Abstract
BACKGROUND: A relationship between ulcerative colitis and diet has been shown in epidemiological and experimental studies. AIMS: To investigate the effectiveness of an anti-inflammatory diet for maintenance of remission in UC patients. METHODS: In this 6-month randomized control trial, adult UC patients in clinical remission (partial Mayo score<3) who had a disease relapse within the previous 18 months were randomized to either an “Anti-inflammatory Diet (AID)” or “Canada’s Food Guide (CFG)” as the control group.A dietitian provided dietary recommendations to all patients in four face-to-face (baseline, month 1, 3, and 6) and three telephone (month 2,4,5) sessions. Menu plans provided to patients in the AID group were designed to increase dietary intake of fiber, prebiotics, probiotics, anti-oxidants, omega-3 fatty acids and to decrease dietary intake of red or processed meat, added sugar and alcohol. To assess clinical relapse, partial Mayo scoring was done monthly. Monthly 24h dietary recalls were used to assess adherence to the diets. At baseline and month 6 or relapse, fecal calprotectin (FCP), serum CRP, and quality of life were assessed. Metabolomic analysis was performed on urine (GC-MS, DI- LC MS/MS), serum (NMR, DI-LC MS/MS) and stool (NMR) samples collected at baseline and month 6 or relapse. RESULTS: Fifty-three patients were randomized to the two diet groups. The mean age of participants was 41.4 ± 14.7 y and 34 (64.2%) subjects were female. Five(19.2%) patients in the AID and 8(29.6%) patients in the control group relapsed during the trial (P=0.38). Patients following CFG had a statistically significant increase in FCP from baseline to month6/relapse, while patients following the AID showed no significant increase in their FCP over the 6 months (Figure1A). At baseline, the metabolomic profiles of patients randomized to the two groups were similar. However, at 6 months/relapse, the two groups had separated (Figure1B). In comparison to CFG group, patients in the AID group had higher glutamic acid(stool), creatinine (stool), and carnosine (urine) but lower 3-(3-hydroxyphenyl)-3-hydroxypropionic acid (urine), hydroxymandelic acid (urine), phosphatidylcholines (serum), acetone (stool), and Sumiki’s acid (urine). In comparison to the CFG group, patients in the AID group had a significant increase in dietary intake of some nutrients including zinc, selenium and phosphorus from baseline to month 6 or relapse. CONCLUSIONS: Modification of diet towards an inclusion of anti-inflammatory and reduction of inflammatory foods alters host and microbial metabolic pathways and can help prevent increases in colonic inflammation in UC patients in remission. FUNDING AGENCIES: Alberta Innovates Health Solutions