B.J. Geerling

Diet as a risk factor for the development of ulcerative colitis

OBJECTIVE:Dietary factors have been considered as a possible risk factor for ulcerative colitis (UC). However, available data are inconsistent. The aim of the present study was to evaluate the etiological role of dietary factors in the development of UC.METHODS:Recently diagnosed (<6 Months) UC patients (n = 43) and age- and gender-matched population controls (n = 43) were studied in a case-control design. The cross-check dietary history method was used to assess dietary intake of 5 yr before the study. Adipose tissue fatty acid composition was used as a biomarker of long-term fat intake. Conditional logistic regression-derived odds ratios (OR), and 95% confidence intervals (CI) were used for statistical analysis. Dietary intake ORs were adjusted for energy intake.RESULTS:High intakes of monounsaturated fat (OR: 33.9 [95% CI 2.6–443.1]), polyunsaturated fat (OR: 5.1 [95% CI 1.0–26.7]), and vitamin B6 (OR: 6.9 [95% CI 1.6–30.7]) were associated with an increased risk to develop UC. No other significant associations were found with UC risk.CONCLUSIONS:High intakes of mono- and polyunsaturated fat and vitamin B6 may enhance the risk of developing UC. Whether this observation is a true risk factor in the development of UC or rather a reflection of a certain dietary lifestyle needs to be investigated.

Fat intake and fatty acid profile in plasma phospholipids and adipose tissue in patients with Crohn's disease, compared with controls.

Objectives:Fatty acid metabolism is involved in the immune response and inflammation processes in patients with Crohns disease (CD). Fatty acid changes may be relevant to the clinical course of the disease. The aim of this study was to compare the qualitative and quantitative fat intake and fatty acid composition of plasma phospholipids and adipose tissue in a defined population of CD patients with those in matched controls.Methods:Dietary fat intake and fatty acid profile of plasma phospholipids and adipose tissue were assessed in two patient populations: 20 patients with recently diagnosed CD and 32 patients with longstanding (>10 yr) CD clinically in remission, matched for age and gender with healthy controls.Results:We observed no significant differences in quantitative or qualitative fat intake between CD patients and controls. Percentages of linoleic acid and α-linolenic acid in plasma phospholipids or adipose tissue were not significantly different between patients and controls. However, we observed a significantly (p < 0.05) lower percentage of the sum of the n-3 fatty acids, with significantly (p < 0.01) higher levels of clupanodonic acid (22:5n-3) and significantly (p < 0.05) lower levels of docosahexaenoic (22:6n-3) and arachidonic acid (20:4n-6). The aberrant fatty acid profile was more evident in patients with longstanding CD than in patients with recently diagnosed CD.Conclusion:The aberrant fatty acid profile found in these CD patients is a result of altered metabolism rather than of essential fatty acid malabsorption. The reported findings may be important in the pathophysiology of CD and hence in the choice of fatty acids to be used when therapeutic supplementation is considered in CD patients.

Nutritional supplementation with N-3 fatty acids and antioxidants in patients with Crohn's disease in remission: effects on antioxidant status and fatty acid profile.

Summary: In patients with Crohns disease (CD), malnutrition is frequently observed and is generally accepted to be an important issue. The aim of this study was to investigate the effects of 3 months of supplementation with a liquid formula containing either antioxidants (AO) or n‐3 fatty acids plus AO on the antioxidant status and fatty acid profile of plasma phospholipids and adipose tissue, respectively, in patients with long‐standing CD currently in remission. In a randomized, double‐blind placebo‐controlled study, CD patients received either placebo, AO, or n‐3 fatty acids plus AO for 3 months in addition to their regular diet. In all, 25/37 CD patients completed the study. AO status was assessed by blood biochemical parameters. A statistical per‐protocol analysis was performed. Serum concentrations of selenium, vitamin C, and vitamin E, the activity of superoxide dismutase and total antioxidant status were significantly (p < 0.05) increased after AO supplementation. Furthermore, compared with controls, serum concentrations of &bgr;‐carotene, selenium, and vitamin C and the activity of glutathione peroxidase (GPx) were significantly (p < 0.05) lower before supplemention; however, after AO supplementation these levels were not significantly different from controls (except for GPx). N‐3 fatty acids plus AO supplementation significantly (p < 0.05) decreased the proportion of arachidonic acid, and increased the proportion of eicosapentanoic acid and docosahexanoic acid in both plasma phospholipids and adipose tissue. Supplementation with antioxidants improved antioxidant status in patients with CD in remission. In addition, supplementation with n‐3 fatty acids plus antioxidants significantly changed the eicosanoid precursor profile, which may lead to the production of eicosanoids with attenuated proinflammatory activity. This study indicates that an immunomodulating formula containing n‐3 fatty acids and/or AO may have the potential to play a role in the treatment of CD.

Initial and chronic gastric acid inhibition by lansoprazole and omeprazole in relation to meal administration.

In a placebo-controlled, double-blind, multiplecrossover study, the initial and chronic acid-inhibitoryeffect of lansoprazole 30 mg, orally administered halfan hour before breakfast or immediately after breakfast, and of omeprazole 20 mg,administered postprandially, respectively, wasinvestigated in 16 healthy volunteers, using ambulant24-hr intragastric pH monitoring. On the first day ofmedication, only preprandially administered lansoprazolereduced acid secretion significantly (median 24-hr pH3.0; P < 0.05). On day 15, the median 24-hrintragastric pH of lansoprazole preprandial (pH 4.1),lansoprazole postprandial (pH 4.3), and omeprazolepostprandial (pH 3.3), respectively, differedsignificantly (P < 0.05) from placebo (pH 1.2). It isconcluded that the interaction between food intake andlansoprazole administration only is important at the startof oral therapy. Lansoprazole taken before breakfast iseffective even on the initial day oftreatment.

Restoration of muscle strength after nutritional supplementation in patients with Crohn's disease in a double blind placebo controlled study

In a recent study we assessed a comprehensive nutritional status in patients with longstanding Crohns disease (CD) and observed a significantly lower hamstrings muscle strength (as a functional parameter of nutritional status) compared with controls. The aim of this study was to investigate the effect of nutritional supplementation in addition to a regular diet on the muscle strength in long-standing (<5 years) CD patients. Patients and methods. In total, 25 CD patients, clinically in remission, were randomized in a double blind placebo controlled study to receive either placebo (n=8) containing macronutrients (600 Kcal), a formula with macronutrients (600 Kcal) and extra antioxidants (AO; n=8) or a formula with macronutrients supplemented with antioxidants and n-3 fatty acids (IMPACT©: 600 Kcal; n=9) for three months. Muscle strength was assessed by an isokinetic dynamometer (CYBEX II) and peak torques (PTs) of quadriceps (extension) and hamstrings (flexion) at 60 and 180°/s were measured. In addition, the muscle strength of 25 age and sex matched healthy controls was determined. Fat-free mass (FFM) was assessed by Dual X-ray absorptiometry. Wilcoxon signed rank tests were used for statistical analysis. Results. At baseline, flexion PTs measured at 60 and 180°/s (71.7 -+ 32.4 Nm; 44.4 -+ 27.1 Nm, respectively) and extension PTs (108.5 -+ 28.2 Nm. 65.5 -+ 22.4 Nm, respectively) were significantly (P<0.01) lower in CD patients compared with controls (flexion PTs: 84.4 + 24.7 Nm; 56.4 -+ 20.9 Nm and extension PTs: 127.6 -+ 28.2 Nm; 83.7 -+ 27.0 Nm, respectively). After 3 months supplementation with placebo, extension PTs (98.3 -+ 26.8 Nm; 61.8 -+ 20.5 Nm, respectively) and flexion PTs (55.6-+ 25.0 Nm; 33.1 -+ 22.5 Nm, respectively) measured at 60 and 180°/s were still significantly lower than extension PTs (113.4-+ 30.4 Nm; 76.8 -+ 28.2 Nm, respectively) and flexion PTs (79.6 -+ 29.0 Nm; 52.5 + 22.9 Nm, respectively) of controls. However, after supplementation with AO or IMPACT, extension PTs (60°/s) and flexion PTs (60/180°/s) were not significantly different from controls. FFM did not change after 3 months supplementation in either treatment group. Conclusion. In patients with Crohns disease, muscle strength compared with Controls was significantly restored after three months supplementation with either macronutrients and extra antioxidants or with macronutrients and a combination of extra antioxidants and n-3 fatty acids, while only macronutrients supplementation did not change muscle strength. This outcome underlines the importance of micronutrient supplementation in longstanding quiescent Crohns disease. This study was financially supported by grants from Novartis Ltd., (Switzerland).