Inflammatory bowel diseases (IBD) are currently a significant health problem affecting an increasing number of people worldwide. These are chronic diseases of the digestive tract that significantly affect the quality of life of patients. The most common forms of IBD include Crohn's disease and ulcerative colitis. Although these diseases differ in the location and extent of involvement of the digestive tract, they are united by chronic inflammation and the need for long-term treatment (Danese, Fiocchi, 2011).
In recent decades, there has been an increase in the incidence of IBD, especially in developed countries, while the incidence is also gradually increasing in regions where these diseases were once rare. This trend points to the importance of environmental and life factors that participate in their origin and course. In addition to genetic predisposition and disorders of immune regulation, more and more attention is being paid to lifestyle, especially eating habits (Kaplan, Windsor, 2021).
Nutrition is one of the key modifiable factors that can affect not only the risk of developing these diseases, but also their course and response to treatment. The modern way of eating, characterized by a higher intake of industrially processed foods, simple sugars and saturated fats, is often associated with changes in the intestinal microbiota and with an increased inflammatory response of the body. On the other hand, a diet rich in fiber, plant components and naturally occurring bioactive substances can be protective and promote intestinal balance (Hou et al., 2011).
Patients with IBD often themselves perceive a connection between diet and worsening of symptoms, which most often include abdominal pain, diarrhea, bloating, or fatigue. For this reason, adjusting the diet is the first step to improving health. Despite this, for a long time there was a lack of clear and scientifically based recommendations regarding specific dietary procedures. In recent years, the situation has changed, and today there is an increase in the number of studies that examine the influence of individual nutrients, food groups, or specific dietary regimens on disease activity, inflammatory markers, and patients' quality of life (Lewis, Abreu, 2017).
Today, nutrition is no longer perceived as just a supporting element of treatment, but as a potential tool that can complement pharmacotherapy and, in some cases, significantly influence the course of the disease. Elimination diets, specific nutritional protocols, or enteral nutrition, which are gradually becoming the subject of clinical research, deserve special attention (Bischoff et al., 2020).
This paper aims to analyze the available scientific literature in order to provide a comprehensive view of the role of nutrition in the context of IBD and to identify areas that require further research.
Methodology
The presented work was processed in the form of a scoping review with the aim of systematically mapping and summarizing the available scientific knowledge about the role of nutrition and dietary factors in the prevention and management of IBD. The methodological procedure was based on the principles of conducting a scoping review and on the recommendations of PRISMA-ScR (Preferred Reporting Items for Systematic Reviews and Meta-Analyses – extension for Scoping Reviews), which are intended for transparent and systematic processing of this type of review work.
The literature search was carried out in the international databases PubMed, Scopus, Web of Science and Google Scholar. In addition, the resources of relevant international organizations were also used, especially WHO, OECD and the European Union, primarily to obtain epidemiological data and a broader context of the issue. The search used combinations of keywords in the English language, with the basis of the terms "inflammatory bowel disease," "Crohn's disease," "ulcerative colitis" combined with the terms "nutrition," "diet," "dietary factors," "prevention," "management," "therapy," and "microbiome." Keywords were combined with each other using logical operators (and, or) in order to refine and expand the search for relevant studies. The search was limited to articles published in the English language.
The review included original scientific studies, including randomized controlled trials, cohort and observational studies, as well as systematic reviews and meta-analyses published in peer-reviewed scientific journals. The main inclusion criterion was thematic relevance, i.e. focusing on the relationship between nutrition, specific dietary factors or nutritional interventions and the risk of developing IBD. Case reports, abstracts without available full text, works not directly related to nutrition (for example, exclusively pharmacologically oriented studies) and studies published before 2005 were excluded from the analysis, with the exception of significant review articles providing a fundamental theoretical framework.
The process of selecting studies took place in several steps. First, relevant records were identified based on title and abstract. Subsequently, potentially suitable articles were subjected to full-text analysis. Duplications were removed and the final set of included studies was thematically divided by focus, for example, into studies evaluating risk and protective dietary factors, the impact of specific dietary regimens, as well as the importance of nutritional interventions in the clinical management of the disease. The results of individual works were subsequently synthesized and processed in the form of a narrative review.
Characteristics and definition of inflammatory bowel diseases
IBDs represent a group of chronic, recurrent inflammatory conditions of the digestive tract, which significantly affect the quality of life of patients and represent a growing health problem throughout the world. IBD most often begins in young adulthood, although it can also develop in childhood or old age, and is typically characterized by alternating periods of active disease and relative remission. This heterogeneous disease is accompanied by symptoms such as diarrhea, abdominal pain, bleeding, or fatigue and often requires long-term multidisciplinary care. Epidemiological data show an increase in the incidence and prevalence of IBD, especially in industrialized countries, which underlines the importance of identifying environmental factors, including nutrition, that can influence the onset and course of these diseases (Wehkamp et al., 2016).
Main forms of inflammatory bowel diseases
In the literature, two main forms of IBD are most often distinguished - Crohn's disease (CD) and ulcerative colitis (UC), which differ not only in the location and extent of inflammation, but also in clinical manifestations, histopathological features and response to treatment. In the following text, various definitions and characteristics of these diseases are presented according to literary sources, creating a solid theoretical framework for analyzing the role of nutrition and dietary factors in their prevention and management (Mayo Clinic, 2025).
IBD are chronic, recurring inflammatory conditions of the digestive tract, which arise from a complex interaction of genetic predispositions, dysregulation of the immune response, and environmental factors, including altered gut microbiota. IBD can be defined as a heterogeneous group of immune-mediated diseases affecting the gastrointestinal tract, characterized by chronic inflammation and the need for lifelong treatment with a significant impact on patients' quality of life (Mentella et al., 2020). According to available professional and clinical sources, the term IBD is used as an umbrella term for two main disease forms – CD and UC, which differ in the localization of inflammation and its morphology, but share the phenomenon of chronic intestinal inflammation with remissions and relapses (Wehkamp et al., 2016).
Crohn's disease
CD represents one of the main forms of IBD and is characterized by chronic, immune-mediated inflammation that can affect any part of the gastrointestinal tract from the oral cavity to the perianal region. Torres et al. (2017) state that a typical sign of the disease is transmural inflammation affecting all layers of the intestinal wall, while the involvement is segmental and interrupted by healthy sections of the intestine. This nature of inflammation is associated with an increased risk of complications such as strictures, fistulas and abscesses. Similarly, Kaplan (2015) emphasizes that the pathogenesis of CD involves a dysregulated immune response to the gut microbiota in genetically predisposed individuals, resulting in chronic inflammation and progressive damage to the gut wall.
Ulcerative Colitis
UC is a chronic inflammatory disease belonging to the IBD group, which is limited to the colon and rectum. A characteristic feature of the disease is continuous mucosal inflammation, which typically begins in the rectal area and can spread proximally to various parts of the colon. In contrast to CD, the inflammation in UC is primarily limited to the mucosa and submucosa and does not have a segmental character. It is important to emphasize that UC is an immune-mediated disease with a relapsing course in which there is a dysregulation of the immune response to intestinal antigens, leading to chronic inflammation of the colonic mucosa. Clinically, the disease is most often manifested by bloody diarrhea, tenesmus, abdominal pain and, in more severe cases, systemic symptoms (Ungaro et al., 2017). Similarly, Ordás et al. (2012) emphasize that UC is the result of a complex interaction of genetic predispositions, environmental factors and a dysregulated mucosal immune response. Chronic inflammation leads to ulceration of the mucosa, loss of the barrier function of the intestinal epithelium and an increased risk of complications, including colorectal cancer, in the long-term duration of the disease.
Epidemiology of inflammatory bowel diseases
Both UC and CD share a chronic, recurrent course and represent a growing burden on the health care system in the population. In recent years, in addition to genetic and immunological mechanisms, the role of environmental factors, including nutrition and the overall dietary pattern, has been emphasized more and more intensively. Epidemiological data show that IBD is no longer a "rare" disease. In many countries of North America, Oceania and Europe, the prevalence exceeds 0.3% of the population, while the number of patients in these regions is also accumulating due to long-term survival with the disease (Ng et al., 2017). In a broader review, the Global Burden of Disease analysis published in BMJ Open reports an increase in global cases of IBD from approximately 3.32 million (in 1990) to 4.90 million (in 2019), underscoring the continuous growth of the disease burden over time (Wang et al., 2023). Kaplan (2015) already pointed out that IBD affects more than 1 million people in the USA and approximately 2.5 million in Europe, while a significant part of patients is diagnosed at a young age, which has long-term medical and socioeconomic consequences.
The relationship between nutrition and the risk of inflammatory bowel diseases
From the point of view of the development of the disease, it is important that the trend of increasing incidence is not limited to traditionally "high-incidence" regions. Current pooled data analyzes suggest that while prevalence continues to increase steadily in earlier industrialized areas, incidence is also increasing in more recently industrialized and developing regions in the 21st century. This trend supports the assumption that changes in lifestyle and dietary habits play a significant role (Hracs et al., 2025). That is why in the current literature, nutrition is perceived not only as a factor that can influence symptoms, but also as a potential determinant of the risk of developing IBD.
In the field of dietary factors, the so-called "Western" dietary pattern (higher intake of refined carbohydrates, saturated fat, processed and ultra-processed foods) contrasted with a diet richer in minimally processed foods, plant-based ingredients and fiber. Reviews and meta-analyses indicate that the relationships between individual foods and IBD may be heterogeneous, but there are consistent signals that processed/highly processed foods are associated with adverse outcomes in at least some subtypes of IBD (Meyer et al., 2025). For example, a review focusing on ultra-processed foods summarizes data from large cohort studies, where the highest intake of ultra-processed foods was associated with an approximately two-fold risk of CD (UK Biobank; HR ~2.0), while for UC the association was less consistent (Choi, Moon, 2025). At the same time, there are cohort data suggesting that lower adherence to a Mediterranean dietary pattern may be associated with a higher risk of later CD (Khalili et al., 2020).
The included prospective cohort studies and meta-analyses suggest that nutrition and dietary patterns are associated with the risk of developing IBD, with some associations being more consistent for CD than for UC. Among the biggest findings is the relationship between fiber intake and CD risk. In the long-term cohorts of the Nurses' Health Study (NHS), Ananthakrishnan et al. (2013) reported that women in the highest quintile of fiber intake had a lower risk of CD incidence compared to the lowest quintile (HR 0.59; 95% CI 0.39–0.90), with the protective effect being strongest for fiber from fruit. For UC, a significant association was not confirmed in the same analysis (HR 0.82; 95% CI 0.58–1.17), supporting the interpretation that preventive indications may differ between IBD subtypes.
A very current and practically relevant finding is the relationship between highly processed foods (UPF) and the risk of IBD. In the prospective PURE cohort, Narula et al. (2021) reported IBD emergencies during a median follow-up of approximately 9.7 years and demonstrated that, compared with intake of <1 serving of UPF/day, intake of 1–4 servings/day was associated with an increased risk of IBD emergencies (HR 1.67; 95% CI 1.18–2.37) and intake of ≥5 servings/day with an even higher risk (HR 1.82; 95% CI 1.22–2.72; p-trend = 0.006). From the point of view of the interpretation of the results, it is important that the associations were observed with several UPF groups (e.g. sweetened drinks, sweets, salty snacks, processed meat), which supports the hypothesis that the risk may be related to a wider set of UPF characteristics (additives, emulsifiers, high energy density, low fiber content, etc.).
Within specific nutrients, the topic of n-6 polyunsaturated fatty acids, especially linoleic acid, appears repeatedly in the literature in relation to UC. In an analysis within EPIC (European Prospective Investigation into Cancer and Nutrition) Tjonneland et al. (2009) reported that the highest quartile of linoleic acid intake was associated with a higher risk of UC (OR 2.49; 95% CI 1.23–5.07; p = 0.01), with the trend being significant across quartiles (OR 1.32 per quartile; 95% CI 1.04–1.66).
The Mediterranean diet is also considered a potentially protective formula. Khalili et al. (2020) reported in a prospective analysis that higher adherence to the modified Mediterranean score was associated with a lower risk of later CD (HR 0.42; 95% CI 0.22–0.80), whereas for UC the effect was not confirmed (HR 1.08; 95% CI 0.74–1.58). An overview of selected studies evaluating the relationship between nutritional factors and the risk of IBD is presented in Tab. 1.
Tab. 1 Prevention of IBD
Source: Own processing (CD - Crohn's disease; UC - ulcerative colitis; IBD - inflammatory bowel disease; HR - hazard ratio; OR - odds ratio; RR - relative risk; CI - confidence interval; NHS - Nurses' Health Study; PURE - Prospective Urban Rural Epidemiology); EPIC - European Prospective Study on Nutrition and cancer (European Prospective Investigation into Cancer and Nutrition)
An additional line of evidence is the relationship between vitamin D (or predicted levels of 25-hydroxyvitamin D [25(OH)D]) and the risk of IBD. Ananthakrishnan et al. (2012) reported that the highest quartile of predicted 25(OH)D was associated with a lower risk of incident CD (HR 0.54; 95% CI 0.30–0.99; p-trend = 0.02), while for UC the direction of effect was similar but not statistically significant.
Furthermore, meta-analytic syntheses show that higher sugar intake may be associated with an increased risk of IBD. In a systematic review and meta-analysis, Khademi et al. (2021) higher sugar intake was associated with an increased risk of both UC (RR 1.59; 95% CI 1.15–2.20) and CD (RR 1.90; 95% CI 1.06–3.41).
fig. 1 shows a comparison of the relative risk (HR, RR, OR) of selected dietary factors in relation to the development of inflammatory bowel diseases. A value of 1 represents a reference level with no association with disease risk.
Fig. 1 Comparison of the relative risk (HR/RR/OR) of selected dietary factors in the development of IBD
Source: Own processing (IBD – inflammatory bowel disease; CD – Crohn's disease; UC – ulcerative colitis; HR – hazard ratio; RR – relative risk; OR – odds ratio; UPF – highly industrially processed food (ultra-processed food))
The most significant protective effect was observed with higher adherence to the Mediterranean diet (HR 0.42) and higher fiber intake (HR 0.59), suggesting a potential protective effect of these dietary factors especially in CD. On the contrary, the highest relative risk was recorded for increased intake of linoleic acid (OR 2.49) and highly industrialized foods (HR 1.82), which points to possible negative effects of the Western dietary pattern. These data support the hypothesis that diet quality can significantly influence the likelihood of developing IBD (Tjonneland et al., 2009; Ananthakrishnan et al., 2013; Khalili et al., 2020; Narula et al., 2021).
Nutrition and dietetic approaches in the management of inflammatory bowel diseases
In the management of IBD, the most evidence concerns CD, especially in pediatric patients, where enteral nutrition and, in recent years, structured elimination protocols have a strong place. Crohn's Disease Exclusion Diet (CDED) in combination with partial enteral nutrition (PEN) has received significant attention. In a randomized trial, Levine et al. (2019) achieved corticosteroid-free remission at 6 weeks in 75% of children (30/40) treated with a combination of CDED and PEN compared to 59% of children (20/34) on exclusively enteral nutrition (EEN). At week 12, the proportion of patients in remission was higher in the group treated with CDED combined with PEN (75.6%; 28/37) compared to the group of patients who switched to PEN after EEN (45.1%; 14/31), the difference being statistically significant (p = 0.01; OR 3.77; 95% CI 1.34–10.59).
In adults with CD, the feasibility and comparative effectiveness of more common healthy eating patterns compared to strict elimination regimens is also addressed. In the DINE-CD randomized clinical trial, Lewis et al. (2021) compared the Mediterranean diet (MD) and the Specific Carbohydrate Diet (SCD) and found that at week 6, symptomatic remission did not differ (43.5% MD vs. 46.5% SCD; p = 0.77), suggesting that the SCD was not more effective than the Mediterranean dietary pattern, at least in the short term from the point of view symptoms. An overview of intervention studies evaluating the impact of different dietary approaches on the course and management of IBD is presented in Tab. 2.
Tab. 2 Management of IBD
Source: Own processing (CD - Crohn's disease, UC - ulcerative colitis, IBD - inflammatory bowel disease, CDED - diet for Crohn's disease, PEN - partial enteral nutrition, MD - Mediterranean diet, SCD - specific carbohydrate diet, Low-FODMAP - diet with a low content of fermentable oligo-, di- and monosaccharides and polyols, FC - fecal calprotectin, OR - odds ratio chances, p – value of statistical significance, μg/g – microgram per gram)
A diet low in fermentable oligo-, di- and monosaccharides and polyols has been used as a symptomatic intervention in patients with IBD in remission who have persistent functional gastrointestinal complaints. In a randomized trial, Cox et al. (2020) after 4 weeks, 52% (14/27) of patients in the low-FODMAP diet group reported adequate relief compared to 16% (4/25) in the control diet (p = 0.007). At the same time, 33% (9/27) achieved a ≥50% reduction in the Irritable Bowel Syndrome Symptom Severity Rating System (IBS-SSS) score compared to 4% (1/25) in the control group (p = 0.012). Biomarkers of inflammation did not change significantly, which supports the interpretation that the low-FODMAP diet aims primarily at alleviating symptoms and not at the inflammatory activity itself.
In UC, there is increasing evidence that quality dietary patterns may also be related to subclinical markers of inflammation. In a randomized controlled trial, Haskey et al. (2023) after 12 weeks, the Mediterranean diet group had a lower proportion of patients with faecal calprotectin (FC) >100 μg/g (20%; 3/15) compared to a control group that continued a normal diet without specific dietary recommendations (75%; 9/12).
Overall, the available evidence suggests that nutrition plays a significant role in both the pathogenesis and clinical course of IBD, with associations appearing to be more pronounced in CD than in UC. Prospective cohort studies show a protective effect of fiber and the Mediterranean diet, while high consumption of highly processed foods and simple sugars is associated with an increased risk of developing the disease. At the same time, interventional studies show that specific dietary therapy protocols can promote the induction of remission or alleviate symptoms, although the effectiveness varies according to the type of disease, the age of the patient and the nature of the intervention (Lewis, Abreu, 2017).
These findings support the concept that nutrition represents not only a modifiable risk factor, but also a potential therapeutic tool in the comprehensive management of IBD. fig. 2 shows the percentage success rate of selected dietary interventions in the management of inflammatory bowel diseases.
Fig. 2 Percentage success rate of selected dietary interventions (remission / relief of symptoms)
Source: Own processing (IBD - inflammatory bowel diseases; CD - Crohn's disease; CDED - Crohn's Disease Exclusion Diet; PEN - partial enteral nutrition; EEN - exclusive enteral nutrition; SCD - specific carbohydrate diet; Low-FODMAP - diet with a low content of fermentable oligo-, di- and monosaccharides and polyols)
The highest remission rate was observed with Crohn's Disease Exclusion Diet combined with partial enteral nutrition (75.6%), indicating a potentially significant therapeutic effect of this intervention in CD. Exclusively enteral nutrition achieved a lower remission rate (45.1%), suggesting a difference in long-term efficacy between individual nutritional approaches. In adult CD patients, symptomatic remission was comparable between the Mediterranean diet (43.5%) and the specific carbohydrate diet (46.5%), which may indicate the absence of greater efficacy of highly restrictive dietary regimens. A diet low in fermentable oligosaccharides, disaccharides, monosaccharides, and polyols (FODMAPs) led to symptom relief in 52% of patients, but its effect was primarily related to symptomatic control, not objective markers of inflammation (Levine et al., 2019; Cox et al., 2020; Lewis et al., 2021).
Importance of nutrition in the prevention and management of inflammatory bowel diseases
The results of this work indicate that nutrition can significantly influence the risk of developing and the clinical course of IBD, while the degree of observed associations varies significantly between individual factors. The protective effect of fiber in CD reported by Ananthakrishnan et al. (2013), represents an approximately 41% risk reduction (HR 0.59; 95% CI 0.39–0.90), which is an epidemiologically clinically significant effect. The fact that a similar association was not confirmed in UC (HR 0.82; 95% CI 0.58–1.17) points to possible differences in the pathophysiology of both diseases. This difference is also supported by the analysis of Khalili et al. (2020), where higher adherence to a Mediterranean diet reduced the risk of CD by 58% (HR 0.42; 95% CI 0.22–0.80), while no significant effect was observed for UC (HR 1.08; 95% CI 0.74–1.58).
On the other hand, consumption of ultra-processed foods showed a consistent increased risk of IBD. Narula et al. (2021) reported that intake of ≥5 servings per day was associated with an 82% higher risk of developing IBD (HR 1.82; 95% CI 1.22–2.72). From an epidemiological point of view, this is a relatively strong association that is comparable to other established environmental risk factors for chronic diseases. Similarly, Tjonneland et al. (2009) noted a more than two-fold risk of UC in the highest quartile of linoleic acid intake (OR 2.49; 95% CI 1.23–5.07). Such effect sizes go beyond weak associations in nutritional epidemiology and suggest potential biological significance.
A meta-analysis by Khademi et al. (2021) supports these findings in that higher sugar intake was associated with an increased risk of both CD (RR 1.90; 95% CI 1.06–3.41) and UC (RR 1.59; 95% CI 1.15–2.20). Although these are observational data, a relative risk close to 2.0 represents a significant population impact, especially if exposure is common in the population.
In the field of IBD management, intervention studies provide more reliable evidence. A randomized controlled trial by Levine et al. (2019) showed a higher rate of corticosteroid-free remission in CDED and PEN (75.6%) compared to the control group (45.1%), with an odds ratio of 3.77 (95% CI 1.34–10.59) indicating a significant therapeutic effect. Such high ORs are considered significant in clinical gastroenterology and support the clinical implementation of this intervention, especially in the pediatric population.
In contrast, the DINE-CD study (Lewis et al., 2021) showed no difference between a Mediterranean diet and a specific carbohydrate diet (43.5% vs. 46.5% symptomatic remission; P = 0.77), suggesting that strict elimination regimens may not provide additional benefit over a balanced, less restrictive eating pattern. This finding has significant practical implications in terms of long-term adherence and quality of life of patients.
FODMAP diet according to Cox et al. (2020) resulted in adequate symptom relief in 52% of patients versus 16% in the control group (P = 0.007), but without a significant decrease in inflammatory markers. This supports the concept that some dietary interventions act primarily symptomatically, while others may influence inflammatory activity itself.
From a methodological point of view, it should be emphasized that most data on prevention come from observational cohort studies, where residual bias caused by unaccounted factors or inaccuracies in recording food intake cannot be excluded. Interventional studies are often short-term and involve relatively small sets of patients. Nevertheless, effect sizes – especially HRs below 0.6 or ORs above 2.0 – suggest that the observed associations may be of clinical significance.
Taken together, these data support the concept that nutrition represents a relevant modifiable factor in both the prevention and management of IBD, with the strongest evidence existing for CD. Future research should focus on long-term randomized trials, which will enable more precise quantification of the effect of individual dietary patterns and identify patients who can benefit the most from diet therapy.
Conclusion
The aim of this work was to evaluate the role of nutrition and dietary factors in the prevention and management of inflammatory bowel diseases based on the available scientific evidence. The results indicate that nutrition is an important modifiable factor that can influence the risk of developing the disease as well as its clinical course. In the field of prevention, dietary patterns characterized by a higher intake of fiber, fruit, vegetables and an overall higher adherence to the Mediterranean diet appear to be protective, especially in relation to CD. Conversely, an increased intake of highly processed foods, simple sugars, and some fat components is associated with an increased risk of IBD. These findings support the hypothesis that the Western dietary pattern may represent an important environmental factor contributing to the increased incidence of the disease.
In the management of IBD, interventional studies provide evidence that specific dietary therapeutic approaches can promote remission induction or alleviate disease symptoms. The most pronounced effect was noted with selective elimination protocols in combination with enteral nutrition in patients with CD. Less restrictive dietary patterns, such as the Mediterranean diet, show comparable efficacy in symptomatic control and represent a potentially more sustainable approach in long-term management.
Despite the growing body of evidence, it is important to consider that most prevention data come from observational studies and intervention research is often time-limited. Future research should focus on long-term randomized trials and on identifying patient groups that may benefit most from individualized nutritional intervention.
In conclusion, it can therefore be concluded that nutrition should be seen as an integral part of the comprehensive management of patients with IBD and as a potential prevention tool in at-risk populations. The integration of nutritional recommendations into clinical practice can contribute to the improvement of clinical results and, last but not least, the quality of life of patients.
Authors: Mgr. Ján Roman, Institute of Public Health and Hygiene, UPJŠ Faculty of Medicine, Košice prof. Mgr. MUDr. Erik Dorko, PhD., MPH, MBA, Institute of Public Health and Hygiene, UPJŠ Faculty of Medicine, Košice Mgr. Anastasiia Ostafiichuk, Institute of Public Health and Hygiene, UPJŠ Faculty of Medicine, Košice prof. MUDr. Kvetoslava Rimárová, CSc., Institute of Public Health and Hygiene, UPJŠ Faculty of Medicine, Košice *** doc. MUDr. Laura Gombošová, PhD., *II. internal clinic UPJŠ LF and UNLP, Košice
Work supported by KEGA grant projects of the Ministry of Education, Research, Development and Youth of the Slovak Republic no. 001UPJŠ-4/2024 and no. 003UPJŠ-4/2024.
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