DOP083Impact of Mediterranean Diet on Disease Activity, Biochemical Markers, and Patient-Centered Outcomes in Patients with Inflammatory Bowel Disease: A Two-Year Prospective Single-Center Study

Abstract Background Nutrition is increasingly recognized as a modifiable factor influencing inflammatory bowel disease (IBD), including Crohn’s disease and ulcerative colitis. The Mediterranean diet (MD), rich in fruits, vegetables, legumes, whole grains, olive oil, and moderate fish, may reduce inflammation, prevent flares, and improve wellbeing. Prospective data in IBD remain limited. This study evaluated the impact of MD adherence on disease activity, biochemical markers, and patient-centered outcomes over two years. Methods This prospective single-center study included 92 consecutive IBD patients (42 Crohn’s disease, 50 ulcerative colitis, mean age 42 years, 52% female) between January 2023 and December 2024. Inclusion criteria were age 18 years, confirmed IBD, and stable maintenance therapy ≥3 months. Patients with significant comorbidities, pregnancy, or recent surgery were excluded. MD adherence was assessed using a validated score and 7-day food diaries at baseline and six-month intervals. Adherence was classified as high, moderate, or low. Disease activity was evaluated using CDAI and partial Mayo score; biochemical markers included CRP, fecal calprotectin, hemoglobin, ferritin, and albumin. Patient-centered outcomes included quality of life (IBDQ, SF-36), fatigue (VAS), sleep quality (PSQI), gastrointestinal symptoms, flare incidence, hospitalizations, self-perceived health, work productivity, and use of rescue medications. Results High adherence was associated with lower clinical activity (mean CDAI 110 vs 180, partial Mayo 1.5 vs 3.2), lower CRP (4.2 vs 8.7 mg/L) and fecal calprotectin (120 vs 280 µg/g), higher hemoglobin (13.2 vs 11.8 g/dL) and ferritin (45 vs 25 µg/L), and improved albumin (4.1 vs 3.6 g/dL). Quality of life was higher (IBDQ 185 vs 160), fatigue lower (VAS 3.8 vs 6.2), sleep quality better (PSQI 5.1 vs 8.3), and gastrointestinal symptoms reduced (2.1 vs 4.5). High adherence correlated with fewer flares (0.8 vs 1.9/year), hospitalizations (0.3 vs 0.8/year), lower rescue medication use (13% vs 35%), better self-perceived health (VAS 8.5 vs 6.3), and improved work productivity (1.2 vs 3.5 hours lost/week). Moderate adherence showed intermediate benefits. Conclusion Longitudinal analyses confirmed dose-response relationships and independent associations after adjusting for confounders. These results suggest that MD adherence reduces disease activity, improves biochemical markers, and enhances multiple patient-centered outcomes. Integrating structured dietary counseling into routine IBD care is safe, accessible, and cost-effective. Future multicenter studies are warranted to confirm these findings. Conflict of interest: Aouroud, Meryem: No conflict of interest Aouroud, Hala: No conflict of interest Nacir, Oussama: Lairani, Fatima Ezzahra: No conflict of interest Ait Errami, Adil: No conflict of interest Oubaha, Sofia: No conflict of interest Samlani, Zouhour: No conflict of interest Krati, Khadija: No conflict of interest