Abstract Background The prevalence of Inflammatory bowel disease (IBD) continues to increase steadily in Western countries, paralleled by Westernization of lifestyle.1 The etiology of IBD is a not fully understood interaction of multiple factors including genetics, immune system, microbial and environmental factors such as diet. Diet is thought to play a pivotal role in intestinal inflammation due to a complex interplay between a patient’s diet and its regulatory effects on the microbiota, the gut immune system and epithelial barrier function. By increased intake of calories derived from polyunsaturated fatty acids, digestible carbohydrates, animal protein and food additives, Western diet appears to promote intestinal inflammation in genetically susceptible individuals.2 Methods A cross-sectional study was conducted. Patients undergoing ambulatory treatment at a day care IBD unit were consecutively recruited. A self-applied semiquantitative food frequency questionnaire, validated for the adult Portuguese population was applied.3,4 The primary outcome was to assess the association between macronutrients consumption (carbohydrates, free sugars and complex carbs, fats and proteins) and disease activity defined by clinical and biological activity markers in a real-life setting. Clinical activity was assessed using the PMS for UC and the HBI for CD, and biological activity was evaluated via fecal calprotectin and C-reactive protein. Patients were considered in remission if PMS≤2 or HBI≤4, fecal calprotectin was 250µg/g, and C-reactive protein 0.5mg/L. Results A total of 89 IBD patients (55 CD, 28 in remission and 27 with active disease; 34 UC, 16 in remission and 18 active) were included. Baseline characteristics are described at table 1. Trans-fatty acid consumption was significantly higher in CD patients than in UC (0.8±0.7 vs 0.6±0.6, p = 0.042), specially in patients with active disease (0.8±0.8 vs 0.5±0.6). No differences in other macronutrients intake were identified between patients with CD vs UC, nor remission vs active disease. In patients with active UC there was a correlation between higher calprotectin levels and higher median consumption of n-6 PUFA (p = 0.031, R 0.509) and saturated fatty acids (p = 0.042, R = 0.483). MUFAs intake was also associated with higher calprotectin levels in UC (active p = 0.031, R = 0.509 and remission p = 0.046, R = 0.505) and active CD (p = 0.022, R = 0.438). PCR is positively correlated with saturated fatty acids and MUFAs in active CD patients. Conclusion Higher intake of n-6 PUFA, saturated fats, and MUFAs may promote inflammation and trigger flares in IBD. Fat quality appears more important than quantity, and effects may vary with disease activity. Further studies are needed to clarify diet’s role in IBD management. References: 1. Kaplan, G.G., Windsor, J.W. The four epidemiological stages in the global evolution of inflammatory bowel disease. Nat Rev Gastroenterol Hepatol 18, 56–66 (2021). 2. Adolph TE, Zhang J. Diet fuelling inflammatory bowel diseases: preclinical and clinical concepts. Gut. 2022 Dec;71(12):2574-2586. 3. Lopes C. Reprodutibilidade e Validação de um questionário semi-quantitativo de frequência alimentar. In: Alimentação e enfarte agudo do miocárdio: um estudo caso-controlo de base populacional. Tese de Doutoramento. Universidade do Porto 2000. p.79-115. 4. Lopes C, Aro A, Azevedo A, Ramos E, Barros H. Intake and adipose tissue composition of fatty acids and risk of myocardial infarction in a male Portuguese community sample. J Am Diet Assoc 2007; 107:276-286. Conflict of interest: Ms. Soares, Caroline: No conflicts Domingues, Ângela: No conflict of interest Gomes, Rute: None. Silva, Gonçalo: No conflict of interest Martins, Diana: No conflict of interest Sousa, Paula Cristina: Receipt of honoraria or consultation fees: Celltrion Participation in a company sponsored speaker’s bureau: Johnson & Johnson Support for attending meetings: Johnson & Johnson Dr. Falk Norgine Pfizer Abbvie. Cancela, Eugénia Maria: I haveńt conflits of interest Marques, Isabel: No conflict of interest Silva, Américo: No conflict of interest Ministro, Paula: I declare that I have served as a speaker and received honoraria from Ferring, Falk, MSD, Johnson and Johnson, AbbVie, Lilly, Celltrion, Takeda and Tillotts.
Soares et al. (Thu,) studied this question.