Comparative efficacy of dietary interventions and enteral nutrition in adults with ulcerative colitis: a network meta-analysis.

Objective: To compare the effects of dietary and enteral nutrition interventions on clinical effectiveness, albumin, C reactive protein, and quality of life in adults with ulcerative colitis. Methods: PubMed, Web of Science, Embase, CNKI, SinoMed, and Wanfang were searched from inception to January 2026. Randomized controlled trials evaluating dietary or enteral nutrition interventions in adults with ulcerative colitis were included. Bayesian network meta analysis was performed using odds ratios or mean differences with 95% credible intervals. Risk of bias and confidence in the evidence were assessed using RoB 2 and CINeMA. Results: Fourteen trials involving 1,039 participants and 10 interventions were included. Enteral nutrition was associated with greater clinical effectiveness than a low residue diet (OR 4.80, 95% CrI 1.21-23.52), and the finding remained consistent in sensitivity analyses. Compared with a low residue diet, enteral nutrition, an IgG guided exclusion diet, a low-FODMAP diet, and a regular diet were associated with higher albumin levels. No statistically significant differences were found for quality of life or C-reactive protein. Confidence in all network estimates was low or very low. Conclusion: Enteral nutrition may improve clinical effectiveness compared with a low residue diet, while several interventions may increase albumin levels. However, the limited evidence precludes firm conclusions. Further large and rigorously designed randomized controlled trials are required. Systematic review registration: https://www.crd.york.ac.uk/PROSPERO/view/CRD420251076943.