Abstract Background The Mediterranean diet (MED) is increasingly recommended as a dietary strategy for patients with inflammatory bowel diseases (IBD). However, feasibility and cultural adaptability across diverse populations may be challenging, and data are limited. The IBDMED is a microbiota-targeted, MED-based nutritional education program tailored for patients with IBD. This study assessed the feasibility of implementing IBDMED beyond the Mediterranean region by comparing adherence and related influencing factors in two distinct geographic and ethnic countries, Israel (ISR) and India (IND). Methods Patients with early mild-to-moderate Crohn’s disease were randomized to the IBDMED intervention or a local standard-of-care dietary counseling (control). The IBDMED program comprised individualized dietitian consultations, a mobile app with MED-based guidance, online dietitian chat and wearables for lifestyle monitoring. Traditional recipes were adapted to MED principles, and in IND, olive oil was provided. Adherence was evaluated using a predefined IBDMED adherence score1. Patient feedback questionnaires were collected at week 8 to identify factors promoting adherence. Analyses were stratified by study arm (IBDMED vs control) and country (ISR, IND). (NCT05536544). Results Seventy-eight patients completed the 8-week program (ISR = 42; IND = 36). The median age was 34 years (IQR 25-42) and median BMI was 23.2 kg/m2 (IQR 20.5-26.7). Adherence scores improved significantly in both arms, with greater improvement in the IBDMED group than in controls (+3.6 vs + 1.2; both p 0.01) and in both countries (ISR + 2.46; IND + 2.28; both p 0.001). Country-specific patterns were observed: in ISR, intake of fruit and yogurt increased, whereas in IND, intake of whole grains, legumes, and nuts increased. Vegetable and olive oil intake increased across both countries. Significant reductions were noted in red and processed meat and artificial sweeteners in ISR, and in sweet pastries and salty snacks in IND. Among IBDMED participants completing feedback (34/39, 87%), satisfaction was high (mean 4.7 ± 0.5 on a 1–5 scale), and only 8.8% reported difficulty adhering. Weekly dietitian calls were rated the most supportive tool for increasing adherence, followed by the daily app questionnaire, online chat, and wearables. Importantly, dietary and lifestyle changes were reported among family members of enrolled patients (ISR: 57.9%; IND: 86.7%). Conclusion The IBDMED intervention was feasible and culturally adaptable across ISR and IND, showing high adherence and favorable, country-specific dietary changes. Collateral household benefits were observed. Identified adherence-promoting factors should be used to implement MED-based dietary strategies in diverse geographic settings. Reference: 1. Godny L. et al, Gastroenterology 2025 PMID: 39814239 Conflict of interest: Shakhman, Shelly: No conflict of interest Elial-Fatal, Sarine: No conflict of interest Godny, Lihi: Grant: Helmsley Charitable Trust Pfeffer-Gik, Tamar: Altman Health Janssen Strauss group Fathima, Sana: None Raghunathan, Nalini: No conflict of interest Yanai, Henit: Grant: Pfizer, ISF Personal Fees: AbbVie, Janssen, Pfizer, Takeda, Bristol Myers Squibb, and Elly Lilli. Rabinowitz, keren: No conflict of interest Banerjee, Rupa: RB has received grants/research support from Asian Healthcare Foundation, and the Leona M and Harry B Helmsley Charitable Trust Advisory board fees from Abbott, AstraZeneca, Abbvie, Cadila, Cipla, Dr Reddy Labs, Eli Lilly, Emcure, Ferring Pharma, Hetero Drugs, Janssen, MSN Labs, Mankind Pharma, Menarini, Micro Labs, Pfizer, Sun Pharmaceuticals, Takeda Pharmaceuticals, Torrent, Waterley, and Zydus. Dotan, Iris: Grant: The Leona M. and Harry B. Helmsley Charitable Trust, Altman Research, Pfizer, BMS Personal Fees: Pfizer, Falk, Ferring, Abbvie, Janssen, Celltrion, Takeda, Celgene/BMS, Gilead, Galapagos, Materia Prima, Sandoz, Sublimity, Sangamo, Spyre, Eli-Lilly, Harp Diagnostics, Gutreat, Astra Zeneca
Shakhman et al. (Thu,) studied this question.