A nurse is caring for a client who has Crohn's disease. Which of the following food choices would follow the recommended diet for clients who have Crohn's disease?

A. Genetics: A family history of multiple sclerosis (MS) increases susceptibility, indicating a genetic predisposition. Specific human leukocyte antigen (HLA) genes are associated with higher risk, suggesting that inheritance plays a role in disease development, though MS is not strictly hereditary.

B. Environmental factors: Geographic location, low vitamin D levels, and reduced sun exposure have been implicated as environmental contributors to MS. Epidemiologic studies show higher prevalence in temperate regions, supporting the influence of environmental conditions on disease risk.

C. Upper respiratory infections: While infections (specifically viral infections like Epstein-Barr) are being studied as potential triggers that might kickstart the autoimmune response in susceptible people, ordinary bacterial URIs or UTIs are not identified as causes of the development of the disease.

D. Autoimmune factors: MS is widely considered an autoimmune disorder in which the body’s immune system erroneously targets central nervous system myelin. T-cell and B-cell mediated immune responses lead to demyelination and axonal injury, driving the characteristic neurologic deficits.

E. Urinary tract infections: While urinary tract infections are common complications in clients with MS due to neurogenic bladder dysfunction, they are not causative factors in the development of the disease. They exacerbate symptoms but do not contribute to disease onset.

A. Strawberry yogurt: During exacerbations, clients are advised a low-residue, low-fiber diet to reduce bowel stimulation. Strawberry yogurt may contain seeds and fruit pieces that increase mechanical irritation of the intestinal mucosa. Some clients with inflammatory bowel disease experience secondary lactose intolerance, which can worsen diarrhea and cramping.

B. Tossed spinach salad: Raw vegetables such as spinach are high in insoluble fiber, which increases stool bulk and intestinal motility. In Crohn’s disease, especially during active inflammation, high-fiber foods can exacerbate abdominal pain, diarrhea, and cramping. Raw leafy greens may also be difficult to digest when the intestinal mucosa is inflamed.

C. Buttered popcorn: Popcorn is high in insoluble fiber and contains hulls that are poorly digested. These can irritate inflamed intestinal tissue and increase peristalsis, potentially worsening symptoms such as diarrhea and abdominal discomfort. High-residue foods are generally avoided during flare-ups of Crohn’s disease.

D. Grilled chicken: Lean protein sources such as grilled chicken are recommended because they are low in fiber and easier to digest. Adequate protein intake supports tissue repair and helps prevent malnutrition, which is common in Crohn’s disease due to inflammation and decreased intake. Prepared without heavy seasoning or frying, grilled chicken aligns with a low-residue dietary approach.