IBD IBD Nutrition and Lifestyle 2 — Questions and Answers
Question 1: Cigarette smoking in Crohn's disease has which effect on disease course compared to UC?
- Smoking is protective in both UC and Crohn's
- Smoking worsens Crohn's disease (increases flares, need for surgery) while being paradoxically protective in UC (Correct answer)
- Smoking has no effect on either IBD type
- Smoking improves Crohn's disease activity similarly to UC
Correct answer: Smoking worsens Crohn's disease (increases flares, need for surgery) while being paradoxically protective in UC
Smoking doubles the risk of Crohn's disease relapse, increases hospitalization and surgical rates, and worsens disease course — the opposite of its paradoxical protective effect in UC.
Question 2: Exercise in IBD patients with quiescent disease has been shown to have which effect?
- Increases flare risk by raising body temperature
- Has anti-inflammatory effects, reduces fatigue, improves quality of life, and may reduce relapse risk (Correct answer)
- Is contraindicated due to risk of intestinal torsion
- Only benefits musculoskeletal extraintestinal manifestations
Correct answer: Has anti-inflammatory effects, reduces fatigue, improves quality of life, and may reduce relapse risk
Regular moderate exercise has anti-inflammatory systemic effects, reduces IBD-related fatigue, improves psychological wellbeing, and emerging evidence suggests it may reduce relapse rates.
Question 3: Zinc deficiency is particularly common in Crohn's disease and manifests clinically with which symptom cluster?
- Peripheral neuropathy and ataxia
- Acrodermatitis enteropathica-like rash, poor wound healing, and impaired immune function (Correct answer)
- Megaloblastic anemia
- Night blindness and xerophthalmia
Correct answer: Acrodermatitis enteropathica-like rash, poor wound healing, and impaired immune function
Zinc deficiency in Crohn's causes perioral and acral dermatitis (acrodermatitis enteropathica), impaired wound healing, taste/smell alterations, and immune dysfunction.
Question 4: Folate supplementation is particularly important for IBD patients on which medication to prevent macrocytic anemia?
- Infliximab
- Methotrexate (Correct answer)
- Vedolizumab
- Budesonide
Correct answer: Methotrexate
Methotrexate is a folate antagonist used in Crohn's disease; concurrent folic acid supplementation (1 mg/day) prevents methotrexate-related macrocytic anemia, mucositis, and hepatotoxicity.
Question 5: The specific carbohydrate diet (SCD) in IBD is based on which theoretical mechanism?
- Eliminating all fiber to reduce bowel wall stress
- Restricting complex carbohydrates to starve pathogenic bacteria and improve gut dysbiosis (Correct answer)
- High-protein intake to repair mucosal damage
- Eliminating all animal products to reduce inflammation
Correct answer: Restricting complex carbohydrates to starve pathogenic bacteria and improve gut dysbiosis
SCD restricts disaccharides, polysaccharides, and processed sugars theoretically used by pathogenic bacteria, aiming to restore a healthier gut microbiome composition.
Question 6: IBD patients have a significantly elevated risk of which nutritional deficiency due to cholestyramine use for bile acid diarrhea after ileal resection?
- Iron deficiency
- Fat-soluble vitamin (A, D, E, K) deficiency (Correct answer)
- Calcium deficiency only
- B-complex vitamin deficiency
Correct answer: Fat-soluble vitamin (A, D, E, K) deficiency
Cholestyramine binds bile acids to reduce secretory diarrhea after ileal resection but also binds fat-soluble vitamins (A, D, E, K), requiring supplementation of these vitamins.
IBD IBD Nutrition and Lifestyle 2
Cigarette smoking in Crohn's disease has which effect on disease course compared to UC?