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

Abstract

INTRODUCTION: Inflammatory Bowel disease (IBD) management involves a delicate balance between medications, diet, and psychosocial care. Dietary factors like sugar consumption have been associated with disease onset. However, it is unknown how sugar intake complicates the medical regimen necessary to induce and maintain disease remission. We sought to characterize differences in IBD treatment regimens among patients with high and low sugar consumption and if medication patterns exist within subgroups that are in remission. METHODS: Using a longitudinal, prospective natural history of consented IBD patients, we meticulously tracked consented IBD patients at a large tertiary referral hospital. Sugar consumption was prospectively assessed using the 2005 National Health Interview Survey Diet and Questionnaire. Patients completed these questionnaires at routine outpatient appointments. The USDA estimates that the average American consumes 73 grams of added sugars on a daily basis. Patients who consumed above this average figure, were allocated to the high consumption group and those below comprised the low sugar consumption group. The primary outcome, medication use, was approximated using prescription data harvested from the electronic medical records. We focused on standard medications used in the management of IBD. We also conducted subgroup analyses to identify potential subpopulations with treatment patterns. Remission was defined as a score of ≤ 3 on the Harvey-Bradshaw index or ≤4 on the Ulcerative Colitis Activity Index. RESULTS: The study population consisted of 1259 adult IBD patients (70%CD, 30%UC, 57% Female). The median age was 40 years old. The mean sugar consumption of this study cohort was 71 grams. About 66% of patients had low sugar consumption while 34% of patients had high sugar consumption. High sugar consumption was associated with increased anti-TNF medication use, higher combination therapy use, and lower 5-ASA use. Among the subgroup of high sugar consumers, those not in remission used more adalimumab and steroids. Deeper analysis with only patients with Crohn’s Disease (CD), revealed differences in Azathioprine, 5-ASA, and steroid use. CONCLUSION: IBD patients consuming high sugar diets require more immunomodulator, biologic and combination therapy. These data suggest that optimal IBD treatment may benefit from incorporating nutritional counseling for healthy diet with low added sugar.Table 1Table 2Table 3