraprocessed foods (UPFs), including those containing food additive emulsifiers,¹¹ is associated with an increased risk of CD, but no clinical trials have assessed causality. Aaron Bancil, MD and gastroenterologist at King’s College London, presented a new, first-of-its-kind, multi-centre, randomised, double-blind, placebo-controlled trial, which showed dietary emulsifier restriction is an effective and safe therapy for mild-to-moderately active CD, reducing clinical symptoms and objective markers of inflammation. Patients with CD who received detailed dietary advice from a dietitian and supermarket deliveries of emulsifier-free packaged foods and additional snacks for 8 weeks were three times more likely to improve their symptoms and twice as likely to achieve a Crohn’s Disease Activity Index remission.¹² Fecal calprotectin levels were reduced by half after following an emulsifier-free diet. A full paper is due later this year. 

Additional data from the ADDapt trial showed that emulsifier restriction did not impair nutrient intake and improved food-related quality of life in people with active CD. These findings suggest that restricting food emulsifiers is feasible and does not compromise nutrient intake in patients with active CD.¹³

Psychosocial Factors are Linked with IBD Flares

Flares remain a significant challenge in IBD, and the PREdiCCt Study is exploring which aspects are associated with and predict flares in IBD. Lauranne Derikx, MD, PhD, from the Erasmus Medical Center in Rotterdam, highlighted that anxiety, depression, high somatization, and poor sleep are associated with clinical flares in patients in clinical remission. Depression and lack of exercise were potentially modifiable factors associated with increased risk of hard flare in UC and IBD unclassified, which supports the need for a holistic approach in IBD patients.^14,15

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The 21st Congress of ECCO will take place from 18-21 February 2026 in Stockholm, Sweden.

Further Reading

^{1. Raghunathan N, Gunala L, Thakur M, et al. P1343 Impact of biologic therapy on gut microbiome in Crohn’s disease: an Indian patient cohort study. J Crohns Colitis. 2025; 19(Suppl 1):i2416-i2418. doi: 10.1093/ecco-jcc/jjae190.1517.}

^{2. Dan L, Fu T, Ruan X, et al. DOP039 Dietary methyl donor intake alleviates the susceptibility to inflammatory bowel disease influenced by environmental pollution in a prospective cohort study. J Crohns Colitis. 2025; 19(Suppl 1):i155-i157. doi: 10.1093/ecco-jcc/jjae190.0078.}

^{3.Alenezy N, Nugent Z, Herman S, et al. Aeroallergen-related diseases predate the diagnosis of inflammatory bowel disease. Inflamm Bowel Dis. 2023; 29(7):1073-1079. doi: 10.1093/ibd/izac184.} 

^{4. Wedlake L, Slack N, Andreyev HJN, et al. Fiber in the treatment and maintenance of inflammatory bowel disease: a systematic review of randomized controlled trials. Inflamm Bowel Dis. 2014; 20(3):576-586. doi: 10.1097/01.MIB.0000437984.92565.31.}

^{5.Yao CK, Burgell RE, Taylor KM, et al. Effects of fiber intake on intestinal pH, transit, and predicted oral mesalamine delivery in patients with ulcerative colitis. J Gastroenterol Hepatol. 2021; 36(6):1580-1589. doi: 10.1111/jgh.15311.}

^{6. Armstrong HK, Bording-Jorgensen M, Santer DM, et al. Unfermented B-fructan fibers fuel inflammation in select inflammatory bowel disease patients. Gastroenterology. 2023; 164(2):228-240. doi: 10.1053/j.gastro.2022.09.034.}

^{7. Melton S, Gibson P, Taylor K, et al. P0983 Addition of fibre to exclusive enteral nutrition (EEN) improves colonic effects and symptoms without compromising the benefits on small bowel paracellular permeability in healthy humans. J Crohns Colitis. 2025; 19(Suppl 1):i1827-i1828. doi: 10.1093/ecco-jcc/jjae190.1157.}

^{8. Chen J, Sun Y, Dan L, et al. Composition of plant-based diets and the incidence and prognosis of inflammatory bowel disease: a multinational retrospective cohort study. Lancet Reg Health Eur. 2025; 52:101264. doi: 10.1016/j.lanepe.2025.101264.} 

^{9. Frutkoff YA, Plotkin L, Shavit Z, et al. OP02 Tasty & Healthy flexible diet induces clinical and biological remission in children and young adults with mild-moderate Crohn’s disease similar to EEN: results from the “TASTI-MM” randomized, physician-blinded, controlled trial. J Crohns Colitis. 2025; 19(Suppl 1): i4. doi: 10.1093/ecco-jcc/jjae190.0002.}

^{10. Plotkin L, Frutkoff YA, Shavit Z, et al. P1093 Personalized Tasty&Healthy whole-food diet for maintaining remission in children and adults with Crohn’s disease: results from the MyTasty open-label trial. J Crohns Colitis. 2025; 19(Suppl 1): i2009-i2010. doi: 10.1093/ecco-jcc/jjae190.1267.}

^{11. Sandall A, Smith L, Svensen E, et al. Emulsifiers in ultra-processed foods in the UK food supply. Public Health Nutr. 2023; 26(11):2256-2270. doi: 10.1017/S1368980023002021.}

^{12. Bancil A, Rossi M, Sandall A, et al. DOP097 Emulsifier restriction restriction is an effective therapy for active Crohn’s disease: the ADDapt trial - a multi-centre, randomised, double-blind, placebo-controlled, re-supplementation trial in 154 patients. J Crohns Colitis. 2025; 19(Suppl 1):i262. doi: 10.1093/ecco-jcc/jjae190.0136.}

^{13. Buckley A, Xu Y, Burke S, et al. P0757 Emulsifier restriction does not impair nutrient intake and improves food-related quality of life in active Crohn’s disease: dietary analysis of the ADDapt randomised controlled trial. J Crohns Colitis. 2025; 19(Suppl 1):i1460-i1462. doi: 10.1093/ecco-jcc/jjae190.0931.}

^{14. Derikx L, Cotronei C, Gros B, et al. OP07 Psychosocial factors are associated with risk of flare in IBD; results from the PREdiCCt study. J Crohns Colitis. 2025; 19(Suppl 1):i13-i15. doi: 10.1093/ecco-jcc/jjae190.007.}

^{15. Gracie DJ, Guthrie EA, Hamlin PJ, et al. Bi-directionality of brain-gut interactions in patients with inflammatory bowel disease. Gastroenterology. 2018; 154(6):1635-1646.e3. doi: 10.1053/j.gastro.2018.01.027.}

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Andreu Prados. BS. Pharm, RD, PhD is a science and medical writer specializing in making reliable evidence of non-prescription therapeutics for gastrointestinal conditions understandable, engaging and ready for use for healthcare professionals and patients.

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