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Article ; Online: Dietary composition of adult eosinophilic esophagitis patients is related to disease severity.

Eussen, Simone R B M / Wielders, Sanne / de Rooij, Willemijn E / Van Ampting, Marleen T J / Van Esch, Betty C A M / de Vries, Jeanne H M / Bredenoord, Albert J / Vlieg-Boerstra, Berber

Immunity, inflammation and disease

2024 Volume 12, Issue 3, Page(s) e1206

Abstract: Background: In addition to the elimination diet, dietary composition may influence disease severity in patients with eosinophilic esophagitis (EoE) through modulation of the immune response.: Aim: To explore the immunomodulatory role of nutrition ... ...

Abstract	Background: In addition to the elimination diet, dietary composition may influence disease severity in patients with eosinophilic esophagitis (EoE) through modulation of the immune response. Aim: To explore the immunomodulatory role of nutrition before and during elimination diet in adult EoE patients. Methods: Nutritional intake was assessed in 39 Dutch adult EoE patients participating in the Supplemental Elemental Trial (Dutch trial registry NL6014, NTR6778) using 3-day food diaries. In this randomized controlled trial, diagnosed patients received either a four-food elimination diet alone (FFED) or FFED with addition of an amino acid-based formula for 6 weeks. Multiple linear regression analyses were performed to assess associations between the intake of nutrients and food groups per 1000 kCal and peak eosinophil count/high power field (PEC), both at baseline and after 6 weeks. Results: At baseline, we found a statistically significant negative (thus favorable) relationship between the intake of protein, total fat, phosphorus, zinc, vitamin B12, folate, and milk products and PEC (p < .05), while calcium (p = .058) and full-fat cheese/curd (p = .056) were borderline (favorably) significant. In contrast, total carbohydrates, prepacked fruit juice, and white bread were significantly positively (unfavorable) related to PEC (p < .05), while ultra-processed meals (p = .059) were borderline (unfavorably) significant. After dietary intervention, coffee/tea were significantly negatively (favorably) related to PEC, hummus/legumes were significantly positively (unfavorably) related with PEC, while peanuts were borderline significantly positively related (p = .058). Conclusion: Dietary composition may be related to inflammation in adult EoE patients. High-quality and anti-inflammatory diets may be a promising adjuvant therapy in the dietary management of EoE.
MeSH term(s)	Adult ; Humans ; Allergens ; Diet ; Eosinophilic Esophagitis ; Food ; Inflammation ; Patient Acuity
Chemical Substances	Allergens
Language	English
Publishing date	2024-04-04
Publishing country	England
Document type	Randomized Controlled Trial ; Journal Article
ZDB-ID	2740382-8
ISSN	2050-4527 ; 2050-4527
ISSN (online)	2050-4527
ISSN	2050-4527
DOI	10.1002/iid3.1206
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Article ; Online: The immune-supportive diet in allergy management: A narrative review and proposal.

Vlieg-Boerstra, Berber / Groetch, Marion / Vassilopoulou, Emilia / Meyer, Rosan / Laitinen, Kirsi / Swain, Anne / Durban, Raquel / Benjamin, Olga / Bottse, Rachelle / Grimshaw, Kate / Netting, Merryn / O'Mahony, Liam / de Jong, Nicolette / Skypala, Isabel J

Allergy

2023 Volume 78, Issue 6, Page(s) 1441–1458

Abstract: The role of nutrition is increasingly recognized in the management of chronic immune diseases. However, the role of an immune-supportive diet as adjuvant therapy in the management of allergic disease has not been similarly explored. This review assesses ... ...

Abstract	The role of nutrition is increasingly recognized in the management of chronic immune diseases. However, the role of an immune-supportive diet as adjuvant therapy in the management of allergic disease has not been similarly explored. This review assesses the existing evidence for a relationship between nutrition, immune function, and allergic disease from a clinical perspective. In addition, the authors propose an immune-supportive diet to enhance dietary interventions and complementing other therapeutic options for allergic disease from early life to adulthood. A narrative review of the literature was conducted, to determine the evidence of the relationship between nutrition and immune function, overall health, epithelial barrier function, and gut microbiome, particularly in relation to allergy. Studies on food supplements were excluded. The evidence was assessed and utilized to develop a sustainable immune-supportive diet to complement other therapies in allergic disease. The proposed diet consists of a highly diverse range of fresh, whole, and minimally processed plant-based and fermented foods supplemented with moderate amounts of nuts, omega-3-rich foods and animal-based products in proportional amounts of the EAT-Lancet diet, such as (fatty) fish, (fermented) milk products which may be full-fat and eggs, lean meat or poultry, which may be free-range or organic.
MeSH term(s)	Animals ; Diet ; Hypersensitivity/therapy ; Meat ; Dietary Supplements ; Eggs
Language	English
Publishing date	2023-04-04
Publishing country	Denmark
Document type	Journal Article ; Review
ZDB-ID	391933-x
ISSN	1398-9995 ; 0105-4538
ISSN (online)	1398-9995
ISSN	0105-4538
DOI	10.1111/all.15687
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Article ; Online: Dietary composition of adult eosinophilic esophagitis patients is related to disease severity

Eussen, Simone R.B.M. / Wielders, Sanne / de Rooij, Willemijn E. / Van Ampting, Marleen T.J. / Van Esch, Betty C.A.M. / de Vries, Jeanne H.M. / Bredenoord, Albert J. / Vlieg-Boerstra, Berber

Immunity, Inflammation and Disease

2024 Volume 12, Issue 3

Abstract: Background: In addition to the elimination diet, dietary composition may influence disease severity in patients with eosinophilic esophagitis (EoE) through modulation of the immune response. Aim: To explore the immunomodulatory role of nutrition before ... ...

Abstract	Background: In addition to the elimination diet, dietary composition may influence disease severity in patients with eosinophilic esophagitis (EoE) through modulation of the immune response. Aim: To explore the immunomodulatory role of nutrition before and during elimination diet in adult EoE patients. Methods: Nutritional intake was assessed in 39 Dutch adult EoE patients participating in the Supplemental Elemental Trial (Dutch trial registry NL6014, NTR6778) using 3-day food diaries. In this randomized controlled trial, diagnosed patients received either a four-food elimination diet alone (FFED) or FFED with addition of an amino acid-based formula for 6 weeks. Multiple linear regression analyses were performed to assess associations between the intake of nutrients and food groups per 1000 kCal and peak eosinophil count/high power field (PEC), both at baseline and after 6 weeks. Results: At baseline, we found a statistically significant negative (thus favorable) relationship between the intake of protein, total fat, phosphorus, zinc, vitamin B12, folate, and milk products and PEC (p <.05), while calcium (p =.058) and full-fat cheese/curd (p =.056) were borderline (favorably) significant. In contrast, total carbohydrates, prepacked fruit juice, and white bread were significantly positively (unfavorable) related to PEC (p <.05), while ultra-processed meals (p =.059) were borderline (unfavorably) significant. After dietary intervention, coffee/tea were significantly negatively (favorably) related to PEC, hummus/legumes were significantly positively (unfavorably) related with PEC, while peanuts were borderline significantly positively related (p =.058). Conclusion: Dietary composition may be related to inflammation in adult EoE patients. High-quality and anti-inflammatory diets may be a promising adjuvant therapy in the dietary management of EoE.
Keywords	anti-inflammatory diet ; disease severity ; eosinophilic esophagitis ; foods ; immunomodulation ; inflammation ; nutrients
Subject code	610
Language	English
Publishing country	nl
Document type	Article ; Online
ZDB-ID	2740382-8
ISSN	2050-4527
ISSN	2050-4527
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Article ; Online: The immune‐supportive diet in allergy management: A narrative review and proposal

Vlieg‐Boerstra, Berber / Groetch, Marion / Vassilopoulou, Emilia / Meyer, Rosan / Laitinen, Kirsi / Swain, Anne / Durban, Raquel / Benjamin, Olga / Bottse, Rachelle / Grimshaw, Kate / Netting, Merryn / O'Mahony, Liam / de Jong, Nicolette / Skypala, Isabel J.

Allergy. 2023 June, v. 78, no. 6, p. 1441-1458

2023 , Page(s) 1441–1458

Abstract: The role of nutrition is increasingly recognized in the management of chronic immune diseases. However, the role of an immune‐supportive diet as adjuvant therapy in the management of allergic disease has not been similarly explored. This review assesses ... ...

Abstract	The role of nutrition is increasingly recognized in the management of chronic immune diseases. However, the role of an immune‐supportive diet as adjuvant therapy in the management of allergic disease has not been similarly explored. This review assesses the existing evidence for a relationship between nutrition, immune function, and allergic disease from a clinical perspective. In addition, the authors propose an immune‐supportive diet to enhance dietary interventions and complementing other therapeutic options for allergic disease from early life to adulthood. A narrative review of the literature was conducted, to determine the evidence of the relationship between nutrition and immune function, overall health, epithelial barrier function, and gut microbiome, particularly in relation to allergy. Studies on food supplements were excluded. The evidence was assessed and utilized to develop a sustainable immune‐supportive diet to complement other therapies in allergic disease. The proposed diet consists of a highly diverse range of fresh, whole, and minimally processed plant‐based and fermented foods supplemented with moderate amounts of nuts, omega‐3‐rich foods and animal‐based products in proportional amounts of the EAT‐Lancet diet, such as (fatty) fish, (fermented) milk products which may be full‐fat and eggs, lean meat or poultry, which may be free‐range or organic.
Keywords	adjuvants ; adulthood ; diet ; epithelium ; fermentation ; fish ; hypersensitivity ; immune response ; intestinal microorganisms ; lean meat ; milk ; poultry ; therapeutics
Language	English
Dates of publication	2023-06
Size	p. 1441-1458
Publishing place	John Wiley & Sons, Ltd
Document type	Article ; Online
Note	REVIEW
ZDB-ID	391933-x
ISSN	1398-9995 ; 0105-4538
ISSN (online)	1398-9995
ISSN	0105-4538
DOI	10.1111/all.15687
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Article ; Online: Peanut thresholds in peanut-allergic children are related to dietary composition.

Luiten, Daisy / Biezeveld, Maarten / van Doorn, Olga / Riady, Hanae / Yang, Ming / Bergsma, Femke / van der Plas, Atie / Brand, Kim / Arends, Nicolette / de Bruin, Annette / de Vries, Jeanne / de Meij, Tim / Vlieg-Boerstra, Berber

Immunity, inflammation and disease

2023 Volume 11, Issue 5, Page(s) e841

Abstract: Background: There is no clear explanation for the large variation in threshold levels among peanut-allergic children. We hypothesized that diet composition can partly explain this variation in thresholds, as nutrients and foods influence the intestinal ... ...

Abstract	Background: There is no clear explanation for the large variation in threshold levels among peanut-allergic children. We hypothesized that diet composition can partly explain this variation in thresholds, as nutrients and foods influence the intestinal barrier function and microbiota. Aim: to explore the relationship between the threshold levels for peanut and nutritional intake and gut microbial composition in peanut-allergic children. Methods: In this explorative cross-sectional study the cumulative threshold levels for peanut were determined by oral food challenge tests. Data on nutrients and foods consumed were obtained from 3-day food diaries. Microbial composition of faeces and saliva were determined by molecular microbiota detection technique. Multivariable linear regression analysis and multiple logistic regression were used to explore the associations, adjusted for energy and senitization. Results: Sixty-five children were included, of whom 32 (49%) (median age 50 months, IQR 28.0-96.5) had a positive oral food challenge. Significant positive associations were found between the intake of total carbohydrates, vitamin A and cumulative threshold levels for peanut, while significant negative associations were found for long-chain polyunsaturated fatty acids, linoleic acid and omega-6 fatty acids. No associations were found between threshold levels and microbial composition of faeces and saliva. However, a significant higher abundance of Proteobacteria and Bacteroidetes in saliva (p = 0.011 and 0.04, respectively) and of Proteobacteria in faeces (p = 0.003) were found in children with a positive peanut challenge compared to children with a negative peanut challenge. Conclusion: As a novel concept, this study showed that dietary composition is related to threshold levels for peanut.
MeSH term(s)	Humans ; Child ; Child, Preschool ; Arachis ; Cross-Sectional Studies ; Peanut Hypersensitivity/diagnosis ; Diet ; Food ; Allergens
Chemical Substances	Allergens
Language	English
Publishing date	2023-06-02
Publishing country	England
Document type	Journal Article ; Research Support, Non-U.S. Gov't
ZDB-ID	2740382-8
ISSN	2050-4527 ; 2050-4527
ISSN (online)	2050-4527
ISSN	2050-4527
DOI	10.1002/iid3.841
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Article ; Online: Overdiagnosis of cow's milk allergy with home reintroduction.

Vlieg-Boerstra, Berber J / Tissen, Inge / Wensing, Carry / Meijer, Yolanda / de Vries, Esther / Hendriks, Tom / Sprikkelman, Aline B

Pediatric allergy and immunology : official publication of the European Society of Pediatric Allergy and Immunology

2020 Volume 31, Issue 6, Page(s) 704–706

MeSH term(s)	Animals ; Cattle ; Female ; Humans ; Infant ; Medical Overuse ; Milk Hypersensitivity/diagnosis ; Milk Proteins
Chemical Substances	Milk Proteins
Language	English
Publishing date	2020-04-28
Publishing country	England
Document type	Letter
ZDB-ID	1057059-7
ISSN	1399-3038 ; 0905-6157 ; 0906-5784
ISSN (online)	1399-3038
ISSN	0905-6157 ; 0906-5784
DOI	10.1111/pai.13251
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Article ; Online: Effect of amino acid-based formula added to four-food elimination in adult eosinophilic esophagitis patients: A randomized clinical trial.

de Rooij, Willemijn E / Vlieg-Boerstra, Berber / Warners, Marijn J / Van Ampting, Marleen T J / van Esch, Betty C A M / Eussen, Simone R B M / Bredenoord, Albert J

Neurogastroenterology and motility : the official journal of the European Gastrointestinal Motility Society

2021 Volume 34, Issue 7, Page(s) e14291

Abstract: Background: Elimination of key foods restricts dietary options in eosinophilic esophagitis (EoE) patients. Addition of amino acid-based formula (AAF) to an elimination diet might facilitate adherence and, therefore, enhance efficacy of dietary ... ...

Abstract	Background: Elimination of key foods restricts dietary options in eosinophilic esophagitis (EoE) patients. Addition of amino acid-based formula (AAF) to an elimination diet might facilitate adherence and, therefore, enhance efficacy of dietary management. Aim: To evaluate whether addition of AAF to a four-food elimination diet (FFED) is more effective than FFED alone in decreasing eosinophilia, endoscopic signs, and clinical outcomes. Methods: This randomized controlled trial enrolled 41 adult patients with active EoE (≥15 eosinophils (eos) per high power field (hpf)) at baseline biopsy. Subjects were randomized (1:1 ratio) to groups given a FFED or FFED with addition of AAF providing 30% of their daily energy needs (FFED + AAF). Histological disease activity, endoscopic signs, symptoms, and disease-related quality of life (EoEQoL) were measured at baseline and after 6 weeks of intervention. Results: Patients (60% male, age 34.5 (interquartile range (IQR) 29-42.8 years)) were randomized to FFED (n = 20) or FFED + AAF (n = 21); 40 participants completed the diet. Complete histological remission (<15 eos/hpf) was achieved in 48% of FFED + AAF subjects (n = 21) vs. 25% of FFED subjects (n = 20), respectively (p = 0.204). Peak eosinophil counts (PEC) decreased significantly in both groups between baseline and week 6, but the change in PEC between groups was not different (p = 0.130). A significant but similar endoscopic and symptomatic reduction was observed in both groups (all; p<0.05). Total EoEQoL scores significantly improved in the FFED + AAF group between baseline and week 6 (p = 0.007), and not in the FFED group. Conclusion: The addition of AAF to a FFED did not lead to a larger decrease in PEC between baseline and 6 weeks, but may result in a significant improvement of QoL in adult EoE patients NL6014 (NTR6778).
MeSH term(s)	Adult ; Amino Acids ; Enteritis ; Eosinophilia ; Eosinophilic Esophagitis/diagnosis ; Eosinophils/pathology ; Female ; Gastritis ; Humans ; Male ; Quality of Life
Chemical Substances	Amino Acids
Language	English
Publishing date	2021-11-18
Publishing country	England
Document type	Journal Article ; Randomized Controlled Trial ; Research Support, Non-U.S. Gov't
ZDB-ID	1186328-6
ISSN	1365-2982 ; 1350-1925
ISSN (online)	1365-2982
ISSN	1350-1925
DOI	10.1111/nmo.14291
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Article ; Online: The Habitual Diet of Dutch Adult Patients with Eosinophilic Esophagitis Has Pro-Inflammatory Properties and Low Diet Quality Scores.

de Kroon, Marlou L A / Eussen, Simone R B M / Holmes, Bridget A / Harthoorn, Lucien F / Warners, Marijn J / Bredenoord, Albert J / van Rhijn, Bram D / van Doorn, Mylene / Vlieg-Boerstra, Berber J

Nutrients

2021 Volume 13, Issue 1

Abstract: We determined the nutritional adequacy and overall quality of the diets of adult patients with eosinophilic esophagitis (EoE). Dietary intakes stratified by sex and age were compared to Dietary Reference Values (DRV). Overall diet quality was assessed by ...

Abstract	We determined the nutritional adequacy and overall quality of the diets of adult patients with eosinophilic esophagitis (EoE). Dietary intakes stratified by sex and age were compared to Dietary Reference Values (DRV). Overall diet quality was assessed by two independent Diet-Quality-Indices scores, the PANDiet and DHD-index, and compared to age- and gender-matched subjects from the general population. Lastly, food and nutrient intakes of EoE patients were compared to intakes of the general population. Saturated fat intake was significantly higher and dietary fiber intake significantly lower than the DRV in both males and females. In males, the DRV were not reached for potassium, magnesium, selenium, and vitamins A and D. In females, the DRV were not reached for iron, sodium, potassium, selenium, and vitamins A, B2, C and D. EoE patients had a significantly lower PANDiet and DHD-index compared to the general population, although the relative intake (per 1000 kcal) of vegetables/fruits/olives was significantly higher (yet still up to 65% below the recommended daily amounts) and alcohol intake was significantly lower compared to the general Dutch population. In conclusion, the composition of the habitual diet of adult EoE patients has several pro-inflammatory and thus unfavorable immunomodulatory properties, just as the general Dutch population, and EoE patients had lower overall diet quality scores than the general population. Due to the observational character of this study, further research is needed to explore whether this contributes to the development and progression of EoE.
MeSH term(s)	Adult ; Comorbidity ; Diet/methods ; Diet/standards ; Energy Intake ; Eosinophilic Esophagitis/diet therapy ; Eosinophilic Esophagitis/epidemiology ; Female ; Humans ; Male ; Middle Aged ; Netherlands/epidemiology ; Nutrition Surveys ; Nutritive Value
Language	English
Publishing date	2021-01-13
Publishing country	Switzerland
Document type	Journal Article
ZDB-ID	2518386-2
ISSN	2072-6643 ; 2072-6643
ISSN (online)	2072-6643
ISSN	2072-6643
DOI	10.3390/nu13010214
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Article ; Online: Elimination and elemental diet therapy in eosinophilic oesophagitis.

Warners, M J / Vlieg-Boerstra, B J / Bredenoord, A J

Best practice & research. Clinical gastroenterology

2015 Volume 29, Issue 5, Page(s) 793–803

Abstract: Eosinophilic oesophagitis (EoE) is a chronic immune-mediated disorder of the oesophagus. The incidence of EoE has been raised substantially and EoE has recently become the most prevalent cause of dysphagia among the adolescents. Food and aeroallergens ... ...

Abstract	Eosinophilic oesophagitis (EoE) is a chronic immune-mediated disorder of the oesophagus. The incidence of EoE has been raised substantially and EoE has recently become the most prevalent cause of dysphagia among the adolescents. Food and aeroallergens are believed to play a major role in the pathogenesis. Current treatment includes topical steroids and dietary therapy. Dietary therapy with elimination of causative allergens could provide a durable long-term solution. Dietary therapy in EoE consists of in elemental and empiric elimination diets. Elemental diet with amino acid-based formula is most effective in achieving disease remission but poor taste makes adherence challenging. Empiric elimination diet based on avoidance of most common food allergens offers moderate response rates, the usefulness of allergy test-directed elimination diets is questioned by low response rates. In conclusion, dietary treatments for EoE seem promising, but further refinement is required before it can become standard care.
MeSH term(s)	Deglutition Disorders/etiology ; Eosinophilic Esophagitis/diet therapy ; Eosinophilic Esophagitis/etiology ; Food Hypersensitivity/complications ; Food Hypersensitivity/diet therapy ; Food, Formulated ; Humans
Language	English
Publishing date	2015-10
Publishing country	Netherlands
Document type	Journal Article ; Research Support, Non-U.S. Gov't ; Review
ZDB-ID	2048181-0
ISSN	1532-1916 ; 1521-6918
ISSN (online)	1532-1916
ISSN	1521-6918
DOI	10.1016/j.bpg.2015.06.013
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Article ; Online: Peanut thresholds in peanut-allergic children are related to dietary composition

Immunity, Inflammation and Disease

2023 Volume 11, Issue 5

Abstract	Background: There is no clear explanation for the large variation in threshold levels among peanut-allergic children. We hypothesized that diet composition can partly explain this variation in thresholds, as nutrients and foods influence the intestinal barrier function and microbiota. Aim: to explore the relationship between the threshold levels for peanut and nutritional intake and gut microbial composition in peanut-allergic children. Methods: In this explorative cross-sectional study the cumulative threshold levels for peanut were determined by oral food challenge tests. Data on nutrients and foods consumed were obtained from 3-day food diaries. Microbial composition of faeces and saliva were determined by molecular microbiota detection technique. Multivariable linear regression analysis and multiple logistic regression were used to explore the associations, adjusted for energy and senitization. Results: Sixty-five children were included, of whom 32 (49%) (median age 50 months, IQR 28.0–96.5) had a positive oral food challenge. Significant positive associations were found between the intake of total carbohydrates, vitamin A and cumulative threshold levels for peanut, while significant negative associations were found for long-chain polyunsaturated fatty acids, linoleic acid and omega-6 fatty acids. No associations were found between threshold levels and microbial composition of faeces and saliva. However, a significant higher abundance of Proteobacteria and Bacteroidetes in saliva (p = 0.011 and 0.04, respectively) and of Proteobacteria in faeces (p = 0.003) were found in children with a positive peanut challenge compared to children with a negative peanut challenge. Conclusion: As a novel concept, this study showed that dietary composition is related to threshold levels for peanut.
Keywords	diet ; microbiome ; oral food challenge ; peanut allergy ; thresholds
Subject code	610
Language	English
Publishing country	nl
Document type	Article ; Online
ZDB-ID	2740382-8
ISSN	2050-4527
ISSN	2050-4527
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