S0890 Can IBD Medications Counteract the Negative Effects of a Deleterious, High Sugar Diet?

The incidence of inflammatory bowel disease (IBD) is strikingly high in Western countries, implicating the role of Western diet in its etiology and pathogenesis. Western diet is characterized by high fat, low fiber, and high sugar. Despite clinical evidence of an association between high sugar diet and IBD susceptibility, the precise role of dietary simple sugars such as glucose, fructose, and sucrose in colitis pathogenesis is unknown. Using dextran sodium sulfate (DSS) and IL10-deficient mouse models of colitis, we studied the effect of simple sugars in colitis susceptibility. Mice were given high glucose, fructose or sucrose in their drinking water or left untreated before and during colitis induced by DSS. Sugar-fed mice exhibited increased colitis susceptibility evidenced by higher body weight loss, diarrhea, rectal bleeding, and severe histopathological changes in the colon as compared to those of sugar-untreated colitic mice. Pre-colitis dietary habit of sugar consumption was critical since sugar pretreated mice were susceptible to DSS-induced colitis even without high sugar diet intake during DSS administration. Consistent with these findings, there were higher incidence of spontaneous colitis development in Il10-/- mice following consumption of high sugar. To understand the underlying mechanism, we evaluated the effect of high sugar diet on intestinal epithelial cell death, inflammation, epithelial barrier permeability, and gut microbiota composition in healthy mice. We did not observe any major pathological changes and apoptosis in the colon of sugar-fed mice. Inflammatory responses, activation of inflammatory signaling pathways, and the expression of tight junction proteins were comparable between control and sugar-fed mice. Interestingly, gut microbiota composition of sugar-fed mice was altered as measured by 16S rRNA gene sequencing of DNA isolated from feces. Microbial species richness was reduced and relative abundance of several bacterial species was either increased or decreased in sugar-fed mice. We further confirmed that sugar-induced alteration of gut microbiota is responsible for exacerbated colitis by using antibiotics or germ-free mice. Mice receiving antibiotics during high-sugar intake did not show increased DSS-colitis susceptibility. Similarly, high-sugar diet did not induce overt colitis pathogenesis in germ-free mice. These findings demonstrate a critical role of dietary caloric sugars in the predisposition and promotion of colitis and could be implicated in the treatment and management of IBD.

P162 CRITICAL ROLES OF DIETARY SIMPLE SUGARS IN COLITIS PATHOGENESIS

Background: The excessive and frequent intake of refined sugar leads to caries. However, the relationship between the amount of sugar intake and the risk of caries is not always consistent. Oral microbial profile and function may impact the link between them. This study aims to identify the plaque microbiota characteristics of caries subjects with low (CL) and high (CH) sugar consumption, and of caries-free subjects with low (FL) and high sugar (FH) consumption. Methods: A total of 40 adolescents were enrolled in the study, and supragingival plaque samples were collected and subjected to metagenomic analyses. The caries status, sugar consumption, and oral-health behaviors of the subjects were recorded. Results: The results indicate that the CL group showed a higher abundance of several cariogenic microorganisms Lactobacillus, A. gerencseriae, A. dentails, S. mutans, C. albicans, S. wiggsiae and P. acidifaciens. C. gingivalis, and P. gingivalis, which were enriched in the FH group. In terms of gene function, the phosphotransferase sugar uptake system, phosphotransferase system, and several two-component responses–regulator pairs were enriched in the CL group. Conclusion: Overall, our data suggest the existence of an increased cariogenic microbial community and sugar catabolism potential in the CL group, and a healthy microbial community in the FH group, which had self-stabilizing functional potential.

Reply to comment: Screening for active COVID-19 infection prior to biologic therapy in IBD patients: primum non nŏcēre

Patients with inflammatory bowel disease (IBD) have a higher incidence of Clostridioides difficile infection (CDI). Previous studies have demonstrated negative clinical outcomes in IBD patients with CDI compared to patients without CDI. The clinical presentation of CDI is indistinguishable from IBD exacerbation, thus posing a frequent clinical dilemma on the role of Clostridioides infection in the testing, diagnosis, and treatment of these patients. To compare clinical outcomes of CDI in patients with IBD to those without IBD. Retrospective cohort of adult patients admitted to Rabin Medical Center Israel between the years 2014 and 2020 with a concurrent diagnosis of IBD and CDI. Matching 1:2 was performed between the IBD patients and the non-IBD population with respect to age and sex. Sixty-seven patients with IBD and 134 patients without IBD were included in the study. The groups' median age was 40.6 (interquartile range [IQR] of 29.8-68.9), with 45.8% male and 54.2% female. The non-IBD group had a higher Charlson score with 2 (IQR 0; 5) versus 0 (IQR 0; 4) in the IBD group (P value <.01). Patients with IBD had more exposure to systemic antibiotics, 71.1% versus 26.3% (P value <.01). In a multivariable analysis we found no difference in 90-day mortality and rate of relapse between the 2 study groups with an odds ratio of 1.709 (95% confidence interval 0.321-9.905) and odds ratio of 0.209 (95% confidence interval 0.055-1.513) respectively. In our cohort patients with IBD who present with diarrhea and concomitant CDI have similar rates of relapse and mortality compared with patients without IBD.

BackgroundEating too much sugar is associated with many negative health effects. Two brief online interventions were carried out to investigate whether information about the negative consequences of eating high-sugar food vs. positive consequences of eating low-sugar food can change reported appetite, mood, and visual food cue attention. MethodFor Study I, participants (n = 201) were allocated to one of three groups: Two groups were asked to list either the negative consequences of high-sugar consumption (negative focus) or the positive consequences of low-sugar consumption (positive focus). The third group carried out a control task (writing a shopping list). For Study II, 200 participants took part in a quiz with questions focusing on either positive, negative, or neutral consequences of high vs. low sugar consumption. Participants evaluated their appetite and mood before and after all interventions (list, quiz) and additionally completed a visual probe task with images depicting high vs. low-sugar food. ResultsIn Study I, the positive focus increased appetite for low-sugar food. The negative focus reduced participants' positive mood but did not change reported appetite. In Study II, all quiz conditions decreased appetite for high-sugar foods but did not affect mood. None of the interventions influenced visual attention to the food images. ConclusionFocusing on negative consequences of a high-sugar diet is less pleasant and is less effective in changing people's appetite than considering the positive aspects of a low-sugar diet. Thus, future interventions should instead spotlight the positive outcomes of a healthy diet.

Although a higher risk of other immune-mediated diseases has been reported in inflammatory bowel disease (IBD) patients, the risk factors of immune-mediated diseases development and the effect of concomitant immune-mediated diseases on outcomes remain poorly defined. To determine the risk factors of incident immune-mediated diseases and the impact of comorbid immune-mediated diseases on outcomes in IBD. Using the National Health Insurance claims data for the entire Korean population, we identified 35581 IBD patients without immune-mediated diseases and 595 IBD patients with immune-mediated diseases from 2012 to 2013, and follow-up until 2016. We selected four controls by age and sex for comparing with cases. A total of 35581 IBD patients without immune-mediated diseases and 142324 matched controls without immune-mediated diseases were followed from 2014 to 2016 and of these 239 IBD patients and 357 controls developed immune-mediated disease. The overall immune-mediated diseases risk was higher in IBD patients (HR, hazard ratio, 2.47; 95% confidence interval, CI, 2.09-2.91). In a nested case-control study of the IBD cohort, adult patients aged ≥20years and frequent hospitalisation ≥1 per year were independent risk factors for incident immune-mediated diseases, in contrast, 5-aminosalicylic acid (5-ASA) use had protective effect (odds ratio, 0.61; 95% CI, 0.41-0.90) for developing immune-mediated diseases. In addition, IBD patients with another immune-mediated disease had an increased risk of needing anti-TNF-α agent (HR, 2.40; 95% CI, 2.02-2.84) and developing acute flare (HR, 1.76; 95% CI, 1.37-2.26). The incidence of immune-mediated diseases in IBD patients was higher than that of non-IBD population. 5-ASA use may reduce this risk.

Screening for active COVID-19 infection prior to biologic therapy in IBD patients: Let's not increase our uncertainty without reducing our concerns

Diabetes, obesity and other cardiovascular diseases are major public health problems that are increasing at an alarming rate. Diabetics and obesity are characterized by high blood glucose level caused by high sugar consumption. New treatment techniques are needed that can lower blood glucose levels without causing any negative effects. Fenugreek known as Methi in Bangla, has been well known to have medicinal properties, such as antidiabetic, anti-hyperlipidaemic, anti-inflammatory, anticancer, antioxidant, and neuroprotective activities. Thus, the supplementation of fenugreek could be an alternative diet that could mitigate the deleterious effect of high sugar consumption and prevent the development of metabolic diseases. Therefore, this experiment was designed to investigate the effect of Fenugreek extract (FE) supplementation on anti-hyperglycemic and anti-hyperlipidemic activities in high sugar diet (HSD) fed mice. Four diet paradigms were selected for this experiment- viz., normal diet (ND), normal diet with Fenugreek extract (ND+FE), 30% sucrose (HSD), and 30% sucrose with Fenugreek extract (HSD+FE). The supplementation of FE (300mg/kg BW) significantly (*p&lt;0.05) hampers the increase in food intake due to high sugar diet consumption in mice. Additionally, mice fed with FE enriched diet significantly lowered body weight as compared with the HSD group. Also, FE supplementation significantly attenuated the increased blood glucose concentration caused by high sugar intake. The inclusion of FE had no effect on heart weight, kidney weight, white adipose tissue and brown adipose tissue but significantly decreased the increased weight of the liver in the HSD-fed group. In addition, FE supplementation also attenuated the HSD-induced elevation of serum total cholesterol (TC), triglycerides (TAG), and low-density lipoprotein C (LDL-C). Considering the above findings, FE could effectively tolerate a normoglycemic state and inhibit the development of diabetics and obesity caused by HSD. Therefore, FE could be beneficial for the management of metabolic disorders due to consumption of high sugar.&#x0D; Bangladesh Journal of Animal Science 51 (3): 90-97, 2022

Heritability of high sugar consumption through drinks and the genetic correlation with substance use

Su1283 Does Autonomic Dysfunction Contribute to Poor Quality of Life in Patients With Inflammatory Bowel Disease? A Prospective Study

Background and aim: Role of 5-aminosalicylic acid (5-ASA), statin and aspirin in reducing cancer risks in inflammatory bowel disease (IBD) remains controversial. We aimed to examine chemo-preventive effects of these drugs in all cancers in IBD in population-based setting.Methods: IBD patients diagnosed between 2000 and 2016 were identified from the Hong Kong IBD Registry and followed from IBD diagnosis until first cancer occurrence. Primary outcome was cancer development ≥6 months after IBD diagnosis. Adjusted hazard ratio (aHR) with 95% confidence interval (CI) was estimated with Cox proportional hazards model. Additional effects of statin and aspirin on chemoprevention were also assessed.Results: Amongst 2103 IBD patients (857 Crohn’s disease, 1246 ulcerative colitis; mean age 40.0 ± 15.6; 60.3% male) with 16,856 person-years follow-up, 48 patients (2.3%) developed cancer. The 5-r, 10-r and 15-year (95% CI) cumulative incidence of cancer were 1% (0.6 − 1.5%), 2.8 (2.0 − 3.9%) and 4.8 (3.4 − 6.5%), respectively. Total 1891 (89.9%) and 222 (10.6%) patients have received one or more prescriptions of 5-ASA and statin respectively. In multivariable analysis adjusted for age, gender, smoking status, IBD type and use of other medications, use of 5-ASA or statin was not associated with a reduced risk of cancer development (5-ASA: aHR 1.22, 95% CI: 0.60–2.48, p = .593; statin: aHR 0.48, 95% CI: 0.14–1.59, p = .227). Adding aspirin was not associated with a lowered cancer risk (aHR 1.18, 95% CI: 0.32–4.35, p = .799).Conclusion: Use of 5-ASA was not associated with a lowered cancer risk in Chinese IBD patients. Addition of statin/aspirin provided no additional benefit.Key summaryInflammatory bowel diseases (IBD) including Crohn’s disease and ulcerative colitis are associated with increased risk of both intestinal and extra- intestinal cancers.Various medications including 5-aminosalicylate acid (5-ASA), statins and aspirin have been studied for their chemoprevention effects. However, most studies focused on colorectal cancer only and showed conflicting evidence. No studies so far looked at the effects of these medications on all cancer development in IBD.The 5-, 10- and 15-year (95% confidence interval) cumulative incidence of cancer in Chinese IBD patients were 1 (0.6–1.5%), 2.8 (2.0–3.9%) and 4.8 (3.4–6.5%), respectively.Use of 5-ASA was not associated with a lowered cancer risk in Chinese IBD patients. Addition of statin/aspirin provided no additional benefit.

Baseline Disease Activity and Steroid Therapy Stratify Risk of COVID-19 in Patients With Inflammatory Bowel Disease

Background: This cross-sectional study investigates the relationship between daily sugar intake from sugar-sweetened beverages (SSBs) and sleep quality in working adults aged 18–45 years who do not have chronic illnesses or diagnosed sleep disorders. The primary objective is to determine whether high sugar consumption increases the risk of poor sleep when other risk factors are considered simultaneously. This study is significant as it adds to the growing body of evidence regarding the impact of dietary factors on sleep quality, highlighting the potential health implications of sugar consumption. Methods: Participants were selected using consecutive sampling, and the study was conducted at Jomtien Hospital in Chonburi Province, Thailand. Data collection involved three key components: general demographic and health information records, a validated Thai questionnaire assessing sweetened beverage consumption, and the Thai version of the Pittsburgh Sleep Quality Index (PSQI). Sugar intake from SSBs was categorized into two groups: high (≥ 50 grams/day) and low (&lt; 50 grams/day). Sleep quality was classified as poor (PSQI &gt; 5) or good (PSQI ≤ 5). The relationship between sugar intake and sleep quality was analyzed using logistic regression, and the results were presented as odds ratios (ORs) with corresponding 95% confidence intervals (CIs). Results: The study included 300 participants, 68% of whom were women, with an average age of 30 ± 7.6 years. A total of 58% of participants were found to have poor sleep quality. Those with poor sleep quality consumed an average of 131.9 ± 102.9 grams of sugar per day, compared to 99.8 ± 86.3 grams for those with good sleep quality, a difference that was statistically significant (p = 0.005). When sugar consumption was categorized, 79.3% of individuals in the high sugar consumption group (≥ 50 grams/day) had poor sleep quality, compared to 65.1% with good sleep quality in the same group. In contrast, 20.7% of individuals in the low sugar consumption group (&lt; 50 grams/day) had poor sleep quality, compared to 34.9% with good sleep quality, also showing a statistically significant difference (p = 0.008). The crude odds ratio for high sugar consumption associated with poor sleep quality was 2.06 (95% CI: 1.22-3.45, p = 0.006). After adjusting for other variables, the odds ratio remained significant, with an adjusted OR of 2.02 (95% CI: 1.05-3.92, p = 0.036). Conclusion: The findings indicate that high sugar consumption from sugar-sweetened beverages is significantly associated with an increased risk of poor sleep quality (adjusted OR: 2.02, 95% CI: 1.05–3.92, p = 0.036). Based on these results, it is recommended that individuals experiencing sleep issues consider reducing their sugar intake. Future research should explore the mechanisms underlying this relationship and evaluate public health strategies aimed at reducing high sugar consumption.

BACKGROUND: Disease specific knowledge amongst inflammatory bowel disease (IBD) patients remains lacking. Our study aims to (1) determine the extent of disease specific knowledge amongst IBD patients in Lebanon and (2) determine the impact of patient knowledge on anxiety, depression, and quality life while controlling for disease activity. METHODS: We prospectively recruited adult IBD patients from the GI clinic at a tertiary referral center in Beirut, Lebanon. Demographic data was collected and patients were asked to fill the following questionnaires: (1) Short IBD Questionnaire (SIBDQ) as a measure of quality of life (QoL), (2) Harvey-Bradshaw Index (HBI) for Crohn’s disease (CD) or Ulcerative Colitis (UC) Activity Index (UCAI) for UC patients as a measure of disease activity, (3) Hospital Anxiety and Depression Scale (HADS), as a measure for anxiety and depression, and (4) the Crohn’s and Colitis Knowledge (CCKnow) questionnaire as a measure of IBD-specific patient knowledge. Pearson Chi-square, student’s t-test and multivariate analysis was used for statistical analyses. RESULTS: A total of 95 patients were included; 55.8% males, 18–65 years of age, mean age 34.5 years ± 12.0. Over half (53.7%) of patients had CD, 44.2% UC, and 2.1% IBD-unclassified. The majority of patients (51.6%) were unmarried and had a university degree (77.9%). The mean CCKnow score amongst patients was 8 ± 4, with 53.7% scoring ≥8. Of all patients, 43.2% had anxiety, 22.1% had depression, mean SIBDQ score was 49 ± 15, with 49.5% having a poor QoL. The 51 CD patients had a mean CCKnow of 8 ± 4, with 45.1% scoring ≥8. These patients had a mean HBI of 5 ± 4. The 29 UC patients had a mean CCKnow of 9 ± 4, with 61.9% scoring ≥8. The mean UCAI for these patients was 5 ± 4. Patients with a university degree had more disease specific knowledge (CCKnow score ≥8). Comparing patients with CCKNOW ≥ 8 to those who lack disease specific knowledge, there was no significant difference in anxiety, depression or quality of life. When analyzing per IBD subtype, CD patients who had more disease specific knowledge had a tendency to be more anxious and depressed. After controlling for disease activity, gender, level of education, age, and years of disease, patients who were considered knowledgeable regarding their disease had no association with any of the following outcomes in the UC population: anxiety, depression, or quality of life; however, being female with CD was associated with increased levels of anxiety. CONCLUSION(S): IBD patients in Lebanon knew less about their IBD compared to values reported in the literature. There were no differences between patients who knew about their disease compared to those who do not except for a trend towards significance in anxiety amongst CD patients who knew more about their disease.