P1102 Adherence to a Mediterranean dietary pattern in patients with Crohn's disease in remission is associated with lower fecal calprotectin levels

Abstract

Abstract Background The Mediterranean Diet (MD) was recently found to be beneficial for Crohn’s Disease CD patients in various stages of the disease. The MD emphasizes the intake of foods that are fiber-rich and high in polyphenols, along with avoidance of ultra-processed foods (UPF) and a low intake of red meat. Previous data show that these dietary patterns could promote gut health and mucosal healing. However, little is known about the overall adherence to the MD and its association with biochemical activity in CD patients in remission. Therefore, we aimed to assess overall adherence to the MD and to investigate the association between adherence to the MD and fecal calprotectin (FC) levels in patients with CD in clinical remission and fecal biochemical inactivity. Methods A cross-sectional analysis of a prospectively maintained database of patients with CD in clinical remission [Harvey-Bradshaw Index (HBI)<5] and fecal biochemical inactivity (FC <250µg/g). FC levels of ≤150µg/g was further categorized as significant biochemical inactivity. Patients were assessed for their medical status, clinical and biochemical disease activity, and nutritional intake by using a Food Frequency Questionnaire (FFQ). The Israeli Mediterranean dietary screener (I-MEDAS) was used to assess adherence to the MD. A positive score for each food component was assigned when a specific cut-off criterion was met. For overall adherence to the MD, the median score of the study sample was used as a cut-off for the classification of “adherence” or “non-adherence”. Results A total of 88 patients were included in this analysis. A high proportion of patients qualified for a positive score for low consumption of butter and margarine (96.6%), salty snacks (94.3%), and savory pastries (83.0%), while a low proportion of patients qualified for a positive score for high intake of whole grains (8.0%), fish (20.9%), fruit (9.1%), and legumes (28.4%) (Figure 1). Twenty-nine patients (32.9%) were adherent to the MD. This group of patients had higher rates of significant biochemical inactivity (i.e., FC≤150µg/g), compared to non-adherent patients (96.6% vs. 79.7% respectively, p=0.036) and lower occurrence of soft/liquid stool (p=0.044). Furthermore, low intake of savory pastries and red/processed meat was associated with significant biochemical inactivity [p=0.026 and p=0.020, respectively. Conclusion Overall adherence to the MD among patients with CD in clinical remission and biochemical inactivity is relatively low, with a low intake of beneficial food groups on one hand, and a low intake of UPF on the other hand. Adherence to the MD was associated with lower FC levels. Future studies should examine the long-term effects of the MD on the maintenance of clinical and biochemical remission.