Introduction

Inflammatory bowel diseases (IBD) are characterized by recurrent flares and periods of remission. Dietary modifications are commonly made by patients with IBD to manage their symptoms. However, there is no single dietary recommendation for all patients with IBD and little is known about the impact of diet on these patients.

Aims & Methods

This study aimed to identify patients' beliefs, attitudes, and behaviors regarding diet in the management of symptoms and flares in patients with IBD, and to assess the impact on their social life.
Methods: This was a cross-sectional, single-center study involving 50 patients with IBD who were followed up in our department. All patients completed a semi-structured questionnaire.

Results

The majority of patients were male (56%) and had Crohn's disease (84%). Four main themes emerged from the analysis: beliefs about the role of diet in disease onset and flares, attempts to control symptoms through diet, changes in appetite during and outside of flares, and the impact of dietary beliefs on social life. Fifty-six percent (n=28) of patients believed that their diet had triggered their disease, while 84% (n=42) believed that diet could trigger flares. Seventy percent of patients identified specific foods as triggers. Participants described a process of trial and error, identifying foods that worsened their symptoms and others that helped them feel better. Twenty-four percent of patients reported that avoiding fiber improved their symptoms during flares. Two patients used diet as their primary treatment for IBD, but 96% of patients considered diet to be complementary to prescribed medication. Eighty-eight percent of respondents reported having received dietary advice at some point. The majority of patients (68%, n = 34) reported that their disease had changed their enjoyment of food. Appetite was lower during flares than during remission. Only 8% of patients followed a normal diet during flares. Dietary beliefs and behaviors had an impact on social life for 56% of patients. Avoiding eating out was reported by 56% of patients and not sharing meals with others was reported by 44% of patients.

Conclusion

Our findings confirm those of previous studies that patients with IBD perceive that certain foods can trigger their disease or symptoms, and dietary control is one of the ways they choose to manage their IBD symptoms. We also noted that patients used a personalized approach to diet, combining experience and knowledge.

Disclosure

No conflict of interest

Introduction

Ultra-processed foods (UPFs) have been linked to inflammatory bowel disease (IBD) incidence and progression(1)

Aims & Methods

We compared UPF and emulsifier intake in patients with IBD and healthy controls (HC) and examined their association with IBD-relevant outcomes.
Dietary intake was calculated from Food Frequency Questionnaires (FFQs) and food logs. Two 24-hour dietary recalls in patients with IBD were compared to two prospective logs from HC from an interventional study. Patients were recruited at the infusion unit and followed up for one year. For cross-sectional analysis, Kruskal Wallis with post-hoc Dunn test and Fisher exact test were used, as appropriate, to compare UPF and emulsifier intake, adjusted for multiple testing using Bonferroni. Kaplan–Meier survival analysis and log-rank tests were used to assess the association between tertiles of UPF and emulsifier intake and the incidence of IBD-related outcomes.

Results

We included 186 subjects (65 HC, 59 Crohn’s disease (CD) and 62 ulcerative colitis (UC)). Median (IQR) age was 26 (23 - 33) years for HCs, and 41 (32 - 51) and 46 (35 - 55) years for CD and UC resp. We included 52 healthy females, and 25 and 24 females in the CD and UC cohort resp.
Assessing food logs, UPF intake was similar in all groups, but emulsifier intakes were higher in IBD compared to HC (Table 1). In both UC and CD, higher intakes of potassium alginate, oat gum, mono- and di-glycerides of fatty acids, as well as carrageenan and xanthan gum were seen, compared to HC. Intake of polyglycerol polyricinoleate was higher in CD compared to HC, while intake of guar gum was higher in UC compared to HC. The proportion of non-consumers of potassium alginate was higher in HC compared to IBD.
Compared to HC, soft drinks, meat, and butter intake was higher in patients with IBD. However, intake of breakfast cereals, legumes, meat substitutes, whole grain pasta and rice, and fiber was lower in UC and CD. Coffee, potato, deli meat, and sodium intake was higher in CD patients than HC, while nut and seed intake was lower. There was no correlation between serum CRP and intake of UPFs, emulsifiers, macronutrients or total energy.
Longitudinal analysis showed a trend towards increased UPF intake and more frequent emergency department (ED) visits (p=0.059) and surgery (p=0.064), but not for IBD-related hospitalization (p>0.1). For increased emulsifier intake, we report a trend towards an increase in IBD-related hospitalisation (p=0.056), but not for ED visits or surgery (p>0.1).

Conclusion

We show higher intakes of emulsifiers in patients with IBD compared to HC, with similar UPF intake. Longitudinal analysis trends towards a link between UPF and emulsifier intake and poorer IBD-related outcomes, emphasizing the need for larger cohorts. The increased intake of specific emulsifiers such as carrageenan and guar gum warrant further investigation into their role in the propagation and maintenance of gut inflammation, as well as their impact on IBD-relevant patient outcomes.

References

(1) Chen J & Wellens J, Kalla R, et al. Intake of Ultra-processed Foods Is Associated with an Increased Risk of Crohn's Disease: A Cross-sectional and Prospective Analysis of 187 154 Participants in the UK Biobank. J Crohns Colitis. 2023 Apr 19;17(4):535-552.

Disclosure

JW reports no conflicts of interest.
MD reports no conflicts of interest.
SH received consultancy fees from Ferring, Takeda.
ML reports no conflicts of interest.
JV received speaker’s fees from Janssen; consultancy fees from Ferring.
EDM reports no conflicts of interest.
EV reports no conflicts of interest.
MF received research grants from AbbVie, EG Pharma, Janssen, Pfizer, Takeda and Viatris; con-sultancy fees from AbbVie, AgomAb Therapeutics, Boehringer Ingelheim, Celgene, Celltrion, Eli Lilly, Janssen-Cilag, Merck Sharp and Dohme, MRM Health, Pfizer, Takeda and ThermoFisher; and speakers’ fees from AbbVie, Biogen, Boehringer Ingelheim, Dr Falk Pharma, Ferring, Janssen-Cilag, Merck Sharp and Dohme, Pfizer, Takeda, Truvion Healthcare and Viatris.
BV reports research support from Sossei Heptares/Nxera and Takeda. In addition, BV reports speaker’s fees from Abbvie, Agomab, Alfasigma, Biogen, Bristol Myers Squibb, Celltrion, Eli Lily, Falk, Ferring, Galapagos, Johnson and Johnson, Pfizer, Sandoz, Takeda, Tillots Pharma, Truvion and Viatris, consultancy fees from Abbvie, Alfasigma, Alimentiv, Anaptys Bio, Applied Strategic, Astrazeneca, Atheneum, BenevolentAI, Biora Therapeutics, Boxer Capital, Bristol Myers Squibb, Domain Therapeutics, Eli Lily, Galapagos, Guidepont, Landos, Merck, Mirador Therapeutics, Mylan, Nxera, Inotrem, Ipsos, Johnson and Johnson, Pfizer, Sandoz, Sanofi, Santa Ana Bio, Sapphire Therapeutics, Sosei Heptares, Takeda, Tillots Pharma and Viatris, and stock options from Vagustim.
SV received financial support for research from AbbVie, J&J, Pfizer, Takeda and Galapagos; receives speakers’ and consultancy fees from AbbVie, Abivax, AbolerlsPharma, AgomAb, Alimentiv, Arena Pharmaceuticals, Astrazeneca, BioraTherapeutics, BMS, Boehringer Ingelheim, Celgene, Cytoki Pharma, Ferring, Galapagos, Genentech Roche, Gilead, GSK, lmidomics, Janssen, J&J, Lilly, Materia Prima, Mestag Therapeutics, Microbiotica, MiroBio, Morphic, MrMHealth, Pfizer, Progenity, Prometheus, Surrozen, Takeda, Theravance, Tillots Pharma AG, VectivBio, Ventyx, Zealand Pharma.
JS received financial support for research from Galapagos and Viatris; receives speakers’ fees from Pfizer, Abbvie, Ferring, Falk, Takeda, Janssen, Fresenius, and Galapagos; and receives consultancy fees from Pfizer, Janssen, Ferring, Fresenius, Abbvie, Galapagos, Celltrion, Pharmacosmos, and Pharmanovia.

Introduction

Anal fissures are painful benign conditions that significantly impact patients' quality of life (QoL).

Aims & Methods

This study aimed to evaluate the QoL of patients with anal fissures and assess the effectiveness of a high-fiber diet in treatment.
A prospective cross-sectional study was conducted over 4 months (September-December 2023) on patients with anal fissures. QoL was assessed using the Hemo/Fiss Burden score and the newly validated REALISE Score. The REALISE Score measures pain severity, post-defecatory pain, analgesic use, bleeding frequency, and impact on QoL.

Results

62 patients were included, with a female predominance (sex ratio: 1/2). The average age was 54.3 years. Both scores revealed significant impairments in QoL across all domains, including physical discomfort, psychological distress, and sexual dysfunction. A strong correlation was found between the Hemo/Fiss and REALISE scores (r: 0.71; p <10-4), indicating the validity of the REALISE Score for QoL assessment.

Conclusion

This study demonstrates the significant impact of anal fissures on QoL and highlights the effectiveness of a high-fiber diet in promoting healing and improving QoL. The REALISE Score offers a valuable tool for assessing the severity of anal fissures and monitoring treatment progress.

Introduction

Modern lifestyles have increased the demand for convenience and extended shelf life, contributing to the rising consumption of ultra-processed foods (UPFs). This trend has been linked to adverse health outcomes, including obesity and inflammatory bowel disease (IBD). IBD encompasses multifactorial digestive disorders characterized by disrupted intestinal homeostasis, resulting in immune dysregulation, impaired nutrient absorption, systemic inflammation, and a marked reduction in quality of life, often associated with chronic fatigue and decreased physical activity. These factors contribute to the activation of muscle protein catabolism and inhibition of skeletal muscle protein synthesis, increasing the risk of sarcopenia in IBD patients.

Aims & Methods

To evaluate ultra-processed food consumption and body composition in patients with IBD. A cross-sectional study was conducted with 105 patients diagnosed with Crohn’s disease or ulcerative colitis at the IBD outpatient clinic of Hospital das Clínicas, Botucatu Medical School (HC-FMB). Assessments included handgrip strength using a dynamometer, bioelectrical impedance analysis, anthropometric measurements, and dietary intake evaluation using a food frequency questionnaire (FFQ).

Results

The sample included 61 patients with ulcerative colitis and 44 with Crohn’s disease, with a mean age of 41.5 ± 15.1 years; 70% were female. Mean disease duration was 11.2 ± 7.6 years. The average BMI was 25.9 ± 5.2 kg/m², with 52.4% classified as overweight. Mean body fat percentage assessed by skinfold measurements was 28.5 ± 7.5%, with 85% exceeding the reference values. Additionally, 18.3% were classified as malnourished based on mid-arm muscle circumference. According to bioelectrical impedance, 86.4% had low muscle mass. Mean handgrip strength was 27.4 ± 8.7 kgf, with 7% presenting inadequate values. Dietary data showed that 22% reported weekly fast food consumption, 30.5% consumed sweets, and 13% drank artificial juices daily. Daily intake of fruits and vegetables was reported by 48% of participants, and 36% reported daily meat consumption.

Conclusion

Patients with IBD are at increased risk of sarcopenia due to inflammatory burden and dietary restrictions. This study identified reduced muscle mass and high intake of certain processed and ultra-processed foods. Regular consumption of UPFs may worsen disease outcomes and negatively affect body composition by increasing fat mass and decreasing muscle mass. Further analyses will explore associations between UPF intake and changes in body composition.

References

• Narula N, Wong ECL, Dehghan M, et al. Association of ultra-processed food intake with risk of inflammatory bowel disease: prospective cohort study. BMJ. 2021;374:n1554.
• Racine A, Carbonnel F, Chan SS, et al. Dietary Patterns and Risk of Inflammatory Bowel Disease in Europe: Results from the EPIC Study. Inflamm Bowel Dis 2016;22:345-54. 10.1097/MIB.0000000000000638
• SUGIHARA, Kohei; KAMADA, Nobuhiko. Diet–microbiota interactions in inflammatory bowel disease. Nutrients, v. 13, n. 5, p. 1533, 2021.
• WANG, Yun et al. Encyclopedia of fecal microbiota transplantation: a review of effectiveness in the treatment of 85 diseases. Chinese Medical Journal, v. 135, n. 16, p. 1927-1939, 2022.
• Whelan K, Bancil AS, Lindsay JO, Chassaing B. Ultra-processed foods and food additives in gut health and disease. Nat Rev Gastroenterol Hepatol. 2024;21(6):406-27.
• World Health Organization (WHO). Prevalence of obesity among adults, BMI (crude estimate). Disponível em: https://www.who.int/data/gho/data/indicators/indicator-details/GHO/prevalence-of-obesity-among-adults-bmi--30-(crude-estimate). Acesso em 28 dez. 2024.
• Meyer A, Dong C, Casagrande C, Chan SSM, Huybrechts I, et al. Food Processing and Risk of Crohn's Disease and Ulcerative Colitis: A European Prospective Cohort Study. Clin Gastroenterol Hepatol. 2023 Jun;21(6):1607-1616.e6.

Introduction

Celiac disease (CD) is an autoimmune disorder triggered by gluten ingestion, leading to intestinal villous atrophy. While a gluten-free diet (GFD) is the mainstay of treatment, some patients exhibit persistent villous atrophy (pVA) on follow-up biopsies. This raises concerns about the long-term health consequences of pVA in CD patients adhering to GFD.

Aims & Methods

Objectives: To evaluate the association between pVA and long-term outcomes in CD patients.

Results

We collected 151 patients with CD. Approximately 24.5% of patients had pVA. Patients with pVA exhibited a significantly higher risk of complications (HR 7.61, 95% CI 3.18 to 17.64, p<0.001). Overall, during follow-up, 9 patients (5.96%) developed a complication (three refractory CD, one B-cell lymphoma, three persistence of malabsorption symptoms and two ulcerative jejuno-ileitis). Over these 9, 7 patients had a pVA.
While most patients adhered to GFD, 35.1% still had persistent VA at follow-up.

Conclusion

This study demonstrates that persistent villous atrophy in CD patients following GFD is associated with increased risk of complications. It also shows the effectiveness of the 5-point scoring system, in stratifying CD patients by risk of pVA. The system accurately identified high-risk patients with a significantly higher prevalence of pVA. It can also help identify these individuals who, despite a lack of current symptoms, may still be at higher risk for future complications so it can be used in clinical practice to personalized follow-up modalities.

References

Rossi A, Lohi J, Mustalahti K, et al. Persistent villous atrophy predicts development of complications and mortality in adult patients with coeliac disease: a multicentre longitudinal cohort study and development of a score to identify high-risk patients [Internet]. BMJ Gut. 2023;72(11):2095-2105. Available from: https://gut.bmj.com/content/72/11/2095

Introduction

Inflammatory Bowel Disease (IBD), encompassing Crohn's Disease (CD) and Ulcerative Colitis (UC), shares chronic and inflammatory characteristics with Non-Alcoholic Fatty Liver Disease (NAFLD). While their precise pathogenesis remains unclear, emerging evidence implicates dysbiosis and metabolic changes. This study aims to investigate the association between IBD and NAFLD, focusing on metabolic syndrome and its nutritional implications

Aims & Methods

Objective: To evaluate the nutritional status and body composition in IBD patients, comparing groups with and without NAFLD, and identifying the associated factors.
Methods: A cross-sectional study was conducted, assessing clinical data, metabolic syndrome presence, nutritional status, and biochemical markers. Patients were categorized into IBD+NAFLD and IBD-only groups based on hepatic ultrasound findings. Statistical analysis included descriptive statistics and logistic regression.

Results

127 patients were included, comprising 58 CD and 69 UC, with a mean age of 45.56 years. Most patients were female and did not engage in physical activity. Patients were mostly in clinical remission and endoscopic activity. 58 patients (45.67%) had hepatic steatosis on ultrasound, forming the IBD+NAFLD group. The IBD+NAFLD group had higher BMI, fat mass, and all circumference values, Table 1, as well as a higher prevalence of hypertension (p=0.0446) and dyslipidemia (p=0.0377). It is noteworthy that, although most of these patients were classified as overweight by BMI, considering anthropometric data, most IBD+NAFLD patients were classified as eutrophic. 86.21% of patients in the IBD+NAFLD group met the criteria for MAFLD. No difference was observed regarding medication in use. Regarding biochemical tests, the IBD+NAFLD group had higher values of hematocrit (p=0.0023), liver enzymes (AST, p=0.0141 and ALT, p<0.0001), fasting glucose (p=0.0107), glycated hemoglobin (p=0.0146), basal insulin (p=0.0003), and triglycerides (p=0.0001), with lower HDL cholesterol (p=0.0101)

Conclusion

The study highlights a significant association between nutritional status and NAFLD in IBD patients. Those categorized as eutrophic had a higher prevalence of hepatic steatosis, potentially linked to dietary factors.

References

Vernon G, Baranova A, Younossi ZM. Systematic review: the epidemiology and
natural history of non‐alcoholic fatty liver disease and non‐alcoholic
steatohepatitis in adults. Alimentary pharmacology & therapeutics.
2011;34(3):274-285./ Silva A.F; Schieferdecker M.H; Amarante M. B. Ingestão alimentar em pacientes
com doença inflamatória intestinal ABCD, arq. bras. cir. dig. 24 (3) • Set 2011/ Rinella ME. Nonalcoholic fatty liver disease: a systematic review. JAMA.
2015;313(22):2263-73