S1031 Association Between Nutritional Profile and Disease Activity in a Sample of Lebanese Patients With Inflammatory Bowel Disease (IBD): A Case Control Study

Abstract

Introduction: Many studies have evaluated dietary habits of patients with inflammatory bowel disease (IBD) and their impact on disease activity. This study aims to evaluate this association in Lebanese patients with IBD, as no investigation of this kind has been done in Lebanon. Methods: In this prospective study, patients with IBD were identified by their treating physicians while controls were recruited via emails sent to staff and students at the affiliated university. Both groups were gender and age matched. Baseline characteristics and nutritional profile, as assessed using a validated food frequency questionnaire (FFQ) adapted to the Lebanese diet were compared between cases and controls. Cases were divided into 2 groups, those in remission and those with active disease according to the Harvey-Bradshaw Index for Crohn’s disease (HBCD) and Ulcerative Colitis Activity Index (UCAI). Results: A total of 47 patients with IBD and 101 controls were included. There was no difference in mean age between cases and controls. Patients with IBD consumed significantly less % of lipids, saturated fatty acids (SFAs), fiber, and sucrose compared to controls (p=0.0001). The multivariate analysis comparing cases to controls showed higher odds of consuming more % carbohydrates of total energy intake (TEI) at 1.31 (95%CI; 1.15-1.51) and more % proteins of TEI at 1.25 (95%CI;1.09-1.43), and lower odds of consuming fiber at 0.934 (95%CI;0.89-0.99). There was no difference in odds of fat consumption between cases and controls. Of 47 IBD patients, 25 UC and 22 CD, 28 were in clinical remission (HBCD ≤ 4 or UCAI ≤ 2) and 19 had active disease. IBD patients in remission consumed more % protein than controls (p=0.032). The % intake of poly-unsaturated fatty acids (PUFAs) was higher among IBD patients with active disease than those in remission, specifically among those with UC (p=0.032). Conclusion: Although there was a difference in protein consumption between cases and controls, it was only significant between controls and IBD patients in remission. It is possible that differences in diet between patients with IBD and controls were associated with nutritional restrictions patients impose on themselves. In contrast, consumption of PUFAs was associated with active disease in IBD patients, which concords with the available literature. This study could serve as a steppingstone for future prospective and experimental studies that could inform nutritional rehabilitation for IBD patients (Table). Table 1. - Energy Intake, Macronutrients and Micronutrients Per Day in Controls, IBD Patients in Remission and IBD Patients with Active Disease Controls (n=101) IBD patients in Remission (n=28) IBD patients with active disease (n=19) p-value DRI Energy Intake (kcals/day) for men 2622.4 ± 0.21 1923.53 ± 0.16 1644.37 ± 0.03 0.015 2300-2900 Energy Intake (kcals/day) for women 2597.2 ± 0.17 1563.15 ± 0.05 1897.14 ± 0.13 0.0001 1900-2200 BMI (kg/m2) 23.29 ± 0.06 25.87 ± 0.06 24.03 ± 0.08 0.007 N/A Average (%) of Protein of TEI 16.06 ± 0.09 18.62 ± 0.05 16.48 ± 0.08 0.004 10-35 Average (%) of Lipids of TEI 38.33 ± 0.08 30.28 ± 0.06 33.02 ± 0.07 0.0001 20-35 MUFAs (%) 12.33 ± 0.11 11.52 ± 0.06 11.04 ± 0.12 0.119 15-20 PUFAs (%) 6.05 ± 0.15 5.14 ± 0.10 6.58 ± 0.12 0.032 5-10 SFAs (%) 11.95 ± 0.12 6.50 ± 0.14 6.84 ± 0.14 0.0001 < 10 Average (%) of carbohydrates of TEI 45.15 ± 0.05 50.68 ± 0.03 49.30 ± 0.05 0.0001 45-65 Average Sucrose (g) 89.16 ± 0.21 43.89 ± 0.22 52.70 ± 0.21 0.0001 50 Average Lactose (g) 5.60 ± 0.59 5.17 ± 0.44 5.17 ± 0.44 0.942 N/A Average Fibers (g) 28.09 ± 0.18 18.02 ± 0.10 21.52 ± 0.20 0.0001 20-38 Alcohol (yes), n (%) 22 (23.9%) 4 (14.3%) 6 (31.6) 0.918 N/A Vitamin D supplementation (yes), n (%) 15 (14.9%) 13 (46.4%) 5 (26.3%) 0.006 N/A Categorical variables were reported as numbers and percentages, test used: chi-square test. Continuous variables were reported as geometric means ± Standard deviation, test used: independent t-test. p<0.05. IBD= Inflammatory Bowel Diseases, DRI= Daily Recommended Intake, BMI= Body Mass Index, TEI= Total Energy Intake, MUFAs= Mono-unsaturated Fatty Acids, PUFAs= Poly-unsaturated Fatty Acids, SFAs= Saturated Fatty Acids, N/A= Not applicable.