A novel Monash Pouch diet in patients with an ileoanal pouch is tolerable and has favorable metabolic luminal effects

Ardalan, Zaid S, Yao, Chu K, Green, Kraig, Probert, Chris ORCID: 0000-0003-0477-6714, Gill, Paul A, Rosella, Sam, Muir, Jane G, Sparrow, Miles P and Gibson, Peter R (2023) A novel Monash Pouch diet in patients with an ileoanal pouch is tolerable and has favorable metabolic luminal effects JGH OPEN, 7 (12). pp. 942-952. ISSN 2397-9070, 2397-9070

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Abstract

Aims: To evaluate a whole-food diet strategy (the Monash Pouch diet [MPD]) designed based on the interacting roles dietary factors play with pouch health. Specifically, its tolerability and acceptability, whether it achieved its dietary and metabolic goals, and the effects on symptoms and inflammation were examined. Methods: In a 6-week open-label trial, patients with ileoanal pouches educated on the MPD were assessed regarding diet tolerability and acceptance, food intake (7-day food diaries), pouch-related symptoms (clinical pouchitis disease activity index), and, in 24-h fecal samples, calprotectin, fermentative biomarkers, and volatile organic compounds (VOC). Results: Of 12 patients, 6 male, mean (SD) age 55 (5) and pouch age 13 (2) years, one withdrew with partial small bowel obstruction. Tolerability was excellent in 9 (75%) and acceptance was high (81%). Targeted changes in dietary intake were achieved. Fecal branched- to short-chain fatty acid ratio increased by median 60 [IQR: 11–80]% (P = 0.02). Fecal VOCs for 3 compounds were also increased, 2-methyl-5-propan-2-ylcyclohexa-1,3-diene (Fold-change [FC] 2.08), 1,3,3-trimethyl-2-oxabicyclo[2.2.2]octane (FC 3.86), propan-2-ol (FC 2.10). All six symptomatic patients achieved symptomatic remission (P = 0.03). Fecal calprotectin at baseline was 292 [176–527] μg/g and at week 5 was 205 [148–310] μg/g (P = 0.72). Conclusion: Well tolerated and accepted, the MPD achieved targeted changes in intakes and fermentation of carbohydrates relative to that of protein. There were signals of improvement in symptoms. These results indicate the need for a randomized-controlled trial. (Trial registration: ACTRN12621000374864; https://www.anzctr.org.au/ACTRN12621000374864.aspx).

Item Type:	Article
Uncontrolled Keywords:	diet, fermentable oligo-, di- and monosaccharides and polyols, pouch, pouchitis, protein fermentation, ulcerative colitis
Divisions:	Faculty of Health & Life Sciences Faculty of Health & Life Sciences > Inst. Systems, Molec & Integrative Biology > Inst. Systems, Molec & Integrative Biology
Depositing User:	Symplectic Admin
Date Deposited:	30 Jan 2024 10:19
Last Modified:	23 May 2026 08:16
DOI:	10.1002/jgh3.13008
Open Access URL:	https://doi.org/10.1002/jgh3.13008
Related Websites:	Author Publisher
URI:	https://livrepository.liverpool.ac.uk/id/eprint/3178090
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