Abstract Background Microbiome modifying treatments show potential in favourably influencing outcomes of patients with mild-moderate Ulcerative Colitis (UC). In a proof-of-concept study, we tested the gastrointestinal tolerability of a novel, “eubiotic” diet (UC-TREAT), and assessed its effects on the gut microbiome and short chain fatty acid (SCFA) production in individuals with UC and healthy controls (HC). Methods In a controlled prospective trial, 36 adults (18 HC and 18 with quiescent UC, defined as SCCAI ≤5) underwent a 10-day “run-in” phase, followed by a 5-day introductory “ramping” phase, and a 10-day “full” dietary intervention with UC-TREAT. UC-TREAT is rich in fermentable carbohydrates (providing 35g/day fibre in addition to habitual intake), and includes daily consumption of 5 different fermented foods, 2 types of berries, and a multivitamin supplement. Faecal samples were collected before and after each study phase, in which microbiome (16S rRNA), bacterial load (quantitative PCR), SCFA (GC-FID) and faecal calprotectin (FCAL) were assessed. Gastrointestinal tolerance (GSRS-IBS), disease activity (SCCAI) and dietary intake were assessed throughout the study. Results Fibre intake doubled during UC-TREAT (9.8 vs 20.8g/1000kcal/day, p 0.001) and fermented food consumption increased by 4.3 portions/d (p 0.001) in all participants. In both participant groups, an increase was observed in faecal acetate median (Q1:Q3) µmol/g: UC: +11.1 (-3.73, 21.5); HC: +15.2 (-0.57, 36.6), both p 0.01, total SCFA UC: +11.6 (2.38, 22.1) µmol/g, p = 0.006; HC: +23.1 (-0.76, 53.2), p = 0.015, and bacterial load log10 16S rRNA gene copies/g, UC: +0.07 (0, 0.22), p = 0.03; HC: +0.06 (-0.04, 0.14), p = 0.07. Butyrate also increased in UC participants +2.79 (-0.75, 4.88) µmol/g, p = 0.03). UC participants reported a short-term increase in bloating [median score: +2 (0, 4.3), p = 0.012, while HC reported prolonged bloating +2.5 (1, 3), p = 0.001 and a transient rise in constipation +1 (0, 3), p = 0.03 and satiety 0 (0, 1), p = 0.03. Disease activity score increased 0 (0, 1), p = 0.012, while all UC participants remained in clinical remission and FCAL remained unchanged in UC, but decreased in HC -3.15 (-10.3, 0.71) mg/kg, p = 0.02. Microbiome composition changed in UC patients (R2=1.2% p 0.01), but not in HC; Abundance of Streptococcus, and Anaerostipes hadrus, a butyrate producer, increased in UC (p 0.001). Conclusion UC-TREAT increased fibre-originating faecal SCFA, bacterial load, and SCFA-producing taxa, without negatively affecting FCAL or GI tolerance in quiescent UC. These proof-of-concept results should be replicated in a larger, well-controlled RCT. Conflict of interest: Ms. Mckirdy, Shona: No conflict of interest Gaya, Daniel: No conflict of interest Russell, Richard K.: Grant: Nestec Other: Abbvie, Celltrion, Janssen, Lilly, Nestle, Pharmacosmos, Pfizer Hansen, Richard: Personal Fees: Dr Hansen has received consultancy fees and travel support from 4D pharma. Macdonald, Jonathan: No conflict of interest Seenan, John Paul: No conflict of interest Nichols, Ben: No conflict of interest Koutsos, Athanasios: No conflict of interest Gerasimidis, Konstantinos: Grant: Nestle Health Science, Nutricia-Danone, Mylan Personal Fees: Abbott, Baxter, Nestle Health Science, Nutricia-Danone, Servier, Janssen
Mckirdy et al. (Thu,) studied this question.
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