ABSTRACT Background and Aim The role of dietitians in inflammatory bowel disease (IBD) care is evolving as evidence increasingly points to the role of diet in disease risk, pathogenesis and therapeutic outcomes. This narrative review by the ECCO committee of Dietitians (D‐ECCO) outlines the progression of dietetic care in IBD from supportive nutrition to a key component of therapeutic management. Methods Literature related to the development of dietetic roles in IBD, the evolution of dietary guidelines and evidence, was reviewed by the D‐ECCO Committee working group. Results Dietitians were once limited to supportive roles, now vital members of multidisciplinary IBD care team. Research has established diet as a modifiable environmental factor affecting intestinal inflammation via proposed mechanisms including microbiota, metabolite production and gut barrier integrity. Interventional studies support dietary strategies such as exclusive enteral nutrition and the Crohn's disease exclusion diet. The 2025 ECCO Consensus on Dietary Management of IBD redefines nutrition care as central to IBD management, outlining five pillars where dietitians with expertise in IBD should engage: induction and maintenance of remission, comorbidity management, nutritional assessment and optimisation and prevention. Conclusion The evolution of dietetic care highlights the critical role of dietitians in IBD management. All patients should have access to dietitians with IBD expertise to ensure effective, personalised care. However, access is hindered by workforce shortages, lack of defined scope, standardised training and systemic barriers. To address this, the D‐ECCO Committee proposes a six‐step roadmap to defined and formalise the IBD dietitian role. International collaboration and real‐world data will be essential to fully integrate nutrition into evidence‐based IBD care.
Day et al. (2026) studied this question.