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Ismond KP, Cruz C, Limon-Miro AT, Low G, Prado CM, Spence JC, Raman M, McNeely ML, Tandon P. An open label feasibility study of a nutrition and exercise app-based solution in cirrhosis. Can Liver J 2024; 7:5-15. [PMID: 38505789 PMCID: PMC10946184 DOI: 10.3138/canlivj-2023-0011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/18/2023] [Accepted: 06/10/2023] [Indexed: 03/21/2024]
Abstract
Background Nutrition and exercise are the mainstay of therapy for the prevention and treatment of frailty in cirrhosis. This pilot study assessed feasibility of the online delivery of an app-based semi-supervised nutrition and exercise intervention in this population. Methods The 11-week pilot recruited adults with cirrhosis who owned internet-connected devices. Patients were encouraged to participate in exercise sessions 3× per week including a combination of online group exercise (weekly) and home-based follow-along exercise (biweekly). They also participated in group nutrition classes (five sessions) and one-to-one exercise and nutrition check-ins delivered through the app. Primary outcome measures pertained to program feasibility: recruitment, retention, adherence, and satisfaction. Exploratory measures included physical performance (liver frailty index [LFI], 6-minute walk test [6MWT]), health behaviour domains, and quality of life. Results Twenty three patients completed baseline measures. Of these, 18 (72%) completed end of study measures (mean MELD-Na, 9.2; female, 44.4%). Over 70% of participants fulfilled 75% or more of the feasibility criteria. Satisfaction with the program was high (mean, 89%). Exercise program modifications were required for 17 patients to accommodate health events or abilities. Exploratory evaluation showed improvement in the LFI and the 6MWT by -0.58-units (95% CI: -0.91 to -0.25) and 46.0 m (95% CI: 22.7-69.3) respectively without changes in quality of life or health behaviour domains. Conclusions Outcomes demonstrate feasibility of the app-based delivery of programming with promising exploratory impact on efficacy for physical performance. Findings can guide the design of a large-scale app-based randomized controlled trials in cirrhosis.
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Affiliation(s)
- Kathleen P Ismond
- Division of Gastroenterology, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Alberta, Canada
| | - Christofer Cruz
- Division of Gastroenterology, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Alberta, Canada
| | - Ana Teresa Limon-Miro
- Division of Gastroenterology, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Alberta, Canada
| | - Gavin Low
- Division of Gastroenterology, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Alberta, Canada
| | - Carla M Prado
- Department of Agricultural, Food and Nutritional Science, Faculty of Agricultural, Life and Environmental Sciences, University of Alberta, Edmonton, Alberta, Canada
| | - John C Spence
- Faculty of Kinesiology, Sport, and Recreation, University of Alberta, Edmonton, Alberta, Canada
| | - Maitreyi Raman
- Division of Gastroenterology, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Margaret L McNeely
- Department of Physical Therapy/ Department of Oncology, Faculty of Rehabilitation Medicine, University of Alberta, Edmonton, Alberta, Canada
| | - Puneeta Tandon
- Division of Gastroenterology, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Alberta, Canada
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Fancy N, Nitin, Kniffen D, Melvin M, Kazemian N, Sadeghi J, Letef CA, D'Aloisio L, Copp AG, Inaba R, Hans G, Jafaripour S, Haskey N, Raman M, Daneshgar P, Chadee K, Ghosh S, Gibson DL, Pakpour S, Zandberg W, Bergstrom KSB. Fecal-adherent mucus is a non-invasive source of primary human MUC2 for structural and functional characterization in health and disease. J Biol Chem 2024; 300:105675. [PMID: 38272223 PMCID: PMC10891339 DOI: 10.1016/j.jbc.2024.105675] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2023] [Revised: 01/05/2024] [Accepted: 01/08/2024] [Indexed: 01/27/2024] Open
Abstract
The O-glycoprotein Mucin-2 (MUC2) forms the protective colon mucus layer. While animal models have demonstrated the importance of Muc2, few studies have explored human MUC2 in similar depth. Recent studies have revealed that secreted MUC2 is bound to human feces. We hypothesized human fecal MUC2 (HF-MUC2) was accessible for purification and downstream structural and functional characterization. We tested this via histologic and quantitative imaging on human fecal sections; extraction from feces for proteomic and O-glycomic characterization; and functional studies via growth and metabolic assays in vitro. Quantitative imaging of solid fecal sections showed a continuous mucus layer of varying thickness along human fecal sections with barrier functions intact. Lectin profiling showed HF-MUC2 bound several lectins but was weak to absent for Ulex europaeus 1 (α1,2 fucose-binding) and Sambucus nigra agglutinin (α2,6 sialic acid-binding), and did not have obvious b1/b2 barrier layers. HF-MUC2 separated by electrophoresis showed high molecular weight glycoprotein bands (∼1-2 MDa). Proteomics and Western analysis confirmed the enrichment of MUC2 and potential MUC2-associated proteins in HF-MUC2 extracts. MUC2 O-glycomics revealed diverse fucosylation, moderate sialylation, and little sulfation versus porcine colonic MUC2 and murine fecal Muc2. O-glycans were functional and supported the growth of Bacteroides thetaiotaomicron (B. theta) and short-chain fatty acid (SCFA) production in vitro. MUC2 could be similarly analyzed from inflammatory bowel disease stools, which displayed an altered glycomic profile and differential growth and SCFA production by B. theta versus healthy samples. These studies describe a new non-invasive platform for human MUC2 characterization in health and disease.
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Affiliation(s)
- Noah Fancy
- Biology, University of British Columbia-Okanagan, Kelowna, Canada
| | - Nitin
- Chemistry, University of British Columbia-Okanagan, Kelowna, Canada
| | - Darrek Kniffen
- Biology, University of British Columbia-Okanagan, Kelowna, Canada
| | - Mackenzie Melvin
- Biology, University of British Columbia-Okanagan, Kelowna, Canada
| | - Negin Kazemian
- School of Engineering, University of British Columbia-Okanagan, Kelowna, Canada
| | - Javad Sadeghi
- School of Engineering, University of British Columbia-Okanagan, Kelowna, Canada
| | - Clara A Letef
- Biology, University of British Columbia-Okanagan, Kelowna, Canada
| | - Leah D'Aloisio
- Biology, University of British Columbia-Okanagan, Kelowna, Canada
| | - Amanda G Copp
- Biology, University of British Columbia-Okanagan, Kelowna, Canada
| | - Rain Inaba
- Biology, University of British Columbia-Okanagan, Kelowna, Canada
| | - Geetkamal Hans
- Biology, University of British Columbia-Okanagan, Kelowna, Canada
| | - Simin Jafaripour
- Biology, University of British Columbia-Okanagan, Kelowna, Canada
| | - Natasha Haskey
- Biology, University of British Columbia-Okanagan, Kelowna, Canada
| | - Maitreyi Raman
- Cumming School of Medicine, University of Calgary, Calgary, Canada
| | | | - Kris Chadee
- Cumming School of Medicine, University of Calgary, Calgary, Canada
| | - Sanjoy Ghosh
- Biology, University of British Columbia-Okanagan, Kelowna, Canada
| | - Deanna L Gibson
- Biology, University of British Columbia-Okanagan, Kelowna, Canada
| | - Sepideh Pakpour
- School of Engineering, University of British Columbia-Okanagan, Kelowna, Canada
| | - Wesley Zandberg
- Chemistry, University of British Columbia-Okanagan, Kelowna, Canada
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3
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D'Silva A, Islam Z, Marshall DA, Vallance JK, Nasser Y, Rajagopalan V, MacKean G, Raman M. Experiences of Irritable Bowel Syndrome Patients in a Virtual Yoga Program: Qualitative Findings from a Clinical Trial. Dig Dis Sci 2024; 69:169-179. [PMID: 37914888 DOI: 10.1007/s10620-023-08125-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/23/2023] [Accepted: 08/23/2023] [Indexed: 11/03/2023]
Abstract
BACKGROUND AND AIMS In-person yoga interventions have shown feasibility and effectiveness in improving the outcomes of patients with irritable bowel syndrome (IBS), but experiences in virtual yoga interventions have not been examined. This study aimed to explore patients' experiences of a virtually delivered yoga intervention for IBS. METHODS An embedded qualitative substudy was included in a randomized controlled trial examining the feasibility and effectiveness of a virtual yoga program among adult patients with IBS. Semi-structured interviews captured participants' past and current experiences, program satisfaction, perceived impact on IBS symptoms and overall physical and mental health, facilitators and barriers to participation, perceptions of social support and supervised learning, and input on improving future programming. Data were coded and analyzed in duplicate using NVivo 12. An analytic template based on the interview guide was developed and thematic analysis identified themes, as well as the relationship between themes and subthemes. RESULTS Among the 14 participants (all female, mean age 47.7 years), three major themes were identified: (1) positive experience in the yoga program, (2) incorporating yoga into IBS management post-study, and (3) recommendations for program improvement. CONCLUSION Patients with IBS experience in a virtual yoga program was positive with improvements in physical and mental health outcomes. Considering the barriers and facilitators to participating in an online yoga program along with participant recommendations may improve future intervention design and delivery to increase self-efficacy and confidence among patients with IBS.
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Affiliation(s)
- Adrijana D'Silva
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, 3280 Hospital Drive NW, Calgary, AB, T2N 4Z6, Canada
| | - Zarmina Islam
- Department of Medicine, Dow Medical College, Bab-E-Urdu Road, Karachi, 74200, Sindh, Pakistan
| | - Deborah A Marshall
- Arthur J.E. Child Chair, Department of Medicine, Cumming School of Medicine, University of Calgary, 3280 Hospital Drive NW, Calgary, AB, T2N 4Z6, Canada
| | - Jeff K Vallance
- Faculty of Health Disciplines, Athabasca University, 1 University Drive, Athabasca, AB, T9S 3A3, Canada
| | - Yasmin Nasser
- Division of Gastroenterology and Hepatology, Department of Medicine, Cumming School of Medicine, University of Calgary, 3380 Hospital Drive NW, Calgary, AB, T2N 4N1, Canada
- Snyder Institute for Chronic Diseases, Cumming School of Medicine, University of Calgary, 3280 Hospital Drive NW, Calgary, AB, T2N 4Z6, Canada
| | - Vidya Rajagopalan
- Division of Gastroenterology and Hepatology, Department of Medicine, Cumming School of Medicine, University of Calgary, 3380 Hospital Drive NW, Calgary, AB, T2N 4N1, Canada
| | - Gail MacKean
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, 3280 Hospital Drive NW, Calgary, AB, T2N 4Z6, Canada
| | - Maitreyi Raman
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, 3280 Hospital Drive NW, Calgary, AB, T2N 4Z6, Canada.
- Division of Gastroenterology and Hepatology, Department of Medicine, Cumming School of Medicine, University of Calgary, 3380 Hospital Drive NW, Calgary, AB, T2N 4N1, Canada.
- Snyder Institute for Chronic Diseases, Cumming School of Medicine, University of Calgary, 3280 Hospital Drive NW, Calgary, AB, T2N 4Z6, Canada.
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Bresee LC, Lamont N, Ocampo W, Holroyd-Leduc J, Sabuda D, Leal J, Dalton B, Kaufman J, Missaghi B, Kim J, Larios OE, Henderson E, Raman M, Fletcher JR, Faris P, Kraft S, Shen Y, Louie T, Conly JM. Implementation strategies for hospital-based probiotic administration in a stepped-wedge cluster randomized trial design for preventing hospital-acquired Clostridioides difficile infection. BMC Health Serv Res 2023; 23:1386. [PMID: 38082421 PMCID: PMC10714625 DOI: 10.1186/s12913-023-10350-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2023] [Accepted: 11/17/2023] [Indexed: 12/18/2023] Open
Abstract
BACKGROUND Clostridioides difficile infection (CDI) is associated with considerable morbidity and mortality in hospitalized patients, especially among older adults. Probiotics have been evaluated to prevent hospital-acquired (HA) CDI in patients who are receiving systemic antibiotics, but the implementation of timely probiotic administration remains a challenge. We evaluated methods for effective probiotic implementation across a large health region as part of a study to assess the real-world effectiveness of a probiotic to prevent HA-CDI (Prevent CDI-55 +). METHODS We used a stepped-wedge cluster-randomized controlled trial across four acute-care adult hospitals (n = 2,490 beds) to implement the use of the probiotic Bio-K + ® (Lactobacillus acidophilus CL1285®, L. casei LBC80R® and L. rhamnosus CLR2®; Laval, Quebec, Canada) in patients 55 years and older receiving systemic antimicrobials. The multifaceted probiotic implementation strategy included electronic clinical decision support, local site champions, and both health care provider and patient educational interventions. Focus groups were conducted during study implementation to identify ongoing barriers and facilitators to probiotic implementation, guiding needed adaptations of the implementation strategy. Focus groups were thematically analyzed using the Theoretical Domains Framework and the Consolidated Framework of Implementation Research. RESULTS A total of 340 education sessions with over 1,800 key partners and participants occurred before and during implementation in each of the four hospitals. Site champions were identified for each included hospital, and both electronic clinical decision support and printed educational resources were available to health care providers and patients. A total of 15 individuals participated in 2 focus group and 7 interviews. Key barriers identified from the focus groups resulted in adaptation of the electronic clinical decision support and the addition of nursing education related to probiotic administration. As a result of modifying implementation strategies for identified behaviour change barriers, probiotic adherence rates were from 66.7 to 75.8% at 72 h of starting antibiotic therapy across the four participating acute care hospitals. CONCLUSIONS Use of a barrier-targeted multifaceted approach, including electronic clinical decision support, education, focus groups to guide the adaptation of the implementation plan, and local site champions, resulted in a high probiotic adherence rate in the Prevent CDI-55 + study.
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Affiliation(s)
- Lauren C Bresee
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
- O'Brien Institute of Public Health, University of Calgary, Calgary, AB, Canada
| | - Nicole Lamont
- W21 Research and Innovation Centre, University of Calgary and Alberta Health Services, Calgary, AB, Canada
| | - Wrechelle Ocampo
- W21 Research and Innovation Centre, University of Calgary and Alberta Health Services, Calgary, AB, Canada
| | - Jayna Holroyd-Leduc
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
- O'Brien Institute of Public Health, University of Calgary, Calgary, AB, Canada
- Department of Medicine, Cumming School of Medicine, University of Calgary and Alberta Health Services, Calgary, AB, Canada
| | - Deana Sabuda
- Pharmacy Services, Alberta Health Services, Calgary, AB, Canada
| | - Jenine Leal
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
- O'Brien Institute of Public Health, University of Calgary, Calgary, AB, Canada
- Infection Prevention and Control, Alberta Health Services, Calgary, AB, Canada
- Department of Microbiology, Immunology, and Infectious Diseases, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
| | - Bruce Dalton
- Pharmacy Services, Alberta Health Services, Calgary, AB, Canada
| | - Jaime Kaufman
- W21 Research and Innovation Centre, University of Calgary and Alberta Health Services, Calgary, AB, Canada
| | - Bayan Missaghi
- Department of Medicine, Cumming School of Medicine, University of Calgary and Alberta Health Services, Calgary, AB, Canada
- Infection Prevention and Control, Alberta Health Services, Calgary, AB, Canada
- Calvin, Phoebe, and Joan Snyder Institute for Chronic Diseases, University of Calgary and Alberta Health Services, Calgary, AB, Canada
| | - Joseph Kim
- Department of Medicine, Cumming School of Medicine, University of Calgary and Alberta Health Services, Calgary, AB, Canada
- Infection Prevention and Control, Alberta Health Services, Calgary, AB, Canada
| | - Oscar E Larios
- Department of Medicine, Cumming School of Medicine, University of Calgary and Alberta Health Services, Calgary, AB, Canada
- Infection Prevention and Control, Alberta Health Services, Calgary, AB, Canada
- Department of Pathology and Laboratory Medicine, Cumming School of Medicine, University of Calgary and Alberta Health Services, Calgary, AB, Canada
| | - Elizabeth Henderson
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
- O'Brien Institute of Public Health, University of Calgary, Calgary, AB, Canada
- Infection Prevention and Control, Alberta Health Services, Calgary, AB, Canada
- Department of Microbiology, Immunology, and Infectious Diseases, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
| | - Maitreyi Raman
- Department of Medicine, Cumming School of Medicine, University of Calgary and Alberta Health Services, Calgary, AB, Canada
- Calvin, Phoebe, and Joan Snyder Institute for Chronic Diseases, University of Calgary and Alberta Health Services, Calgary, AB, Canada
| | - Jared R Fletcher
- Department of Health and Physical Education, Mount Royal University, Calgary, AB, Canada
| | - Peter Faris
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
- Department of Analytics, Alberta Health Services, Calgary, AB, Canada
| | - Scott Kraft
- W21 Research and Innovation Centre, University of Calgary and Alberta Health Services, Calgary, AB, Canada
| | - Ye Shen
- Infection Prevention and Control, Alberta Health Services, Calgary, AB, Canada
| | - Thomas Louie
- Department of Medicine, Cumming School of Medicine, University of Calgary and Alberta Health Services, Calgary, AB, Canada
- Infection Prevention and Control, Alberta Health Services, Calgary, AB, Canada
- Department of Microbiology, Immunology, and Infectious Diseases, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
- Calvin, Phoebe, and Joan Snyder Institute for Chronic Diseases, University of Calgary and Alberta Health Services, Calgary, AB, Canada
| | - John M Conly
- O'Brien Institute of Public Health, University of Calgary, Calgary, AB, Canada.
- W21 Research and Innovation Centre, University of Calgary and Alberta Health Services, Calgary, AB, Canada.
- Department of Medicine, Cumming School of Medicine, University of Calgary and Alberta Health Services, Calgary, AB, Canada.
- Infection Prevention and Control, Alberta Health Services, Calgary, AB, Canada.
- Department of Microbiology, Immunology, and Infectious Diseases, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada.
- Calvin, Phoebe, and Joan Snyder Institute for Chronic Diseases, University of Calgary and Alberta Health Services, Calgary, AB, Canada.
- Department of Pathology and Laboratory Medicine, Cumming School of Medicine, University of Calgary and Alberta Health Services, Calgary, AB, Canada.
- AGW5 - Special Services Bldg, Foothills Medical Centre, 1403 29th Street NW, Calgary, AB, Canada, T2N 2T9.
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Taylor LM, Tandon P, Raman M. Using a Patient-Completed Food Frequency Questionnaire to Determine Mediterranean Diet Score in People with Inflammatory Bowel Disease. CAN J DIET PRACT RES 2023; 84:247-250. [PMID: 37265086 DOI: 10.3148/cjdpr-2023-005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
Purpose: To examine the level of agreement between a patient-completed food frequency questionnaire (FFQ) and assessment of usual intake by a registered dietitian (RD) to score adherence to a Mediterranean diet (MedD) in patients with inflammatory bowel disease (IBD).Methods: Patients with IBD completed a short FFQ and were subsequently interviewed by an RD. A 12-item MedD score (MDS), adapted from the Mediterranean Diet Adherence Screener (MEDAS), was calculated from the FFQ and RD assessments. To determine agreement between individual items, Cohen's kappa coefficients were calculated. Absolute agreement between assessment methods was quantified using a one-way random intra-class correlation coefficient for a single measure.Results: Forty-six patients with IBD participated. The mean FFQ-MDS was 4.59 (standard deviation [SD] = 1.65), and mean RD-MDS was 4.83 (SD = 1.53). Kappa coefficients for individual MEDAS items ranged from 0.41 to 0.78 (p < 0.01) between the FFQ- and RD-MDS. Most items demonstrated moderate to substantial agreement. The intra-class correlation coefficient for absolute agreement between the summed FFQ-MDS and RD-MDS was 0.71 (95% confidence interval: 0.52-0.83, p < 0.001), indicating moderate reliability.Conclusions: This patient-completed FFQ may be a promising tool in clinical practice and research and would benefit from additional evaluation to validate its use in patients with IBD.
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Affiliation(s)
| | - Puneeta Tandon
- Division of Gastroenterology (Liver Unit), Department of Medicine, University of Alberta, Zeidler Ledcor Centre, Edmonton, AB
| | - Maitreyi Raman
- Department of Medicine, University of Calgary, Calgary, AB
- Department of Community Health Sciences, University of Calgary, Calgary, AB
- Snyder Institute of Chronic Diseases, University of Calgary, Calgary, AB
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Bedard K, Taylor L, Rajabali N, Kroeker K, Halloran B, Meng G, Raman M, Tandon P, Abraldes JG, Peerani F. Handgrip strength and risk of malnutrition are associated with an increased risk of hospitalizations in inflammatory bowel disease patients. Therap Adv Gastroenterol 2023; 16:17562848231194395. [PMID: 37667803 PMCID: PMC10475242 DOI: 10.1177/17562848231194395] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/05/2023] [Accepted: 07/26/2023] [Indexed: 09/06/2023] Open
Abstract
Background In patients with inflammatory bowel disease (IBD), frailty is independently associated with mortality and morbidity. Objectives This study aimed to extend this work to determine the association between the clinical frailty scale (CFS), handgrip strength (HGS), and malnutrition with IBD-related hospitalizations and surgeries. Design IBD patients ⩾18 years of age were prospectively enrolled from two ambulatory care clinics in Alberta, Canada. Methods Frailty was defined as a CFS score ⩾4, dynapenia as HGS < 16 kg for females and <27 kg for males, malnutrition using the subjective global assessment (SGA), and the risk of malnutrition using either the abridged patient-generated SGA (abPG-SGA), or the Saskatchewan Inflammatory Bowel Disease Nutrition Risk Tool (SaskIBD-NRT). Logarithm relative hazard graphs and multivariable logistic regression models adjusting for relevant confounders were constructed. Results One hundred sixty-one patients (35% ulcerative colitis, 65% Crohn's disease) with a mean age of 42.2 (±15.9) years were followed over a mean period of 43.9 (±10.1) months. Twenty-seven patients were hospitalized, and 13 patients underwent IBD-related surgeries following baseline. While the CFS (aHR 1.34; p = 0.61) and SGA (aHR 0.81; p = 0.69) did not independently predict IBD-related hospitalizations, decreased HGS (aHR 3.96; p = 0.03), increased abPG-SGA score (aHR 1.07; p = 0.03) and a SaskIBD-NRT ⩾ 5 (aHR 4.49; p = 0.02) did. No variable was independently associated with IBD-related surgeries. Conclusion HGS, the abPG-SGA, and the SaskIBD-NRT were independently associated with an increased risk of IBD-related hospitalizations. Future studies should aim to validate other frailty assessments in the IBD population in order to better tailor care for all IBD patients.
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Affiliation(s)
- Katherine Bedard
- Department of Medicine, Faculty of Graduate Studies and Research, University of Alberta, Edmonton, AB, Canada
| | - Lorian Taylor
- Department of Medicine, University of Calgary, Calgary, AB, Canada
| | - Naheed Rajabali
- Division of Geriatric Medicine, University of Alberta, Edmonton, AB, Canada
| | - Karen Kroeker
- Division of Gastroenterology, University of Alberta, Edmonton, AB, Canada
| | - Brendan Halloran
- Division of Gastroenterology, University of Alberta, Edmonton, AB, Canada
| | - Guanmin Meng
- Division of Gastroenterology, University of Alberta, Edmonton, AB, Canada
| | - Maitreyi Raman
- Department of Medicine, University of Calgary, Calgary, AB, Canada
- Department of Community Health Sciences, University of Calgary, Calgary, AB, Canada
| | - Puneeta Tandon
- Division of Gastroenterology, University of Alberta, Edmonton, AB, Canada
| | - Juan G. Abraldes
- Division of Gastroenterology, University of Alberta, Edmonton, AB, Canada
| | - Farhad Peerani
- Division of Gastroenterology, University of Alberta, 1-59 Zeidler Ledcor Centre, 8540 – 112 Street NW, Edmonton AB T6G 2P8, Canada
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7
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Lavallee CM, Bruno A, Ma C, Raman M. A review of the role of intermittent fasting in the management of inflammatory bowel disease. Therap Adv Gastroenterol 2023; 16:17562848231171756. [PMID: 37284561 PMCID: PMC10240551 DOI: 10.1177/17562848231171756] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/16/2022] [Accepted: 04/06/2023] [Indexed: 06/08/2023] Open
Abstract
Intermittent fasting (IF) may be a weight management strategy for patients with inflammatory bowel disease (IBD). The aim of this short narrative review is to summarize the evidence related to IF in the management of IBD. A literature search of English publications related to IF or time-restricted feeding and IBD, Crohn's disease, or ulcerative colitis was conducted in PubMed and Google Scholar. Four publications on studies of IF in IBD were found: three randomized controlled trials in animal models of colitis and one prospective observational study in patients with IBD. The results from animal studies suggest either moderate or no changes in weight but improvements in colitis with IF. These improvements may be mediated through changes in the gut microbiome, decreased oxidative stress and increased colonic short-chain fatty acids. The study in humans was small and uncontrolled, and it did not assess changes in weight, making it difficult to draw conclusions around the effects of IF on changes in weight or disease course. Given that preclinical evidence suggests intermittent fasting may play a beneficial role in IBD, randomized controlled trials in large patients with active disease are warranted to determine whether intermittent fasting could be an integrated therapy for patients with IBD management, either for weight or for disease management. These studies should also explore the potential mechanisms of action related to intermittent fasting.
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Affiliation(s)
| | - Andreina Bruno
- Institute of Translational Pharmacology, National Research Council of Italy (CNR), Palermo, Italy
| | - Christopher Ma
- Department of Medicine, University of Calgary, Calgary, AB, Canada
- Department of Community Health Sciences, University of Calgary, Calgary, AB, Canada
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Strauss JC, Haskey N, Ramay HR, Ghosh TS, Taylor LM, Yousuf M, Ohland C, McCoy KD, Ingram RJM, Ghosh S, Panaccione R, Raman M. Weighted Gene Co-Expression Network Analysis Identifies a Functional Guild and Metabolite Cluster Mediating the Relationship between Mucosal Inflammation and Adherence to the Mediterranean Diet in Ulcerative Colitis. Int J Mol Sci 2023; 24:ijms24087323. [PMID: 37108484 PMCID: PMC10138710 DOI: 10.3390/ijms24087323] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2023] [Revised: 04/09/2023] [Accepted: 04/13/2023] [Indexed: 04/29/2023] Open
Abstract
Diet influences the pathogenesis and clinical course of inflammatory bowel disease (IBD). The Mediterranean diet (MD) is linked to reductions in inflammatory biomarkers and alterations in microbial taxa and metabolites associated with health. We aimed to identify features of the gut microbiome that mediate the relationship between the MD and fecal calprotectin (FCP) in ulcerative colitis (UC). Weighted gene co-expression network analysis (WGCNA) was used to identify modules of co-abundant microbial taxa and metabolites correlated with the MD and FCP. The features considered were gut microbial taxa, serum metabolites, dietary components, short-chain fatty acid and bile acid profiles in participants that experienced an increase (n = 13) or decrease in FCP (n = 16) over eight weeks. WGCNA revealed ten modules containing sixteen key features that acted as key mediators between the MD and FCP. Three taxa (Faecalibacterium prausnitzii, Dorea longicatena, Roseburia inulinivorans) and a cluster of four metabolites (benzyl alcohol, 3-hydroxyphenylacetate, 3-4-hydroxyphenylacetate and phenylacetate) demonstrated a strong mediating effect (ACME: -1.23, p = 0.004). This study identified a novel association between diet, inflammation and the gut microbiome, providing new insights into the underlying mechanisms of how a MD may influence IBD. See clinicaltrials.gov (NCT04474561).
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Affiliation(s)
- Jaclyn C Strauss
- Department of Medicine, Cumming School of Medicine, University of Calgary, 2500 University Drive NW, Calgary, AB T2N 1N4, Canada
| | - Natasha Haskey
- Department of Biology, Irving K Barber Faculty of Science, University of British Columbia-Okanagan, 3137 University Way, Kelowna, BC V1V 1V7, Canada
| | - Hena R Ramay
- International Microbiome Centre, HRIC 4AA08 Foothills Campus, University of Calgary, Calgary, AB T2N 1N4, Canada
| | - Tarini Shankar Ghosh
- APC Microbiome Ireland, College of Medicine and Health, University College Cork, College Road, National University of Ireland, T12 K8AF Cork, Ireland
| | - Lorian M Taylor
- Department of Medicine, Cumming School of Medicine, University of Calgary, 2500 University Drive NW, Calgary, AB T2N 1N4, Canada
| | - Munazza Yousuf
- Department of Medicine, Cumming School of Medicine, University of Calgary, 2500 University Drive NW, Calgary, AB T2N 1N4, Canada
| | - Christina Ohland
- International Microbiome Centre, HRIC 4AA08 Foothills Campus, University of Calgary, Calgary, AB T2N 1N4, Canada
| | - Kathy D McCoy
- International Microbiome Centre, HRIC 4AA08 Foothills Campus, University of Calgary, Calgary, AB T2N 1N4, Canada
| | - Richard J M Ingram
- Department of Medicine, Cumming School of Medicine, University of Calgary, 2500 University Drive NW, Calgary, AB T2N 1N4, Canada
| | - Subrata Ghosh
- APC Microbiome Ireland, College of Medicine and Health, University College Cork, College Road, National University of Ireland, T12 K8AF Cork, Ireland
| | - Remo Panaccione
- Department of Medicine, Cumming School of Medicine, University of Calgary, 2500 University Drive NW, Calgary, AB T2N 1N4, Canada
| | - Maitreyi Raman
- Department of Medicine, Cumming School of Medicine, University of Calgary, 2500 University Drive NW, Calgary, AB T2N 1N4, Canada
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Gold SL, Raman M, Sands BE, Ungaro R, Sabino J. Review article: Putting some muscle into sarcopenia-the pathogenesis, assessment and clinical impact of muscle loss in patients with inflammatory bowel disease. Aliment Pharmacol Ther 2023; 57:1216-1230. [PMID: 37051722 DOI: 10.1111/apt.17498] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/31/2022] [Revised: 03/20/2023] [Accepted: 03/21/2023] [Indexed: 04/14/2023]
Abstract
BACKGROUND Sarcopenia, a loss of skeletal muscle mass or function, affects up to 50% of patients with inflammatory bowel disease (IBD) and is associated with poor clinical outcomes including increased hospitalizations, need for surgery and post-operative complications. Despite the high prevalence and clinical significance of sarcopenia in patients with IBD, few patients undergo routine muscle evaluation. AIM The goal of this study was to review the mechanisms of sarcopenia in patients with IBD and understand novel modalities to assess and treat impaired muscle mass or function. METHODS Pubmed and Cochrane databases were searched including articles published up to February 2023 utilizing the following keywords: "inflammatory bowel disease", "IBD", "Crohn's disease", "ulcerative colitis", "sarcopenia", "myosteatosis", "muscle health", and "frailty". RESULTS The pathogenesis of sarcopenia in IBD is not well defined, however, there is evidence supporting the role of malabsorption, reduced protein intake, chronic inflammation, dysbiosis, decreased physical activity, medication effects and hormone signaling from visceral adiposity. Traditional sarcopenia assessment techniques include direct measurements on cross sectional imaging. However, given the time, cost and radiation exposure associated with cross sectional imaging, new bedside tools are now available to estimate muscle mass, including assessment of grip strength, mid upper arm circumference and body composition utilizing bioelectrical impedance analysis. In addition, novel biomarkers for assessing muscle mass and techniques utilizing point of care ultrasound have been proposed to make sarcopenia evaluation more streamlined in the IBD clinic. CONCLUSION Sarcopenia is associated with poor clinical outcomes independent of IBD activity and therefore muscle health should be assessed in all IBD patients at routine intervals. Future studies to better our understanding of the pathophysiology as well as most effective management of sarcopenia in IBD will help guide clinical care and reduce disease related complications.
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Affiliation(s)
- Stephanie L Gold
- The Dr. Henry D. Janowitz Division of Gastroenterology, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Maitreyi Raman
- Department of Medicine, University of Calgary, Calgary, Canada
| | - Bruce E Sands
- The Dr. Henry D. Janowitz Division of Gastroenterology, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Ryan Ungaro
- The Dr. Henry D. Janowitz Division of Gastroenterology, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - João Sabino
- Department of Gastroenterology and Hepatology, University Hospital Leuven, Leuven, Belgium
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Raman M, Vishnubhotla R, Ramay HR, Gonçalves MCB, Shin AS, Pawale D, Subramaniam B, Sadhasivam S. Isha yoga practices, vegan diet, and participation in Samyama meditation retreat: impact on the gut microbiome & metabolome - a non-randomized trial. BMC Complement Med Ther 2023; 23:107. [PMID: 37020274 PMCID: PMC10074366 DOI: 10.1186/s12906-023-03935-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2022] [Accepted: 03/22/2023] [Indexed: 04/07/2023] Open
Abstract
BACKGROUND Growing evidence suggests a role for gut bacteria and their metabolites in host-signaling responses along the gut-brain axis which may impact mental health. Meditation is increasingly utilized to combat stress, anxiety, and depression symptoms. However, its impact on the microbiome remains unclear. This study observes the effects of preparation and participation in an advanced meditation program (Samyama) implemented with a vegan diet including 50% raw foods, on gut microbiome and metabolites profiles. METHODS There were 288 subjects for this study. Stool samples were collected at 3-time points for meditators and household controls. Meditators prepared for 2 months for the Samyama, incorporating daily yoga and meditation practices with a vegan diet including 50% raw foods. Subjects were requested to submit stool samples for 3 time points - 2 months before Samyama (T1), right before Samyama (T2), and 3 months following Samyama (T3). 16 s rRNA sequencing was used to study participants' microbiome. Alpha and beta diversities along with short-chain fatty acid (SCFA) were assessed. Metabolomics were performed on a mass spectrometer coupled to a UHLPC system and analyzed by El-MAVEN software. RESULTS Alpha diversity showed no significant differences between meditators and controls, while beta diversity showed significant changes (padj = 0.001) after Samyama in meditators' microbiota composition. After the preparation phase, changes in branched short-chain fatty acids, higher levels of iso-valerate (padj = 0.02) and iso-buytrate (padj = 0.019) were observed at T2 in meditators. Other metabolites were also observed to have changed in meditators at timepoint T2. CONCLUSION This study examined the impact of an advanced meditation program combined with a vegan diet on the gut microbiome. There was an increase in beneficial bacteria even three months after the completion of the Samyama program. Further study is warranted to validate current observations and investigate the significance and mechanisms of action related to diet, meditation, and microbial composition and function, on psychological processes, including mood. TRIAL REGISTRATION Registration number: NCT04366544 ; Registered on 29/04/2020.
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Affiliation(s)
- Maitreyi Raman
- Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
| | - Ramana Vishnubhotla
- Department of Radiology and Imaging Sciences, Indiana University School of Medicine, Indianapolis, IN, USA
| | - Hena R Ramay
- International Microbiome Centre, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
| | - Maria C B Gonçalves
- Department of Anesthesia, Critical Care and Pain Medicine, Sadhguru Center for a Conscious Planet, Beth Israel Deaconess Medical Center, Boston, MA, USA
| | - Andrea S Shin
- Division of Gastroenterology and Hepatology, Indiana University School of Medicine, Indianapolis, IN, USA
| | - Dhanashri Pawale
- Department of Anesthesiology and Perioperative Medicine, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - Balachundhar Subramaniam
- Department of Anesthesia, Critical Care and Pain Medicine, Sadhguru Center for a Conscious Planet, Beth Israel Deaconess Medical Center, Boston, MA, USA
| | - Senthilkumar Sadhasivam
- Department of Anesthesiology and Perioperative Medicine, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA.
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Sasson AN, Noelting J, Schwenger K, Armstrong D, Raman M, Duerksen D, Whittaker S, Lu Y, Jurewitsch B, Gramlich L, Ananthakrishnan A, Allard J. A287 HOME PARENTERAL NUTRITION FOR INDIVIDUALS WITH SHORT BOWEL SYNDROME SECONDARY TO CROHN’S DISEASE VERSUS OTHER ETIOLOGIES: A PROSPECTIVE COHORT STUDY. J Can Assoc Gastroenterol 2023. [PMCID: PMC9991271 DOI: 10.1093/jcag/gwac036.287] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/09/2023] Open
Abstract
Background Individuals with short bowel syndrome (SBS) have reduced intestinal absorptive capacity and many require home parenteral nutrition (PN) support. One of the common causes of SBS is secondary to intestinal resections in the management of Crohn’s disease (CD). Complication rates and survival in SBS secondary to CD on PN versus other etiologies remains unknown. Purpose To determine whether patients with SBS secondary to CD versus SBS secondary to other etiologies on home PN, have increased risk of hospitalizations and complications including central line associated bloodstream infection (CLABSI) and venous thromboembolism and whether there is a difference in overall survival between groups. Method This is a multicentre prospective cohort study using the Canadian Home Parenteral Nutrition (HPN) Registry on individuals with defined SBS separated into two cohorts: 1) Patients with SBS secondary to Crohn’s disease vs. 2) Patients with SBS secondary to other aetiologies (trauma, surgical complication, vascular event, volvulus, malignancy). Patient characteristics and clinical factors are presented as mean (standard deviation) for continuous variables and as frequency (percentage) for categorical variables. Comparison between groups (SBS CD vs SBS other) were performed using 2-sample t-test for continuous variables and Chi-square or Fisher exact tests when appropriate for categorical variable. Survival probabilities will be estimated using the Kaplan-Meier method. Result(s) The study included a total of 379 patients with short bowel syndrome on home PN. There are 170 (45%) patients with SBS secondary to CD and 209 (55%) patients with SBS from other secondary causes. The average age of those with CD is 52 and 65% female patients. The average age of those with other causes of SBS is 56 with similar percentage of female patients (65%). There were significant differences in baseline medications with higher use of immunosuppressant therapy (39% vs. 7%, p<0.001) in those with CD. There was no significant difference in total number of hospitalizations, hospitalizations related to PN and CLABSI. Image ![]()
Conclusion(s) Individuals with SBS secondary to CD do not appear to be at increased risk of central line infections or hospitalizations compared those with SBS from other causes. Please acknowledge all funding agencies by checking the applicable boxes below None Disclosure of Interest None Declared
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Affiliation(s)
- A N Sasson
- Gastroenterology, University of Toronto, Toronto, Canada
| | - J Noelting
- Gastroenterology, Essentia Health, Duluth, United States
| | - K Schwenger
- Gastroenterology, University of Toronto, Toronto, Canada
| | - D Armstrong
- Gastroenterology, McMaster University, Hamilton
| | - M Raman
- Gastroenterology, University of Calgary, Calgary
| | - D Duerksen
- Gastroenterology, University of Manitoba, Winnipeg
| | - S Whittaker
- Gastroenterology, University of British Columbia, Vancouver
| | - Y Lu
- Gastroenterology, McGill University, Montreal
| | | | - L Gramlich
- Gastroenterology, University of Alberta, Edmonton, Canada
| | - A Ananthakrishnan
- Gastroenterology, Massachusetts General Hospital, Boston, United States
| | - J Allard
- Gastroenterology, University of Toronto, Toronto, Canada
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12
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Sousa J, Callejas B, Deshpande R, Yousuf M, Taylor L, Wang A, McKay D, Raman M. A196 CROHN’S DISEASE PATIENT DERIVED MACROPHAGES ARE MORE SUSCEPTIBLE TO HYDROGEN PEROXIDE INDUCED CELL DEATH. J Can Assoc Gastroenterol 2023. [PMCID: PMC9991216 DOI: 10.1093/jcag/gwac036.196] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/09/2023] Open
Abstract
Background Crohn’s disease (CD) is characterized by intestinal inflammation due to the interplay between immunity, genetics, and environmental factors such as diet. Selenium (Se) deficiency is common in patients with CD due to malabsorption or high enteric losses. Selenium is used in the synthesis of selenoproteins that have antioxidant properties (e.g. glutathione peroxidases (GPx)) and are highly expressed in macrophages. However, how Se deficiency affects immune system function in patients with CD is unknown. We hypothesize that characterizing Se status, selenoprotein expression and subsequently macrophage function will advance knowledge of mucosal immunity and provide novel insight into CD. Purpose To determine if patients with active CD and healthy controls differ in Se dietary intake and status, oxidative stress, and macrophage cytotoxicity in response to oxidative stress. Method Blood was collected from healthy volunteers and patients diagnosed with ileal, ileocolonic or colonic CD (age ≥18 years, with mild or moderate endoscopic disease activity or fecal calprotectin ≥250 µg/g, and Harvey Bradshaw index <16, stable medications including biologics for at least 8-weeks prior to recruitment). Serum was analyzed for GPx activity, malondialdehyde (MDA) and C-reactive protein (CRP) concentrations. Monocytes were isolated by plastic adherence and treated with M-CSF (10 ng/ml, 7d) to derive macrophages. mRNA expression of GPx1, GPx4 and SelenoP was determined by qPCR. Lactate dehydrogenase release was measured in macrophages treated with 500 µM H2O2 for 2h. Result(s) Samples and/or dietary intake data were collected from 9 patients with CD (3 female, 6 male, mean age=36.8 years) and 13 controls (7 female, 6 male, mean age=27.7 years). Dietary Se intake did not differ between patients with CD and controls (126.1 ± 23.2 vs. 123.3 ± 19.8 µg/day). GPx activity was greater in the serum of patients with CD compared to controls (369 ± 49 vs. 169 ± 27 mU/mL, n=6-8, p<0.005). Patients with CD and controls did not differ in serum MDA concentration (7.80 ± 0.57 vs. 6.53 ± 1.1 µM). CRP levels correlated with serum MDA concentration in patients with CD (r=0.95, n=5, p<0.05) but not GPx activity. Macrophages from patients with CD (n=6) and controls (n=7) did not differ in expression of GPx1 and GPx4 mRNA, whereas SelenoP mRNA was ~200-fold lower in macrophages from patients with CD. Macrophages derived from patients with CD were more susceptible to H2O2-evoked cell death (10.3 ± 1.1 vs. 4.7 ± 0.7 % n=2-3 p<0.05). Conclusion(s) Despite adequate dietary Se intake our findings suggest altered Se metabolism in patients with active CD, with increases in serum GPx potentially indicative of the need for antioxidant activity to counter oxidative stress. The increased sensitivity of macrophages from patients with CD to H2O2 emphasizes the role of oxidative stress and redox balance in IBD. Defining how micronutrients, in this instance Se, impacts innate immunity may provide new approaches to the management of CD. Disclosure of Interest None Declared
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Affiliation(s)
- J Sousa
- Department of Physiology & Pharmacology
| | | | | | - M Yousuf
- Department of Medicine, University of Calgary
| | - L Taylor
- Department of Medicine, University of Calgary
| | - A Wang
- Department of Physiology & Pharmacology
| | - D McKay
- Department of Physiology & Pharmacology,Snyder Institute for Crohnic Diseases
| | - M Raman
- Snyder Institute for Crohnic Diseases,Department of Community Health Sciences, University of Calgary, Calgary, Canada
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Chiew BA, Lyden KA, Schick A, Ohland C, McCoy K, Kaur S, Yousuf M, Taylor L, Raman M, Vallance JK. A77 THE ASSOCIATIONS OF OBJECTIVELY ASSESSED SEDENTARY TIME AND STEP COUNT ON ULCERATIVE COLITIS OUTCOMES. J Can Assoc Gastroenterol 2023. [PMCID: PMC9991098 DOI: 10.1093/jcag/gwac036.077] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/09/2023] Open
Abstract
Background Physical activity has been associated with positive health outcomes in those with Ulcerative Colitis (UC). The extent to which other more prominent behaviours occurring throughout the 24-hour day (i.e., sitting, standing, lying down, and stepping) are associated with UC outcomes is unknown. Purpose The purpose of this study was to explore whether objectively measured time spent sitting, lying down, standing, and stepping were associated with Total Mayo score (TMS), fecal calprotectin (FCP), and C-reactive protein (CRP) in patients with UC. Method Patients were recruited from the Foothills Medical Center in Calgary, Alberta and were given activPALTM accelerometers (PAL Technologies Limited, Glasgow, UK) to wear on their thigh for 7 days. Step count, sitting time, standing time, and time lying down (excluding sleep) were recorded for a minimum of 4 days, including at least one day on the weekend. TMS was used to determine disease activity and patients were categorized into normal/mild (TMS score <6) or moderate/severe (TMS score 6). FCP, a marker of gut inflammation, was measured using stool samples. Blood samples were collected to measure serum CRP, a marker of systemic inflammation. Univariate analysis of covariance (ANCOVA) was used to evaluate associations between the activPALTM daily activity variables, TMS, FCP (< or >250ug/g) and CRP (< or > 5 mg/L). Analyses were controlled for age, sex, body mass index (BMI), and antibiotic use. Result(s) Patients (N=29; 15 male, 14 female) were on average 38 years of age (SD=12.1). The average BMI was 26.2 kg/m2 (SD=3.2). Based on TMS, 14 had moderate/severe disease activity and 16 had normal/mild disease activity. Average CRP was 2.16 mg/L (SD=2.49) while the mean FCP was 954.5 ug/g (SD=1427.7). Patients recorded an average of 8,137 steps (SD=3,051) per day. Average standing time was 240 minutes (SD=84) per day, sitting time was 503 minutes (SD=131) per day, and time spent lying down was 527 minutes (SD=111) per day. FCP was negatively associated with step count (D=-2,134 steps, 95% CI: -4,360 to 93, p=0.06). Patients with lower FCP values (<250mg/g) spent 60 fewer minutes sitting (p=.25), and 52 more minutes standing (p=.12) during the day compared to patients with higher FCP values (>250mg/g). Patients with normal/mild disease severity (TMS <6) spent 83 fewer minutes per day sitting compared to those with moderate/severe disease severity (TMS >6, p=.12). CRP was not associated with any behavioural outcomes. Conclusion(s) In our study, daily steps appeared to be most strongly associated with FCP. While not statistically significant, patients with lower FCP reported less sitting and more standing compared to those with higher FCP. Future studies with larger sample sizes should continue to explore these activity behaviours and their potential associations with UC disease outcomes. Please acknowledge all funding agencies by checking the applicable boxes below Other Please indicate your source of funding; Alberta's Collaboration of Excellence for Nutrition in Digestive Diseases (ASCEND) Disclosure of Interest B. Chiew: None Declared, K. Lyden Consultant of: PAL Technologies, the company that manufactures the activPAL device., A. Schick: None Declared, C. Ohland: None Declared, K. McCoy: None Declared, S. Kaur: None Declared, M. Yousuf: None Declared, L. Taylor: None Declared, M. Raman Shareholder of: LyfeMD – Director, Shareholder, Grant / Research support from: Pfizer, Takeda, Speakers bureau of: Fresenius Kabi, Pfizer, Mckesson, Takeda, Lupin, J. Vallance Grant / Research support from: Canada Research Chairs Program
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Affiliation(s)
- B A Chiew
- Cumming School of Medicine, University of Calgary, Calgary, Canada
| | - K A Lyden
- KAL Research & Consulting, LLC, Denver, United States
| | - A Schick
- University of Calgary, Calgary, Canada
| | - C Ohland
- Department of Physiology and Pharmacology, Snyder Institute of Chronic Disease, Cumming School of Medicine
| | - K McCoy
- International Microbiome Centre, Cumming School of Medicine, University of Calgary
| | - S Kaur
- Cumming School of Medicine, University of Calgary, Calgary, Canada
| | - M Yousuf
- Cumming School of Medicine, University of Calgary, Calgary, Canada
| | - L Taylor
- Cumming School of Medicine, University of Calgary, Calgary, Canada
| | - M Raman
- Cumming School of Medicine, University of Calgary, Calgary, Canada
| | - J K Vallance
- Faculty of Health Disciplines, Athabasca University, Calgary, Canada
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Rosentreter R, Cheng E, Shen H, Ma C, Bhayana D, Panaccione R, Raman M, Medellin A, Lu C. A107 VISCERAL ADIPOSE TISSUE VOLUME DIFFERENTIATES BETWEEN FIBROSTENOTIC AND INFLAMMATORY CROHN’S DISEASE. J Can Assoc Gastroenterol 2023. [PMCID: PMC9991293 DOI: 10.1093/jcag/gwac036.107] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/09/2023] Open
Abstract
Background Creeping fat, a form of visceral adipose tissue (VAT) that wraps the intestinal wall, influences the formation of Crohn’s disease (CD) strictures. The degree of fat wrapping from intestinal stricture resections is correlated with the extent of chronic inflammation, fibrosis, stricture formation, and response to biologic therapy. VAT and subcutaneous adipose tissue (SAT) ratios from CTE (computed tomography) scans are elevated in CD strictures. However, the definition of strictures in these studies has been poorly defined and not included current well-recognized criteria: 1) bowel wall thickness (BWT), 2) narrowed luminal diameter, and 3) pre-stenotic dilation. (PSD). Purpose The objective of this pilot study was to assess the relationship of 2D and 3D VAT:SAT ratios with CT stricture parameters in patients with terminal ileal (TI) CD strictures. Method 2D VAT:SAT ratios from CT’s of CD patients with TI strictures defined as increased BWT, narrowed luminal diameter (< 50% relative to normal adjacent distended loop), and PSD greater than the stricture diameter were retrospectively obtained from a database and chart review. CT’s from fibrostenotic CD patients were sex and BMI matched to patients with only TI inflammatory behaviour. Patient demographics, medication, smoking, and surgical history were also obtained. Analyses were adjusted for age, sex, and BMI covariates. Unpaired t-tests and multi-variable logistic regression analyses were conducted. Result(s) Twenty-eight patients with stricturing CD had a significantly greater mean VAT:SAT volume ratio than 29 non-stricturing CD (41.5 cm3 vs 34.2 cm3, p=0.03). Thirty-six percent (10/28) of CD stricture patients had prior ileocolic resection with a mean disease duration of 13.5 years (range 0-48). The median ileal BWT (7.0 mm, range 4.0-13.0 mm) for the stricturing group was significantly greater than those with inflammatory behaviour (BWT 2.0 mm, p<0.0001). The median luminal diameter and PSD for the stricture group was 2.0 mm (range 0 - 14.0 mm), and 3.0 cm (range 1.0 - 7.3 cm), respectively. Image ![]()
Conclusion(s) Fibrostenotic TI CD patients have increased VAT:SAT ratios in comparison to those with only inflammatory behaviour. These pilot VAT:SAT results provide an initial foundation for further studies to assess its predictive role in responsiveness of medical or surgical therapies in stricturing CD. Please acknowledge all funding agencies by checking the applicable boxes below None Disclosure of Interest None Declared
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Affiliation(s)
| | | | - H Shen
- Department of Mathematics and Statistics
| | - C Ma
- Department of Medicine,Department of Community Health Sciences, University of Calgary, Calgary, Canada
| | | | | | - M Raman
- Department of Medicine,Department of Community Health Sciences, University of Calgary, Calgary, Canada
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15
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Macci A, Klassen R, Rosentreter R, Szostakiwskyj J, Billington E, Panaccione R, Raman M, Burt L, Lu C. A225 QUANTIFICATION OF BONE DENSITY AND DIETARY RISK FACTORS FOR BONE FRAGILITY IN INFLAMMATORY BOWEL DISEASE. J Can Assoc Gastroenterol 2023. [PMCID: PMC9991248 DOI: 10.1093/jcag/gwac036.225] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/09/2023] Open
Abstract
Abstract
Background
Nutrition and bone fracture risk are intimately related in inflammatory bowel disease (IBD). Crohn’s disease (CD) patients are at increased risk of low bone mineral density (BMD) and fractures. This may be due to chronic inflammation, corticosteroid exposure, inadequate consumption of nutrients and minerals such as calcium (ie. lactose intolerance), food aversion, bowel symptoms, and/or possible altered absorption. Fibrostenotic CD is characterized by debilitating strictures where patients are known to alter food intake to avoid obstructive symptoms. However, relationships between food intake patterns and BMD have not been well delineated according to CD phenotypes.
Purpose
Our study evaluated 1) BMD as measured by dual X-ray absorptiometry (DXA), and 2) energy intake, dietary components and/or micronutrients in CD patients with strictures versus inflammatory (non-stricture) behaviour.
Method
In this prospective pilot study, patients > 55 years old with ileal CD strictures or inflammatory behavior were recruited from the University of Calgary IBD clinic. All patients completed hip and spine DXA scans and two dietary assessment questionnaires: 1) The Automated Self-Administered 24-hour Dietary Assessment Tool (ASA24) and 2) the Diet History Questionnaire III (DHQ III). Additional data collected included past fracture history, medication (glucocorticoid exposure), smoking, and surgical history. Standard of care laboratory investigations obtained included C-reactive protein, parathyroid hormone, calcium, albumin, and 25-hydroxyvitamin D. Patients with celiac disease, cirrhosis, heart failure, kidney disease, short gut, estrogen use, and dysphagia were excluded. Independent samples t-test and multi-variable regression analyses was conducted.
Result(s)
Seventeen patients had stricturing and twelve had non-stricturing CD (demographics Table 1). The mean BMD for non-stricturing CD patients was not significantly different from those with a stricturing CD phenotype (p =0.140). Non-stricture patients consumed significantly more dairy, calcium, and phosphate. For all CD patients, there was a positive correlation with BMD and intake of fat (p=0.03), carbohydrates (p=0.01), fiber (p=0.01), and alcohol (p=0.01). There was no statistically significant difference in corticosteroid exposure or smoking status. 74.7% (11/17) patients with stricturing CD had past bowel resection compared to only one patient with non-stricturing CD.
Image
Conclusion(s)
In this pilot study, there was no difference in BMD between CD patients with and without small bowel strictures despite inflammatory behaviour patients having less surgical resections and consuming more calcium rich foods known to improve BMD. Further studies may delineate the dietary differences among CD phenotypes and provide information for interventions for nutrient supplementation, and a greater understanding of their relationships with BMD.
Please acknowledge all funding agencies by checking the applicable boxes below
Other
Please indicate your source of funding;
Koopmans Memorial Research Fund
Disclosure of Interest
None Declared
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Affiliation(s)
- A Macci
- Department of Medicine , University of Calgary Cumming School of Medicine
| | - R Klassen
- Department of Medicine , University of Calgary Cumming School of Medicine
| | - R Rosentreter
- Department of Medicine , University of Calgary Cumming School of Medicine
| | - J Szostakiwskyj
- Department of Medicine , University of Calgary Cumming School of Medicine
| | - E Billington
- Department of Medicine , Alberta Health Services
| | - R Panaccione
- Division of Gastroenterology, Department of Medicine
| | - M Raman
- Department of Medicine , University of Calgary Cumming School of Medicine
| | - L Burt
- Department of Radiology, University of Calgary Cumming School of Medicine , Calgary , Canada
| | - C Lu
- Division of Gastroenterology, Department of Medicine
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Gold SL, Manning L, Kohler D, Ungaro R, Sands B, Raman M. Micronutrients and Their Role in Inflammatory Bowel Disease: Function, Assessment, Supplementation, and Impact on Clinical Outcomes Including Muscle Health. Inflamm Bowel Dis 2023; 29:487-501. [PMID: 36287025 DOI: 10.1093/ibd/izac223] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/19/2022] [Indexed: 12/09/2022]
Affiliation(s)
- Stephanie L Gold
- Dr. Henry D. Janowitz Division of Gastroenterology, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Laura Manning
- Dr. Henry D. Janowitz Division of Gastroenterology, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - David Kohler
- Icahn School of Medicine at Mount Sinai Hospital, New York, NY, USA
| | - Ryan Ungaro
- Dr. Henry D. Janowitz Division of Gastroenterology, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Bruce Sands
- Dr. Henry D. Janowitz Division of Gastroenterology, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Maitreyi Raman
- Department of Medicine, University of Calgary, Calgary, AB, Canada
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Cooper JL, Rosentreter RE, Filyk A, Premji ZA, Shen H, Ingram R, Kaplan GG, Ma C, Novak K, Panaccione R, Seow CH, Rieder F, Raman M, Lu C. Nutritional interventions in adult fibrostenotic Crohn's disease: A systematic review. Front Nutr 2023; 10:1017382. [PMID: 36895272 PMCID: PMC9988909 DOI: 10.3389/fnut.2023.1017382] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2022] [Accepted: 02/03/2023] [Indexed: 02/23/2023] Open
Abstract
Background Management of Crohn's disease (CD) using dietary interventions has become an area of increased research interest. There is a lack of specific research exploring if diet and nutrition interventions are beneficial in patients with strictures, as current dietary recommendations in fibrostenotic CD are often based on clinical judgment. The aim of this systematic review was to assess the impact of dietary interventions in fibrostenotic CD on medical and surgical outcomes. Methods A systematic search of MEDLINE (Ovid), EMBASE (Ovid), CINAHL (EBSCO), and Cochrane Central Register of Controlled Trials (Ovid) was conducted. Studies reporting dietary interventions or nutritional factors in fibrostenotic CD were included. Outcomes for studies assessing dietary interventions such as enteral nutrition were evaluated as changes in (1) CD symptoms (CD Activity Index), (2) stricture parameters on diagnostic imaging, and (3) rates of surgical or medical intervention following dietary interventions. Results Five studies were included in this review. Three studies assessed exclusive enteral nutrition (EEN), one evaluated total parenteral nutrition (TPN), and one studied a liquid diet. All included studies evaluated symptoms as an outcome, while diagnostic imaging parameters and surgical outcomes in the studies were either absent or too heterogeneous to appraise improvement post dietary intervention. Included EEN studies displayed similar efficacy, with approximately 60% of patients having symptom improvement. The included TPN study also reported 75% of patients with symptom improvement, while the liquid diet did not. Conclusion Exclusive enteral nutrition and total parental nutrition may provide benefit for use as a dietary intervention for fibrostenotic CD. There remains a need for high-quality controlled trials which utilize standardized definitions of strictures.
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Affiliation(s)
- Jared L. Cooper
- Department of Medicine, University of Calgary, Calgary, AB, Canada
| | - Ryan E. Rosentreter
- Division of Gastroenterology and Hepatology, Department of Medicine, University of Calgary, Calgary, AB, Canada
| | - Alexis Filyk
- Division of Gastroenterology and Hepatology, Department of Medicine, University of Calgary, Calgary, AB, Canada
| | | | - Hua Shen
- Department of Mathematics and Statistics, University of Calgary, Calgary, AB, Canada
| | - Richard Ingram
- Division of Gastroenterology and Hepatology, Department of Medicine, University of Calgary, Calgary, AB, Canada
| | - Gilaad G. Kaplan
- Division of Gastroenterology and Hepatology, Department of Medicine, University of Calgary, Calgary, AB, Canada
- Department of Community Health Sciences, University of Calgary, Calgary, AB, Canada
| | - Christopher Ma
- Division of Gastroenterology and Hepatology, Department of Medicine, University of Calgary, Calgary, AB, Canada
- Department of Community Health Sciences, University of Calgary, Calgary, AB, Canada
| | - Kerri Novak
- Division of Gastroenterology and Hepatology, Department of Medicine, University of Calgary, Calgary, AB, Canada
| | - Remo Panaccione
- Division of Gastroenterology and Hepatology, Department of Medicine, University of Calgary, Calgary, AB, Canada
| | - Cynthia H. Seow
- Division of Gastroenterology and Hepatology, Department of Medicine, University of Calgary, Calgary, AB, Canada
- Department of Community Health Sciences, University of Calgary, Calgary, AB, Canada
| | - Florian Rieder
- Department of Inflammation and Immunity, Lerner Research Institute, Cleveland Clinic Foundation, Cleveland, OH, United States
- Department of Gastroenterology, Hepatology and Nutrition, Digestive Diseases and Surgery Institute, Cleveland Clinic Foundation, Cleveland, OH, United States
| | - Maitreyi Raman
- Division of Gastroenterology and Hepatology, Department of Medicine, University of Calgary, Calgary, AB, Canada
- Department of Community Health Sciences, University of Calgary, Calgary, AB, Canada
| | - Cathy Lu
- Division of Gastroenterology and Hepatology, Department of Medicine, University of Calgary, Calgary, AB, Canada
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Haskey N, Gold SL, Faith JJ, Raman M. To Fiber or Not to Fiber: The Swinging Pendulum of Fiber Supplementation in Patients with Inflammatory Bowel Disease. Nutrients 2023; 15:nu15051080. [PMID: 36904081 PMCID: PMC10005525 DOI: 10.3390/nu15051080] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2023] [Revised: 02/18/2023] [Accepted: 02/20/2023] [Indexed: 02/24/2023] Open
Abstract
Evidence-based dietary guidance around dietary fiber in inflammatory bowel disease (IBD) has been limited owing to insufficient reproducibility in intervention trials. However, the pendulum has swung because of our increased understanding of the importance of fibers in maintaining a health-associated microbiome. Preliminary evidence suggests that dietary fiber can alter the gut microbiome, improve IBD symptoms, balance inflammation, and enhance health-related quality of life. Therefore, it is now more vital than ever to examine how fiber could be used as a therapeutic strategy to manage and prevent disease relapse. At present, there is limited knowledge about which fibers are optimal and in what form and quantity they should be consumed to benefit patients with IBD. Additionally, individual microbiomes play a strong role in determining the outcomes and necessitate a more personalized nutritional approach to implementing dietary changes, as dietary fiber may not be as benign as once thought in a dysbiotic microbiome. This review describes dietary fibers and their mechanism of action within the microbiome, details novel fiber sources, including resistant starches and polyphenols, and concludes with potential future directions in fiber research, including the move toward precision nutrition.
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Affiliation(s)
- Natasha Haskey
- Department of Biology, The Irving K. Barber Faculty of Science, University of British Columbia—Okanagan, 3187 University Way, Kelowna, BC V1V 1V7, Canada
- Division of Gastroenterology, Cumming School of Medicine, University of Calgary, 6D33 TRW Building, 3280 Hospital Drive NW, Calgary, AB T2N 4N1, Canada
| | - Stephanie L. Gold
- Division of Gastroenterology, Icahn School of Medicine at Mount Sinai, 1 Gustave L. Levy Place, New York, NY 10029, USA
| | - Jeremiah J. Faith
- Precision Immunology Institute and Department of Genetics and Genomic Sciences, Icahn School of Medicine at Mount Sinai, 1 Gustave L. Levy Place, New York, NY 10029, USA
| | - Maitreyi Raman
- Division of Gastroenterology, Cumming School of Medicine, University of Calgary, 6D33 TRW Building, 3280 Hospital Drive NW, Calgary, AB T2N 4N1, Canada
- Correspondence:
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Lavallee CM, Bruno A, Ma C, Raman M. The Role of Intermittent Fasting in the Management of Nonalcoholic Fatty Liver Disease: A Narrative Review. Nutrients 2022; 14:4655. [PMID: 36364915 PMCID: PMC9657169 DOI: 10.3390/nu14214655] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2022] [Revised: 10/28/2022] [Accepted: 10/29/2022] [Indexed: 08/30/2023] Open
Abstract
Intermittent fasting is a non-pharmacological dietary approach to management of obesity and metabolic syndrome, involving periodic intervals of complete or near-complete abstinence from food and energy-containing fluids. This dietary strategy has recently gained significant popularity in mainstream culture and has been shown to induce weight loss in humans, reduce gut and systemic inflammation, and improve gut microbial diversity and dysbiosis (largely in animal models). It has been hypothesized that intermittent fasting could be beneficial in the management of nonalcoholic fatty liver disease, given the condition's association with obesity. This review summarizes protocols, potential mechanisms of action, and evidence for intermittent fasting in nonalcoholic fatty liver disease. It also highlights practical considerations for implementing intermittent fasting in clinical practice. A search of the literature for English-language articles related to intermittent fasting or time-restricted feeding and liver disease was completed in PubMed and Google Scholar. Potential mechanisms of action for effects of intermittent fasting included modulation of circadian rhythm, adipose tissue and adipokines, gut microbiome, and autophagy. Preclinical, epidemiological, and clinical trial data suggested clinical benefits of intermittent fasting on metabolic and inflammatory markers in humans. However, there was a paucity of evidence of its effects in patients with nonalcoholic fatty liver disease. More clinical studies are needed to determine mechanisms of action and to evaluate safety and efficacy of intermittent fasting in this population.
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Affiliation(s)
| | - Andreina Bruno
- Institute of Translational Pharmacology, National Research Council of Italy (CNR), Via Ugo La Malfa, 153, 90146 Palermo, Italy
| | - Christopher Ma
- Department of Medicine, University of Calgary, Calgary, AB T2N 4N1, Canada
- Department of Community Health Sciences, University of Calgary, Calgary, AB T2N 4N1, Canada
| | - Maitreyi Raman
- Department of Medicine, University of Calgary, Calgary, AB T2N 4N1, Canada
- Department of Community Health Sciences, University of Calgary, Calgary, AB T2N 4N1, Canada
- Snyder Institute of Chronic Diseases, University of Calgary, Calgary, AB T2N 4N1, Canada
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20
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Peerani F, Watt M, Ismond KP, Whitlock R, Ambrosio L, Hotte N, Mitchell N, Bailey RJ, Kroeker K, Dieleman LA, Siffledeen J, Lim A, Wong K, Halloran BP, Baumgart DC, Taylor L, Raman M, Madsen KL, Tandon P. A randomized controlled trial of a multicomponent online stress reduction intervention in inflammatory bowel disease. Therap Adv Gastroenterol 2022; 15:17562848221127238. [PMID: 36187365 PMCID: PMC9520184 DOI: 10.1177/17562848221127238] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/08/2022] [Accepted: 08/30/2022] [Indexed: 02/04/2023] Open
Abstract
BACKGROUND Psychological stress negatively impacts inflammatory bowel disease (IBD) outcomes. Patients have prioritized access to online interventions; yet, the data on these have been limited by mixed in-person/online interventions, low adherence, and non-randomized controlled trial (RCT) design. OBJECTIVES We assessed the efficacy of and adherence to a 12-week online multicomponent stress reduction intervention in IBD. DESIGN This is a RCT. METHODS Adult participants on stable IBD medical therapy with elevated stress levels from four centers were randomized to intervention or control groups. Intervention participants received a 12-week online program including a weekly yoga, breathwork and meditation video (target 2-3 times/week), a weekly cognitive behavioral therapy/positive psychology informed video activity, and weekly 10-min check-ins by a study team member. Control participants received weekly motivational messages by email. All patients received standard of care IBD therapy. The primary outcome was Cohen's Perceived Stress Scale (PSS). Secondary outcomes evaluated mental health, resilience, health-related quality of life (HRQoL), symptom indices, acceptability, adherence, and inflammatory biomarkers. Analysis of covariance was used to determine between-group differences. RESULTS Of 150 screened patients, 101 were randomized to the intervention (n = 49) and control (n = 52) groups (mean age: 42.5 ± 14.1 years; M:F 1:3, 48% with ulcerative colitis and 52% with Crohn's disease). The between-group PSS improved by 22.4% (95% confidence interval, 10.5-34.3, p < 0.001). Significant improvements were seen in mental health, resilience, and HRQoL measures, with a median satisfaction score of 89/100 at the end of the 12 weeks. In the 44/49 patients who completed the intervention, 91% achieved program adherence targets. CONCLUSION This 12-week online intervention improved perceived stress, mental health, and HRQoL, but did not impact IBD symptom indices or inflammatory biomarkers. The program was readily adopted and adhered to by participants with high retention rates. After iterative refinement based on participant feedback, future studies will evaluate the impact of a longer/more intense intervention on disease course. REGISTRATION ClinicalTrials.gov Identifier NCT03831750. PLAIN LANGUAGE SUMMARY An online stress reduction intervention in inflammatory bowel disease patients improves stress, mental health, and quality of life People with inflammatory bowel disease (IBD) have high levels of stress, anxiety, and depression. Although IBD patients have expressed the need for online mental wellness interventions, the existing data to support these interventions in IBD are limited. In this trial, 101 IBD patients had the chance to participate in a 12-week online stress reduction intervention. In those patients randomly selected to participate in the online intervention, each week they received the following: a 20- to 30-min yoga, breathwork, and meditation video that they were asked to do 2-3 times a week, a 10- to 20-min mental wellness activity they were asked to do once during the week, and a 10-min telephone check-in with a study team member. Participants who were not selected to use the online intervention received a weekly motivational message by email. In all, 90 of the 101 participants (89%) completed the study with the mean age of participants being 43 years and the majority being females (75%). Ninety-one percent of participants who completed the intervention met the program target of doing the yoga, breathwork, and meditation video at least 2 times per week. Significant improvements were seen in perceived stress (by 22.4%), depression (by 29.5%), anxiety (by 23.7%), resilience (by 10.6%), and quality of life (by 8.9%). No changes were seen in IBD severity or in blood markers of inflammation. In conclusion, this study demonstrates evidence that a 12-week online stress reduction intervention had low dropout rates, high adherence and beneficial effects on stress, mental health, and quality of life measures. Continued feedback will be sought from study participants and our IBD patient partners to refine the intervention and assess the impact in future studies of patients with active IBD, as well as the impact of a longer/more intense intervention.
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Affiliation(s)
- Farhad Peerani
- Division of Gastroenterology, Department of Medicine, University of Alberta, Edmonton, AB, Canada
| | - Makayla Watt
- Division of Gastroenterology, Department of Medicine, University of Alberta, Edmonton, AB, Canada
| | - Kathleen P Ismond
- Division of Gastroenterology, Department of Medicine, University of Alberta, Edmonton, AB, Canada
| | - Reid Whitlock
- Chronic Disease Innovation Centre, Seven Oaks General Hospital, Winnipeg, MB, Canada
| | - Lindsy Ambrosio
- Division of Gastroenterology, Department of Medicine, University of Alberta, Edmonton, AB, Canada
| | - Naomi Hotte
- Division of Gastroenterology, Department of Medicine, University of Alberta, Edmonton, AB, Canada
| | - Nicholas Mitchell
- Department of Psychiatry, University of Alberta, Edmonton, AB, Canada
| | - Robert J Bailey
- Division of Gastroenterology, Department of Medicine, University of Alberta, Edmonton, AB, Canada
| | - Karen Kroeker
- Division of Gastroenterology, Department of Medicine, University of Alberta, Edmonton, AB, Canada
| | - Levinus A Dieleman
- Division of Gastroenterology, Department of Medicine, University of Alberta, Edmonton, AB, Canada
| | - Jesse Siffledeen
- Division of Gastroenterology, Department of Medicine, University of Alberta, Edmonton, AB, Canada
| | - Allen Lim
- Division of Gastroenterology, Department of Medicine, University of Alberta, Edmonton, AB, Canada
| | - Karen Wong
- Division of Gastroenterology, Department of Medicine, University of Alberta, Edmonton, AB, Canada
| | - Brendan P Halloran
- Division of Gastroenterology, Department of Medicine, University of Alberta, Edmonton, AB, Canada
| | - Daniel C Baumgart
- Division of Gastroenterology, Department of Medicine, University of Alberta, Edmonton, AB, Canada
| | - Lorian Taylor
- Division of Gastroenterology, University of Calgary, Calgary, AB, Canada
| | - Maitreyi Raman
- Division of Gastroenterology, University of Calgary, Calgary, AB, Canada
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21
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D’Silva A, Marshall DA, Vallance JK, Nasser Y, Taylor LM, Lazarescu A, Raman M. Gastroenterologist and Patient Attitudes Toward Yoga as a Therapy for Irritable Bowel Syndrome: An Application of the Theory of Planned Behaviour. J Can Assoc Gastroenterol 2022; 6:17-25. [PMID: 36789144 PMCID: PMC9915057 DOI: 10.1093/jcag/gwac028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Objectives To identify irritable bowel syndrome (IBS) patients' attitudes, subjective norms, perceived control and intention to practice yoga and gastroenterologists' attitudes and current yoga recommendations for their patients with IBS. Methods Gastroenterologists and IBS patients completed online surveys including Theory of Planned Behaviour (TPB) constructs. Among IBS patients, multiple linear regression determined the multivariate associations between TPB variables and intention to practice yoga while controlling for significant socio-demographic variables. Gastroenterologists were asked about their attitudes and current yoga recommendations for patients with IBS. Chi-square analyses examined associations between gastroenterologists' demographics and recommending yoga. Binomial logistic regression described associations between attitude variables and current yoga recommendations. Results For patients (n = 109), controllability (β = 0.5, P < 0.001), affective attitude (β = 0.4, P < 0.05) and self-efficacy (β = 0.3, P < 0.05) were significantly associated with intention to do yoga in the regression model. TPB variables explained 34% of the variance in patients' intentions to practice yoga. The binomial regression analysis revealed that gastroenterologists (n = 79) who have confidence in recommending yoga (39%) were seven times more likely to recommend it (odds ratio = 7.3, P = 0.002) and those who agreed yoga improves IBS symptom severity (54%) were 10 times more likely to recommend yoga (odds ratio = 10.1, P < 0.001). Most (86%) wanted more evidence to support efficacy of yoga for IBS and 44% asked for more knowledge on how to refer a patient. Conclusion Controllability, affective attitude and self-efficacy predicted IBS patients' intentions to practice yoga. Although gastroenterologists believed yoga is safe and beneficial for IBS patients, most do not recommend yoga due to lack of confidence and scientific evidence.
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Affiliation(s)
- Adrijana D’Silva
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Deborah A Marshall
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada,Arthur J.E. Child Chair, Department of Medicine, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Jeff K Vallance
- Faculty of Health Disciplines, Athabasca University, Athabasca, Alberta, Canada
| | - Yasmin Nasser
- Division of Gastroenterology and Hepatology, Department of Medicine, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada,Snyder Institute for Chronic Diseases, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Lorian M Taylor
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Adriana Lazarescu
- Division of Gastroenterology, Department of Medicine, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Alberta, Canada
| | - Maitreyi Raman
- Correspondence: Maitreyi Raman, MD, Faculty of Medicine, University of Calgary, 6D33 TRW Building, 3280 Hospital Drive NW, Calgary, Alberta, T2N 4Z6, Canada, e-mail:
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22
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Gold SL, Raman M. Editorial: a formula shake each day keeps the complications away - the tolerability and effect of orally-delivered enteral nutrition in improving post-operative outcomes in patients with Crohn's disease. Aliment Pharmacol Ther 2022; 56:739-740. [PMID: 35879892 DOI: 10.1111/apt.17087] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/09/2022]
Affiliation(s)
- Stephanie L Gold
- The Dr. Henry D. Janowitz Division of Gastroenterology, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Maitreyi Raman
- Department of Medicine, Division of Gastroenterology and Hepatology, University of Calgary, Calgary, Alberta, Canada
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23
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Ratcliffe H, Tiley KS, Andrews N, Amirthalingam G, Vichos I, Morey E, Douglas NL, Marinou S, Plested E, Aley P, Galiza EP, Faust SN, Hughes S, Murray CS, Roderick M, Shackley F, Oddie SJ, Lees T, Turner DPJ, Raman M, Owens S, Turner P, Cockerill H, Lopez Bernal J, Linley E, Borrow R, Brown K, Ramsay ME, Voysey M, Snape MD. Community seroprevalence of SARS-CoV-2 in children and adolescents in England, 2019-2021. Arch Dis Child 2022; 108:archdischild-2022-324375. [PMID: 35858775 PMCID: PMC9887370 DOI: 10.1136/archdischild-2022-324375] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/05/2022] [Accepted: 06/23/2022] [Indexed: 02/03/2023]
Abstract
OBJECTIVE To understand community seroprevalence of SARS-CoV-2 in children and adolescents. This is vital to understanding the susceptibility of this cohort to COVID-19 and to inform public health policy for disease control such as immunisation. DESIGN We conducted a community-based cross-sectional seroprevalence study in participants aged 0-18 years old recruiting from seven regions in England between October 2019 and June 2021 and collecting extensive demographic and symptom data. Serum samples were tested for antibodies against SARS-CoV-2 spike and nucleocapsid proteins using Roche assays processed at UK Health Security Agency laboratories. Prevalence estimates were calculated for six time periods and were standardised by age group, ethnicity and National Health Service region. RESULTS Post-first wave (June-August 2020), the (anti-spike IgG) adjusted seroprevalence was 5.2%, varying from 0.9% (participants 10-14 years old) to 9.5% (participants 5-9 years old). By April-June 2021, this had increased to 19.9%, varying from 13.9% (participants 0-4 years old) to 32.7% (participants 15-18 years old). Minority ethnic groups had higher risk of SARS-CoV-2 seropositivity than white participants (OR 1.4, 95% CI 1.0 to 2.0), after adjusting for sex, age, region, time period, deprivation and urban/rural geography. In children <10 years, there were no symptoms or symptom clusters that reliably predicted seropositivity. Overall, 48% of seropositive participants with complete questionnaire data recalled no symptoms between February 2020 and their study visit. CONCLUSIONS Approximately one-third of participants aged 15-18 years old had evidence of antibodies against SARS-CoV-2 prior to the introduction of widespread vaccination. These data demonstrate that ethnic background is independently associated with risk of SARS-CoV-2 infection in children. TRIAL REGISTRATION NUMBER NCT04061382.
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Affiliation(s)
| | - K S Tiley
- Department of Paediatrics, University of Oxford, Oxford, UK
| | - Nick Andrews
- Statistics, Modelling and Economics Department, Health Protection Agency, London, UK
| | - Gayatri Amirthalingam
- Immunisation, Hepatitis and Blood Safety Department, Public Health England, London, UK
| | - I Vichos
- Department of Paediatrics, University of Oxford, Oxford, UK
| | - E Morey
- Department of Paediatrics, University of Oxford, Oxford, UK
| | - N L Douglas
- Department of Paediatrics, University of Oxford, Oxford, UK
| | - S Marinou
- Department of Paediatrics, University of Oxford, Oxford, UK
| | - Emma Plested
- Department of Paediatrics, University of Oxford, Oxford, UK
| | - Parvinder Aley
- Department of Paediatrics, University of Oxford, Oxford, UK
| | - Eva P Galiza
- St George's Vaccine Institute, St. George's University Hospitals NHS Foundation Trust, London, UK
| | - Saul N Faust
- Academic Unit of Clinical & Experimental Sciences, Faculty of Medicine, University of Southampton, Southampton, UK
- NIHR Wellcome Trust Clinical Research Facility, University Hospital Southampton NHS Foundation Trust, Southampton, UK
| | - S Hughes
- Department of Paediatrics, Royal Manchester Children's Hospital, Manchester, UK
| | - Clare S Murray
- Department of Paediatrics, Royal Manchester Children's Hospital, Manchester, UK
- Respiratory Group, University of Manchester, Manchester, UK
| | - Marion Roderick
- Paediatric Infectious Diseases and Immunology, University Hospitals Bristol NHS Foundation Trust, Bristol, UK
| | - Fiona Shackley
- Immunology, Allergy and Infectious Diseases, Sheffield Children's Hospital NHS Foundation Trust, Sheffield, UK
| | - Sam J Oddie
- Bradford Neonatology, Bradford Teaching Hospitals NHS Foundation Trust, West Yorkshire, UK
| | - Tim Lees
- Paediatric Respiratory Medicine, Leeds Teaching Hospitals NHS Trust, Leeds, UK
| | - D P J Turner
- School of Life Sciences, University of Nottingham and Nottingham University Hospitals NHS Trust, Nottingham, UK
| | - M Raman
- Department of Paediatrics, University Hospitals Plymouth NHS Trust, Plymouth, UK
| | - Stephen Owens
- Paediatric Immunology and Infectious Diseases, Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, UK
- Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, UK
| | - Paul Turner
- Section of Paediatrics, Imperial College London, London, UK
| | - H Cockerill
- Department of Paediatrics, West Suffolk NHS Foundation Trust, Bury Saint Edmunds, UK
| | - J Lopez Bernal
- Immunisation, Hepatitis and Blood Safety Department, Public Health England, London, UK
| | - E Linley
- Vaccine Evaluation Unit, UK Health Security Agency, London, UK
| | - Ray Borrow
- Vaccine Evaluation Unit, UK Health Security Agency, London, UK
| | - Kevin Brown
- Virus Reference Department, Public Health England, Colindale, UK
| | - Mary Elizabeth Ramsay
- Immunisation, Hepatitis and Blood Safety Department, Public Health England, London, UK
| | - M Voysey
- Department of Paediatrics, University of Oxford, Oxford, UK
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24
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Limon-Miro AT, Jackson CD, Eslamparast T, Yamanaka-Okumura H, Plank LD, Henry CJ, Madden AM, Ferreira LG, Kalaitzakis E, Prieto de Frías C, Knudsen AW, Gramlich L, Raman M, Alberda C, Belland D, Den Heyer V, Tandon P, Morgan MY. Predicted estimates of resting energy expenditure have limited clinical utility in patients with cirrhosis. J Hepatol 2022; 77:98-107. [PMID: 35090958 DOI: 10.1016/j.jhep.2022.01.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/11/2021] [Revised: 01/11/2022] [Accepted: 01/13/2022] [Indexed: 12/11/2022]
Abstract
BACKGROUND & AIMS Malnutrition is associated with adverse clinical outcomes in patients with cirrhosis. Accurate assessment of energy requirements is needed to optimize dietary intake. Resting energy expenditure (REE), the major component of total energy expenditure, can be measured using indirect calorimetry (mREE) or estimated using prediction equations (pREE). This study assessed the usefulness of predicted estimates of REE in this patient population. METHODS Individual mREE data were available for 900 patients with cirrhosis (mean [±1 SD] age 55.7±11.6 years-old; 70% men; 52% south-east Asian) and 282 healthy controls (mean age 36.0±12.8 years-old; 52% men; 18% south-east Asian). Metabolic status was classified using thresholds based on the mean ± 1 SD of the mREE in the healthy controls. Comparisons were made between mREE and pREE estimates obtained using the Harris-Benedict, Mifflin, Schofield and Henry equations. Stepwise regression was used to build 3 new prediction models which included sex, ethnicity, body composition measures, and model for end-stage liver disease scores. RESULTS The mean mREE was significantly higher in patients than controls when referenced to dry body weight (22.4±3.8 cf. 20.8±2.6 kcal/kg/24 hr; p <0.001); there were no significant sex differences. The mean mREE was significantly higher in Caucasian than Asian patients (23.1±4.4 cf. 21.7±2.9 kcal/kg/24 hr; p <0.001). Overall, 37.1% of Caucasian and 25.3% of Asian patients were classified as hypermetabolic. The differences between mREE and pREE were both statistically and clinically relevant; in the total patient population, pREE estimates ranged from 501 kcal/24 hr less to 548 kcal/24 hr more than the mREE. Newly derived prediction equations provided better estimates of mREE but still had limited clinical utility. CONCLUSIONS Prediction equations do not provide useful estimates of REE in patients with cirrhosis. REE should be directly measured. LAY SUMMARY People with cirrhosis are often malnourished and this has a detrimental effect on outcome. Provision of an adequate diet is very important and is best achieved by measuring daily energy requirements and adjusting dietary intake accordingly. Prediction equations, which use information on age, sex, weight, and height can be used to estimate energy requirements; however, the results they provide are not accurate enough for clinical use, particularly as they vary according to sex and ethnicity.
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Affiliation(s)
| | - Clive Douglas Jackson
- Department of Clinical Neurophysiology, Royal Free Hospital, Royal Free London NHS Foundation Trust, London, UK
| | | | - Hisami Yamanaka-Okumura
- Department of Clinical Nutrition and Food Management, Institute of Biomedical Sciences, Tokushima University Graduate School, Kuramoto-cho, Tokushima, Japan
| | | | | | - Angela Mary Madden
- School of Life and Medical Sciences, University of Hertfordshire, Hatfield, UK
| | - Livia Garcia Ferreira
- Graduate Program in Nutrition and Health, Department of Nutrition, Universidade Federal de Lavras, Brazil
| | - Evangelos Kalaitzakis
- Gastro Unit, Division of Endoscopy, Copenhagen University Hospital Herlev, Denmark; Department of Gastroenterology, University Hospital of Heraklion, University of Crete, Heraklion, Greece
| | | | - Anne Wilkens Knudsen
- Gastrounit, Medical Division, Copenhagen University Hospital - Hvidovre, Denmark
| | - Leah Gramlich
- Department of Medicine, University of Alberta, Edmonton, Canada
| | - Maitreyi Raman
- Department of Medicine, Division of Gastroenterology, University of Calgary, Calgary, Alberta, Canada
| | - Cathy Alberda
- Royal Alexandra Hospital, Alberta Health Services, Edmonton, Alberta, Canada
| | - Dawn Belland
- University of Alberta Hospital, Alberta Health Services Nutrition Services, Edmonton, Canada
| | - Vanessa Den Heyer
- University of Alberta Hospital, Alberta Health Services Nutrition Services, Edmonton, Canada
| | - Puneeta Tandon
- Department of Medicine, University of Alberta, Edmonton, Canada.
| | - Marsha Yvonne Morgan
- UCL Institute for Liver & Digestive Health, Division of Medicine, Royal Free Campus, University College London, UK.
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Raman M, Rajagopalan V, Kaur S, Reimer RA, Ma C, Ghosh S, Vallance J. Physical Activity in Patients With Inflammatory Bowel Disease: A Narrative Review. Inflamm Bowel Dis 2022; 28:1100-1111. [PMID: 34605548 DOI: 10.1093/ibd/izab218] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/27/2021] [Indexed: 12/15/2022]
Abstract
BACKGROUND Despite advancement in the treatment of inflammatory bowel disease (IBD), induction and maintenance of remission remain challenging to achieve in many patients and a significant proportion of patients with IBD experience mental health conditions, including anxiety, depression, and fatigue, which impair their quality of life (QoL). We aim to describe the available evidence regarding the effects of physical activity (PA) on the onset of IBD, its disease course, and important patient-reported outcome measures (PROMs), such as QoL, fatigue, and mental health. METHODS A literature search was performed using electronic databases to identify original articles that assessed the effects of PA in patients with IBD using PROMs. RESULTS Prospective cohort and case-control studies demonstrate inverse relationships between PA and new-onset IBD in Crohn's disease but not in ulcerative colitis; however, they have small sample sizes and caution must be taken in considering associations versus causation. Small randomized controlled trials suggest promise for PA and beneficial outcomes, such as maintenance of clinical remission and improvement in QoL, fatigue, depression, and anxiety. However, these studies were small and underpowered, and limited by outcome measurements and durations of follow-up. CONCLUSIONS Physicians may consider discussing PA interventions with their patients on an individual basis, especially if they report impaired QoL, fatigue, depression, or anxiety, until disease-specific guidelines are available. Including PA as part of a primary prevention strategy in high-risk patients could be considered.
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Affiliation(s)
- Maitreyi Raman
- Department of Medicine, Cumming School of Medicine, University of Calgary, Calgary, ABCanada
| | - Vidya Rajagopalan
- Department of Medicine, Cumming School of Medicine, University of Calgary, Calgary, ABCanada
| | - Sandeep Kaur
- Department of Medicine, Cumming School of Medicine, University of Calgary, Calgary, ABCanada
| | | | - Christopher Ma
- Department of Medicine, Cumming School of Medicine, University of Calgary, Calgary, ABCanada
| | - Subrata Ghosh
- College of Medicine and Health, University College Cork, Cork, Ireland
| | - Jeff Vallance
- Faculty of Health Disciplines, Athabasca University, Athabasca, Canada
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Raman M, Reimer RA, Ghosh S, Vallance J. The Importance of Physical Activity in Patients With Inflammatory Bowel Disease: A Narrative Review. Inflamm Bowel Dis 2022; 28:e89. [PMID: 34919683 DOI: 10.1093/ibd/izab325] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/09/2022]
Affiliation(s)
- Maitreyi Raman
- Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
| | - Raylene A Reimer
- Faculty of Kinesiology, University of Calgary, Calgary, AB, Canada
| | - Subrata Ghosh
- College of Medicine and Health, University College Cork, Cork, Ireland
| | - Jeff Vallance
- Faculty of Health Disciplines, Athabasca University, Athabasca, AB, Canada
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D'Silva A, Fox DE, Raman M. Reply. Clin Gastroenterol Hepatol 2022; 20:1416-1417. [PMID: 34411710 DOI: 10.1016/j.cgh.2021.08.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/10/2021] [Accepted: 08/12/2021] [Indexed: 02/07/2023]
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D'Silva A, Marshall DA, Vallance J, Nasser Y, Rajagopalan V, MacKean G, Raman M. Meditation and yoga for irritable bowel syndrome: study protocol for a randomised clinical trial (MY-IBS study). BMJ Open 2022; 12:e059604. [PMID: 35618329 PMCID: PMC9137346 DOI: 10.1136/bmjopen-2021-059604] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
INTRODUCTION When delivered in person, yoga has been shown to be effective in managing irritable bowel syndrome (IBS) symptoms. Research is needed to test the feasibility and effectiveness of yoga as a therapeutic option when delivered virtually. The primary aim of the mind and yoga for IBS randomised controlled trial is to determine the effects of an 8-week virtual meditation and yoga intervention on IBS symptom severity compared with an advice-only active control group. METHODS AND ANALYSIS Adults diagnosed with IBS will be randomised to receive either a Upa Yoga intervention or an advice-only control group. The intervention will consist of weekly online classes for 8 weeks delivered by a facilitator using Microsoft Office Teams and daily home practice. Feasibility will be evaluated by examining recruitment and attrition rates, adherence, participant satisfaction with the programme and safety. The primary outcome is IBS symptom severity, and key secondary outcomes include (but not limited to) quality of life, anxiety and depression symptoms, COVID-19-related stress and anxiety, and fatigue. Outcomes will be assessed at baseline, 4 weeks and 8 weeks. An embedded design experimental model substudy will be conducted post intervention using qualitative research methods to identify participants' experiences in the yoga programme. ETHICS AND DISSEMINATION This study has been approved by the Conjoint Health Research Ethics Board (REB ID 20-0084). Findings will be disseminated through peer-reviewed publication, conference presentation and social media. TRIAL REGISTRATION NUMBER NCT04302623.
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Affiliation(s)
- Adrijana D'Silva
- Department of Community Health Sciences, University of Calgary, Calgary, Alberta, Canada
| | - Deborah A Marshall
- Department of Community Health Sciences, University of Calgary, Calgary, Alberta, Canada
| | - Jeffrey Vallance
- Faculty of Health Disciplines, Athabasca University, Athabasca, Alberta, Canada
| | - Yasmin Nasser
- Department of Medicine, University of Calgary, Calgary, Alberta, Canada
- Department of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Vidya Rajagopalan
- Department of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Gail MacKean
- Department of Community Health Sciences, University of Calgary, Calgary, Alberta, Canada
| | - Maitreyi Raman
- Department of Medicine, University of Calgary, Calgary, Alberta, Canada
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Mahesh M, Pauly M, Krishna SM, Raman M, Biswas J. Clinicopathological study of parasitic lesions of the eye and ocular adnexa in a tertiary care ophthalmic center in South India. Indian J Ophthalmol 2022; 70:1713-1717. [PMID: 35502058 PMCID: PMC9332949 DOI: 10.4103/ijo.ijo_2470_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Purpose: To study clinical and pathological features of parasitic lesions in the ocular adnexa in a tertiary care ophthalmic center in south India. Methods: 43 cases of ocular parasitosis were analysed clinically and correlated with the pathological findings (gross morphology and histopathology) over a period of five years (2015–2020). Results: Among the 43 cases, the age group ranged from 9 months to 78 years (mean age of 41.6 years). Female patients were more common than male patients, with a percentage of 63% (27) and 37% (16) respectively. Cystic lesion in the lid or orbit was seen in 23 cases (53.4%); solid mass lesions were seen in 17 cases (39.5%); subconjunctival worms in three cases; and subretinal parasite in one. Gross examination and histopathologic study showed Dirofilaria in 23 cases (53.5%), followed by Cysticercus in six cases (14%) and Microfilariae in four cases (9.3%). Exact species identification was not possible in ten cases (23.25%). Correlation between the type of lesion and type of inflammatory cells with the specific parasite was done. Conclusion: Our study showed that important clinicopathological correlations can be made from the parasitic lesions in the eye and adnexa, which can aid in definitive diagnosis and prompt identification of the parasite for patient management.
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Affiliation(s)
| | | | | | - M Raman
- Madras Veterinary College, Chennai, Tamil Nadu, India
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D'Silva A, Fox DE, Nasser Y, Vallance JK, Quinn RR, Ronksley PE, Raman M. Prevalence and Risk Factors for Fatigue in Adults With Inflammatory Bowel Disease: A Systematic Review With Meta-Analysis. Clin Gastroenterol Hepatol 2022; 20:995-1009.e7. [PMID: 34216824 DOI: 10.1016/j.cgh.2021.06.034] [Citation(s) in RCA: 35] [Impact Index Per Article: 17.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/05/2021] [Revised: 06/10/2021] [Accepted: 06/18/2021] [Indexed: 12/13/2022]
Abstract
BACKGROUND AND AIMS Inflammatory bowel disease (IBD) is a chronic relapsing and remitting disease with high morbidity, substantial health care costs, and increasing incidence. Fatigue is one of the most common symptoms that impacts quality of life and is a leading concern for patients with IBD. The aim of this study was to determine the global prevalence, risk factors, and impact of fatigue in adults with IBD. METHODS A systematic review and meta-analysis was conducted. Data were retrieved from Medline, Embase, CINAHL, and PsycINFO from database inception to October 2019. A pooled prevalence of fatigue was calculated using a random-effects model. Stratified meta-analyses explored sources of between-study heterogeneity. Study quality was assessed using an adapted checklist from Downs and Black. RESULTS The search yielded 4524 studies, of which 20 studies were included in the systematic review and meta-analysis. Overall, the studies were of good quality. The pooled prevalence of fatigue was 47% (95% confidence interval, 41%-54%), though between-study heterogeneity was high (I2 = 98%). Fatigue prevalence varied significantly by the definition of fatigue (chronic: 28%; high: 48%; P < .01) and disease status (active disease: 72%; remission: 47%; P < .01). Sleep disturbance, anxiety, depression, and anemia were the most commonly reported fatigue-related risk factors. CONCLUSIONS The prevalence of fatigue in adults with IBD is high, emphasizing the importance of additional efforts to manage fatigue to improve the care and quality of life for patients with IBD.
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Affiliation(s)
- Adrijana D'Silva
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Danielle E Fox
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Yasmin Nasser
- Snyder Institute of Chronic Disease, Department of Medicine, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Jeff K Vallance
- Faculty of Health Disciplines, Athabasca University, Alberta, Canada
| | - Robert R Quinn
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada; Division of Nephrology, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Paul E Ronksley
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Maitreyi Raman
- Division of Gastroenterology and Hepatology, Department of Medicine, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada.
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Klonarakis M, Andrews CN, Raman M, Panaccione R, Ma C. Review article: therapeutic targets for the pharmacologic management of coeliac disease-the future beyond a gluten-free diet. Aliment Pharmacol Ther 2022; 55:1277-1296. [PMID: 35229332 DOI: 10.1111/apt.16846] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/04/2021] [Revised: 11/03/2021] [Accepted: 02/13/2022] [Indexed: 12/15/2022]
Abstract
BACKGROUND Coeliac disease (CeD) is an immune-mediated small bowel enteropathy resulting from dietary gluten exposure. Presently, the only effective treatment is adoption of a gluten-free diet (GFD), although strict adherence is challenging to maintain, and inadvertent gluten exposures are inevitable for most patients. Hence, there is substantial interest in drug development in CeD and multiple novel therapies are under investigation. AIMS To review existing and upcoming clinical trial programmes for pharmacologic agents for CeD. METHODS A narrative review was performed, informed by a search of MEDLINE, Embase, the Cochrane CENTRAL Library and clinicaltrials.gov. RESULTS We summarise the pathophysiology of CeD and the specific steps that are potentially amenable to pharmacologic treatment. We evaluate the evidence supporting existing and future drug targets, including trials of peptidases, gluten sequestrants, tight junction regulators, anti-transglutaminase 2 therapies, immune tolerizing agents, advanced biologics and small molecules, and microbiome-targeted strategies. We highlight unique considerations for conducting CeD trials, including identifying appropriate study populations, assessing results in the context of a gluten challenge, and interpreting CeD-specific clinical and histologic outcomes. Understanding these factors is crucial for accurately appraising the evidence. Finally, we outline what the future of CeD therapy may hold with the introduction of pharmacotherapies. CONCLUSIONS There is a need for pharmacologic options for CeD, either used adjunctively with a GFD for accidental or intentional gluten exposures or for refractory disease. Multiple promising agents are in development, and these trials are likely to lead to approvals for the first generation of pharmacologic agents for CeD within the next 5 years.
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Affiliation(s)
| | - Christopher N Andrews
- Division of Gastroenterology & Hepatology, University of Calgary, Calgary, Alberta, Canada
| | - Maitreyi Raman
- Division of Gastroenterology & Hepatology, University of Calgary, Calgary, Alberta, Canada.,Alberta's Collaboration of Excellence for Nutrition in Digestive Diseases, Calgary, Alberta, Canada
| | - Remo Panaccione
- Division of Gastroenterology & Hepatology, University of Calgary, Calgary, Alberta, Canada
| | - Christopher Ma
- Division of Gastroenterology & Hepatology, University of Calgary, Calgary, Alberta, Canada.,Department of Community Health Sciences, University of Calgary, Calgary, Alberta, Canada
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Kaur S, D’Silva A, Shaheen AA, Raman M. Yoga in Patients With Inflammatory Bowel Disease: A Narrative Review. Crohns Colitis 360 2022; 4:otac014. [PMID: 36777040 PMCID: PMC9802393 DOI: 10.1093/crocol/otac014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/09/2022] [Indexed: 11/13/2022] Open
Abstract
Despite advancements in the treatment of inflammatory bowel disease (IBD), the global prevalence of IBD is increasing. Patients with IBD often experience a high psychosocial burden, worsening their IBD symptoms and increasing relapse, hospitalization rates, and healthcare costs, which impairs their quality of life (QoL). Evidence suggests that mind-body intervention in many chronic illnesses is effective in improving symptoms and QoL. Yoga is the most frequently used mind-body practice globally. Meta-analyses of randomized clinical trials and prospective studies have highlighted that yoga improves symptoms and QoL of patients with IBD; however, recommendations about indications for yoga as well as dose and frequency of yoga are lacking. The present narrative review aims to describe the available evidence regarding the effects of yoga on common patient-reported outcome measures in IBD, including depression, anxiety, stress, and QoL. Physicians can hence promote yoga interventions in their discussions with patients to help control these IBD-related outcome measures.
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Affiliation(s)
| | | | - Abdel-Aziz Shaheen
- Department of Medicine, Cumming School of Medicine, University of Calgary, Calgary, AB T2N 4N1, Canada
| | - Maitreyi Raman
- Address correspondence to: Maitreyi Raman, 6D33 TRW Building, 3280 Hospital Drive NW, Calgary, AB T2N 4N1, Canada ()
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Chiew BA, Raman M, Tandon P, Panaccione R, Taylor L. A73 CANADIAN INFLAMMATORY BOWEL DISEASE MOBILE APPS: CURRENT LANDSCAPE AND NEEDS. J Can Assoc Gastroenterol 2022. [PMCID: PMC8859374 DOI: 10.1093/jcag/gwab049.072] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
Abstract
Background Evidence-based digital health applications (apps) offering comprehensive lifestyle therapies for inflammatory bowel disease (IBD) patients are limited in Canada. Aims The aims of this study were to explore the Canadian IBD digital app landscape and review preliminary data from a recently launched digital app for IBD, LyfeMD. (www.lyfemd.ca). Methods “IBD”, “Inflammatory bowel disease”, “UC”, “Ulcerative colitis”, “Crohns” and “Crohn’s disease (CD)” were searched by one team member (BC) on the App Store. Apps were included if they offered any type of lifestyle therapy, including education. The mobile application rating system (MARS) was used to evaluate each app and is a validated tool used to assess the quality of mobile health apps. For the LyfeMD app, 35 IBD users completed a baseline assessment survey to identify: 1) physical activity, sitting, and screen time, and; 2) stress, sleep, depression and anxiety. Eleven participants completed in-depth user experience evaluations after 4 weeks. Survey scores were calculated using published scoring protocols and descriptive data were prepared. Results The LyfeMD and My IBD Care app scored highest on the MARS with a total score of 4.8/5. Of the other eight apps identified, scores ranged from 2.4 to 4.6 (overall mean=4.0). LyfeMD differentiated itself from other apps by providing lifestyle programs to improve nutrition, physical activity and mental health. Of the LyfeMD users, 74% had CD (median Harvey Bradshaw index=3.1, IQR=1.1–4.8) and 26% had ulcerative colitis (median partial mayo score=1.0, 0.5–6.0), 60% had a BMI ≥25 kg/m2, 57% were meeting 150 minute/week activity guidelines, 49% had high sitting time, 100% had high screen time, 69% had a moderate to high level of stress, 100% experienced sleep problems, 69% reported depression, and 49% reported anxiety. Eleven people completed the detailed user experience evaluations. They reported the app helped them identify behaviour changes to improve overall wellness; most often what they eat (64%), overall well-being (64%) and physical activity (46%). Conclusions Two IBD apps available in Canada had a high MARS rating, however only the LyfeMD app offered comprehensive lifestyle therapies. The growing literature supports benefit for lifestyle therapies in IBD, and the LyfeMD app may be effective to identify areas amenable to lifestyle modification. Funding Agencies Ascend, Alberta Innovates
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Affiliation(s)
- B A Chiew
- University of Calgary Cumming School of Medicine, Calgary, AB, Canada
| | - M Raman
- University of Calgary Cumming School of Medicine, Calgary, AB, Canada
| | - P Tandon
- University of Alberta Faculty of Medicine & Dentistry, Edmonton, AB, Canada
| | - R Panaccione
- University of Calgary Cumming School of Medicine, Calgary, AB, Canada
| | - L Taylor
- University of Calgary Cumming School of Medicine, Calgary, AB, Canada
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Chiu E, Taylor L, Ingram R, Panaccione R, Ghosh S, Ramay H, McCoy K, Reimer R, Raman M. A54 DIETARY COMPONENTS ARE ASSOCIATED WITH FECAL CALPROTECTIN IN ULCERATIVE COLITIS. J Can Assoc Gastroenterol 2022. [PMCID: PMC8859225 DOI: 10.1093/jcag/gwab049.053] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Abstract
Background
Ulcerative colitis (UC) is thought to arise from dysregulated immune responses due to intestinal dysbiosis and altered epithelial barrier function. Dietary components may affect the gut microbiome and contribute to either inflammation or its resolution. The relationship between diet and disease activity in UC warrants further investigation.
Aims
This prospective cohort study explored the relationship between dietary components, and markers of disease activity: fecal calprotectin (FCP) and partial Mayo score (PMS) in patients with UC.
Methods
40 participants were recruited from University of Calgary IBD clinics. Study staff obtained two 24-hour diet recalls using the validated automated self administered (ASA)-24 and captured PMS at baseline (T1) and follow-up at week 12 (T2). FCP samples were collected at T1 and T2. Diet variables included adjusted macro/micronutrients (n=44), food groups (n=36) and the validated Canadian healthy eating index-2009 (CHEI) where higher scores reflect healthier intake. CHEI captures intake of dark green and orange foods (DGO) and moderation scoring (MOD) of saturated fats (SF), sodium and added sugars. Higher CHEI scores result from increased intake of DGO and lower intake of SF, sodium and added sugars (higher MOD score). Associations with outcome variables were examined at T1 and T2 individually and across both timepoints (BT). Mixed effect logistic regression models identified relationships between dietary variables, FCP and PMS. Models were adjusted for age, sex, BMI, medications, probiotics, and for repeated measures in both timepoint analyses.
Results
A positive association was identified between FCP as a continuous variable and SF (T1:Coef=0.22, p_adj=0.02) and a negative association identified between FCP with citrus/melon/berries (BT:Coef=-1.01, p_adj =0.04), total sugars (BT:Coef=-0.06, p_adj=0.025) and HEI (BT:Coef=-0.13, p_adj =0.06 and T1 coef=-0.18, p_adj =7.0 e-5). FCP increased as SF (-0.30,p_adj=0.01), DGO (-0.60, p_adj=0.02), and MOD (-0.21, p_adj=0.02) scores decreased. The presence of inflammation (as a binary variable, FCP >250) was negatively associated with higher fiber intake (BT: Odds Ratio (OR)= 0.016, CI(0.001,0.40) p_adj=0.08). For PMS as a continuous variable, HEI had a negative association with PMS (T2: -0.05, p_adj=0.06). With PMS as a discrete score (remission=PMS<2) there was no significant association with any diet components.
Conclusions
This study suggests that a healthier diet, both in overall pattern and specific dietary components, was associated with lower FCP and PMS. Our findings related to SF, citrus/melons/berries, and DGO parallel the IOIBD dietary guidelines. Future research should explore through controlled intervention studies whether modifying dietary patterns and components independently reduces disease activity.
Funding Agencies
Crohn’s and Colitis Foundation
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Affiliation(s)
- E Chiu
- Medicine, University of Calgary, Calgary, AB, Canada
| | - L Taylor
- Medicine, University of Calgary, Calgary, AB, Canada
| | - R Ingram
- Medicine, University of Calgary, Calgary, AB, Canada
| | - R Panaccione
- Medicine, University of Calgary, Calgary, AB, Canada
| | - S Ghosh
- Medicine, University of Calgary, Calgary, AB, Canada
| | - H Ramay
- Medicine, University of Calgary, Calgary, AB, Canada
| | - K McCoy
- Medicine, University of Calgary, Calgary, AB, Canada
| | - R Reimer
- Medicine, University of Calgary, Calgary, AB, Canada
| | - M Raman
- Medicine, University of Calgary, Calgary, AB, Canada
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D’Silva A, Marshall D, Rajagopalan V, Nasser Y, Vallance J, Raman M. A247 MEDITATION AND YOGA FOR IRRITABLE BOWEL SYNDROME (MY-IBS): A RANDOMIZED CONTROLLED TRIAL. J Can Assoc Gastroenterol 2022. [PMCID: PMC8859308 DOI: 10.1093/jcag/gwab049.246] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Background When delivered in person, yoga is effective in managing Irritable Bowel Syndrome (IBS) symptoms. However, research is needed to determine the feasibility and effectiveness of yoga as a therapeutic option when delivered virtually. Aims The aim was to explore the feasibility and effectiveness of a yoga program, delivered virtually, for patients with IBS. We hypothesized the program would be feasible and effective in improving outcomes in the intervention group compared to the control group. Methods Adults diagnosed with IBS were randomized to receive either a Hatha yoga intervention or to an advice-only control group. The intervention consisted of facilitator-led weekly online classes for eight weeks delivered using Microsoft Office Teams and daily home practice. Yoga sessions included sequential delivery of postures, chanting, breathing exercises, and meditation over four weeks, with integrated practice over the final four weeks. Feasibility was evaluated with recruitment and attrition rates, adherence, and safety. The primary outcome was severity of IBS symptoms (IBS-Symptom Severity Score, IBS-SSS). Secondary outcomes included anxiety (General Anxiety Disorder-7), depression (Patient Health Questionnaire-9), and stress (Perceived Stress Scale) assessed at baseline and eight weeks. Unadjusted and adjusted analysis of variance (and covariance) models compared baseline and post-intervention data between groups using intent to treat analysis. Results Sixty-five participants participated (32 treatment, 33 control). The mean age was 44.2±14.1 years and 91% identified as female. Participants had been living with IBS for 11.7±11 years. Fifteen participants were lost to follow-up (20% attrition rate). Participants attended on average 5.9±1.7 out of a possible 8 sessions (74% adherence) and accumulated 1,187±545 minutes in daily practice over eight weeks. No adverse events were reported. The groups did not differ at baseline (P>0.05). From baseline to post intervention, unadjusted ANOVA models indicated the yoga program was not statistically superior to the control group for IBS-symptoms (-17.5 points; 95% CI -62.6 to 27.6; P = 0.440), anxiety (-0.91 points; 95% CI -2.47 to 0.64; P = 0.245) and stress (-0.65 points; 95% CI -1.73 to 0.44; P = 0.239). Significant differences between groups were seen for depression (-1.82 points; 95% CI -3.49 to -0.15; P = 0.033). A second model considered relevant covariates including age, comorbidities, and years since diagnosis (i.e., ANCOVA), and the results were similar to the unadjusted model. Conclusions Our virtual Hatha yoga and mediation program was feasible, and participants showed improvement in their depression scores. However, they did not experience a significant improvement in their IBS symptoms, anxiety, or stress, perhaps due to the short timeframe of the intervention. Funding Agencies None
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Affiliation(s)
- A D’Silva
- Medicine, University of Calgary, Calgary, AB, Canada
| | - D Marshall
- Medicine, University of Calgary, Calgary, AB, Canada
| | - V Rajagopalan
- Medicine, University of Calgary, Calgary, AB, Canada
| | - Y Nasser
- Medicine, University of Calgary, Calgary, AB, Canada
| | - J Vallance
- Athabasca University, Athabasca, AB, Canada
| | - M Raman
- Medicine, University of Calgary, Calgary, AB, Canada
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Raman M, Ma C, Taylor LM, Dieleman LA, Gkoutos GV, Vallance JK, McCoy KD, Lewis I, Jijon H, McKay DM, Mutch DM, Barkema HW, Gibson D, Rauch M, Ghosh S. Crohn's disease therapeutic dietary intervention (CD-TDI): study protocol for a randomised controlled trial. BMJ Open Gastroenterol 2022; 9:bmjgast-2021-000841. [PMID: 35046093 PMCID: PMC8772401 DOI: 10.1136/bmjgast-2021-000841] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/13/2021] [Accepted: 01/04/2022] [Indexed: 11/03/2022] Open
Abstract
INTRODUCTION Dietary patterns that might induce remission in patients with active Crohn's disease (CD) are of interest to patients, but studies are limited in the published literature. We aim to explore the efficacy of the CD therapeutic dietary intervention (CD-TDI), a novel dietary approach developed from best practices and current evidence, to induce clinical and biomarker remission in adult patients with active CD. METHODS AND ANALYSIS This study is a 13-week, multicentre, randomised controlled trial in patients with mild-to-moderate active CD at baseline. One hundred and two patients will be block randomised, by sex, 2:1 to the intervention (CD-TDI) or conventional management. Coprimary outcomes are clinical and biomarker remission, defined as a Harvey Bradshaw Index of <5 and a faecal calprotectin of <250 µg/g, respectively.Secondary outcomes include gut microbiota diversity and composition, faecal short-chain fatty acids, regulatory macrophage function, serum and faecal metabolomics, C reactive protein, peripheral blood mononuclear cell gene expression profiles, quality of life, sedentary time and physical activity at 7 and/or 13 weeks. Predictive models of clinical response to a CD-TDI will be investigated. ETHICS AND DISSEMINATION The research protocol was approved by the Conjoint Health Research Ethics Board at the University of Calgary (REB19-0402) and the Health Research Ethics Board-Biomedical Panel at the University of Alberta (Pro00090772). Study findings will be presented at national and international conferences, submitted for publication in abstracts and manuscripts, shared on social media and disseminated through patient-education materials. TRIAL REGISTRATION NUMBER NCT04596566.
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Affiliation(s)
- Maitreyi Raman
- Department of Medicine, University of Calgary, Calgary, Alberta, Canada
- Department of Community Health Sciences, University of Calgary, Calgary, Alberta, Canada
| | - Christopher Ma
- Department of Medicine, University of Calgary, Calgary, Alberta, Canada
- Department of Community Health Sciences, University of Calgary, Calgary, Alberta, Canada
| | - Lorian M Taylor
- Department of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Levinus A Dieleman
- Department of Medicine & Dentistry, University of Alberta, Edmonton, Alberta, Canada
| | - Georgios V Gkoutos
- Institute of Cancer and Genomics, University of Birmingham, Birmingham, UK
| | - Jeff K Vallance
- Faculty of Health Disciplines, Athabasca University, Athabasca, Alberta, Canada
| | - Kathy D McCoy
- Department of Physiology and Pharmacology, University of Calgary, Calgary, Alberta, Canada
| | - Ian Lewis
- Department of Biological Sciences, University of Calgary, Calgary, Alberta, Canada
| | - Humberto Jijon
- Department of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Derek M McKay
- Department of Physiology and Pharmacology, Calvin, Phoebe and Joan Snyder Institute for Chronic Diseases, University of Calgary, Calgary, Alberta, Canada
| | - David M Mutch
- Department of Human Health & Nutritional Science, University of Guelph, Guelph, Ontario, Canada
| | - Herman W Barkema
- Department of Production Animal Health, University of Calgary, Calgary, Alberta, Canada
| | - Deanna Gibson
- Department of Biology, The University of British Columbia Okanagan, Kelowna, British Columbia, Canada
| | | | - Subrata Ghosh
- Institute of Translational Medicine, University of Birmingham, Birmingham, UK
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Islam Z, D'Silva A, Raman M, Nasser Y. The role of mind body interventions in the treatment of irritable bowel syndrome and fibromyalgia. Front Psychiatry 2022; 13:1076763. [PMID: 36620663 PMCID: PMC9814478 DOI: 10.3389/fpsyt.2022.1076763] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/24/2022] [Accepted: 12/06/2022] [Indexed: 12/24/2022] Open
Abstract
INTRODUCTION Irritable bowel syndrome and fibromyalgia share similar pathophysiologic mechanisms including sensitization of peripheral and central pain pathways, autonomic dysfunction and are often co-diagnosed. Co-diagnosed patients experience increased symptom severity, mental health comorbidities, and decreased quality of life. The role of mind-body interventions, which have significant effects on central pain syndromes and autonomic dysregulation, have not been well-described in co-diagnosed patients. The aim of this state-of-the art narrative review is to explore the relationship between irritable bowel syndrome and fibromyalgia, and to evaluate the current evidence and mechanism of action of mind-body therapies in these two conditions. METHODS The PubMed database was searched without date restrictions for articles published in English using the following keywords: fibromyalgia, irritable bowel syndrome, mind-body interventions, cognitive behavioral therapy, mindfulness based stress reduction, and yoga. RESULTS Mind-body interventions resulted in improved patient-reported outcomes, and are effective for irritable bowel syndrome and fibromyalgia individually. Specifically, cognitive behavioral therapy and yoga trials showed decreased symptom severity, improved mental health, sleep and quality of life for both conditions individually, while yoga trials demonstrated similar benefits with improvements in both physical outcomes (gastrointestinal symptoms, pain/tenderness scores, insomnia, and physical functioning), mental health outcomes (anxiety, depression, gastrointestinal-specific anxiety, and catastrophizing), and quality of life, possibly due to alterations in autonomic activity. CONCLUSION Mind-body interventions especially CBT and yoga improve patient-reported outcomes in both irritable bowel syndrome and fibromyalgia individually. However, limited available data in co-diagnosed patients warrant high quality trials to better tailor programs to patient needs.
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Affiliation(s)
- Zarmina Islam
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
| | - Adrijana D'Silva
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
| | - Maitreyi Raman
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada.,Division of Gastroenterology and Hepatology, Department of Medicine, University of Calgary, Calgary, AB, Canada.,Snyder Institute for Chronic Diseases, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
| | - Yasmin Nasser
- Division of Gastroenterology and Hepatology, Department of Medicine, University of Calgary, Calgary, AB, Canada.,Snyder Institute for Chronic Diseases, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
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Abstract
Probiotic supplements have been shown to improve bone health in animal models, although it remains uncertain whether these beneficial effects extend to humans. We undertook a systematic review of the literature to determine the effects of probiotic interventions on skeletal outcomes in postmenopausal women. MEDLINE, EMBASE, CENTRAL, and the Cochrane Database of Systematic Reviews were searched from inception to October 2020 for controlled trials comparing the effects of probiotic-containing supplements with placebo on bone mineral density (BMD) or bone turnover markers. Risk of bias was assessed using the Cochrane Risk of Bias 2 Tool. Of 338 records identified, six randomized, placebo-controlled trials (n = 632) were eligible for inclusion. All studies assessed postmenopausal women for durations of 6-12 months; three were considered to be at high risk of bias. Four studies examined Lactobacillus-containing probiotics, one assessed a proprietary blend of lactic acid bacteria, and one evaluated Bacillus subtilis. Effects of probiotic interventions on BMD were inconsistent, with the majority of studies demonstrating no benefit at the spine or hip. Probiotic effects on bone turnover markers were similarly heterogeneous. High quality studies are needed to determine whether probiotic interventions have a role in maintaining bone health in humans.
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Affiliation(s)
- Emma O Billington
- Division of Endocrinology & Metabolism, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada.,McCaig Institute for Bone & Joint Health, University of Calgary, Calgary, Alberta, Canada
| | - Amita Mahajan
- Division of Endocrinology & Metabolism, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Jamie L Benham
- Division of Endocrinology & Metabolism, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada.,Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Maitreyi Raman
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada.,Division of Gastroenterology, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
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Marion-Letellier R, Leboutte M, Amamou A, Raman M, Savoye G, Ghosh S. Diet in Intestinal Fibrosis: A Double-Edged Sword. Nutrients 2021; 13:nu13093148. [PMID: 34579023 PMCID: PMC8470259 DOI: 10.3390/nu13093148] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2021] [Revised: 09/07/2021] [Accepted: 09/07/2021] [Indexed: 11/30/2022] Open
Abstract
The natural history of inflammatory bowel diseases, especially Crohn’s disease, is frequently complicated by intestinal fibrosis. Because of the lack of effective treatments for intestinal fibrosis, there is an urgent need to develop new therapies. Factors promoting intestinal fibrosis are currently unclear, but diet is a potential culprit. Diet may influence predisposition to develop intestinal fibrosis or alter its natural history by modification of both the host immune response and intestinal microbial composition. Few studies have documented the effects of dietary factors in modulating IBD-induced intestinal fibrosis. As the mechanisms behind fibrogenesis in the gut are believed to be broadly similar to those from extra-intestinal organs, it may be relevant to investigate which dietary components can inhibit or promote fibrosis factors such as myofibroblasts progenitor activation in other fibrotic diseases.
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Affiliation(s)
- Rachel Marion-Letellier
- UNIROUEN, INSERM UMR 1073 Nutrition, Inflammation and Gut-Brain Axis, Normandie University, 76183 Rouen, France; (M.L.); (G.S.)
- Institute for Research and Innovation in Biomedicine (IRIB), UNIROUEN, 76183 Rouen, France
- Correspondence:
| | - Mathilde Leboutte
- UNIROUEN, INSERM UMR 1073 Nutrition, Inflammation and Gut-Brain Axis, Normandie University, 76183 Rouen, France; (M.L.); (G.S.)
- Institute for Research and Innovation in Biomedicine (IRIB), UNIROUEN, 76183 Rouen, France
| | - Asma Amamou
- APC Microbiome Ireland, Biosciences Building, University College Cork, Cork, Ireland; (A.A.); (S.G.)
| | - Maitreyi Raman
- Division of Gastroenterology, University of Calgary, Calgary, AB T2N 4N1, Canada;
- Department of Community Health Sciences, University of Calgary, Calgary, AB T2N 4N1, Canada
| | - Guillaume Savoye
- UNIROUEN, INSERM UMR 1073 Nutrition, Inflammation and Gut-Brain Axis, Normandie University, 76183 Rouen, France; (M.L.); (G.S.)
- Institute for Research and Innovation in Biomedicine (IRIB), UNIROUEN, 76183 Rouen, France
- Department of Gastroenterology, Rouen University Hospital, 76031 Rouen, France
| | - Subrata Ghosh
- APC Microbiome Ireland, Biosciences Building, University College Cork, Cork, Ireland; (A.A.); (S.G.)
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Taylor LM, Eslamparast T, Farhat K, Kroeker K, Halloran B, Shommu N, Kumar A, Fitzgerald Q, Gramlich L, Abraldes JG, Tandon P, Raman M. Using Patient Completed Screening Tools to Predict Risk of Malnutrition in Patients With Inflammatory Bowel Disease. Crohns Colitis 360 2021; 3:otab043. [PMID: 36776646 PMCID: PMC9802362 DOI: 10.1093/crocol/otab043] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/24/2021] [Indexed: 12/15/2022] Open
Abstract
Background Malnutrition is associated with adverse clinical outcomes in patients with inflammatory bowel disease (IBD), however, malnutrition screening is not routinely performed. This study aimed to identify the prevalence of malnutrition in patients with IBD and compare the accuracy of patient completed screens to a gold-standard malnutrition assessment tool: the dietitian-completed subjective global assessment (SGA). Methods This cross-sectional study was conducted at 2 hospitals and 2 ambulatory care clinics in Alberta, Canada. Patients with IBD completed 4 malnutrition screening tools: abridged patient-generated SGA (abPG-SGA), Malnutrition Universal Screening Tool (MUST), Canadian Nutrition Screening Tool (CNST), and Saskatchewan IBD-nutrition risk (SaskIBD-NR). Risk of malnutrition was calculated for each tool and differences were compared between IBD subtype and body mass index (BMI) categories. Sensitivity and specificity, negative and positive predictive values (NPV and PPV), and area under the receiver operating characteristic curve (AUC) were calculated compared to SGA. Results Patients with Crohn's disease (n = 149) and ulcerative colitis (n = 96) participated in this study. Overall prevalence of malnutrition using SGA was 23% and malnutrition risk for CNST, abPG-SGA, SaskIBD-NR, and MUST was 37%, 36%, 36%, and 27%, respectively. Overall, the abPG-SGA had the highest sensitivity (83%), PPV (53%), and NPV (94%), and largest AUC (0.837) compared to SGA. For patients with a BMI ≥25 kg/m2, sensitivity and PPV of the abPG-SGA decreased to 73% and 41%, respectively, with a AUC of 0.841. Conclusions Malnutrition is prevalent in patients with IBD and using malnutrition risk screening tools such as the abPG-SGA may be useful to identify patients who would benefit from further assessment.
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Affiliation(s)
- Lorian M Taylor
- Department of Medicine, University of Calgary, Calgary, Alberta T2N 4N1, Canada
| | - Tannaz Eslamparast
- Department of Medicine, University of Alberta, Zeidler Ledcor Centre, 130 University Campus, Edmonton, Alberta T6G 2X8, Canada
| | - Kamal Farhat
- Department of Medicine, University of Alberta, Zeidler Ledcor Centre, 130 University Campus, Edmonton, Alberta T6G 2X8, Canada
| | - Karen Kroeker
- Division of Gastroenterology, University of Alberta, Zeidler Ledcor Centre, 130 University Campus, Edmonton, Alberta T6G 2X8, Canada
| | - Brendan Halloran
- Division of Gastroenterology, University of Alberta, Zeidler Ledcor Centre, 130 University Campus, Edmonton, Alberta T6G 2X8, Canada
| | - Nusrat Shommu
- Department of Family Medicine, University of Calgary, Health Sciences Center, 3330 Hospital Drive Northwest, Calgary, Alberta T2N 4N1, Canada
| | - Ankush Kumar
- Department of Medicine, University of Calgary, Calgary, Alberta T2N 4N1, Canada
| | - Quinn Fitzgerald
- Department of Family Medicine, University of Calgary, Health Sciences Center, 3330 Hospital Drive Northwest, Calgary, Alberta T2N 4N1, Canada
| | - Leah Gramlich
- Department of Medicine, Royal Alexandra Hospital, University of Alberta, Edmonton, Alberta, Canada
| | - Juan G Abraldes
- Department of Medicine, University of Alberta, Zeidler Ledcor Centre, 130 University Campus, Edmonton, Alberta T6G 2X8, Canada
| | - Puneeta Tandon
- Department of Medicine, University of Alberta, Zeidler Ledcor Centre, 130 University Campus, Edmonton, Alberta T6G 2X8, Canada
| | - Maitreyi Raman
- Division of Gastroenterology and Hepatology, University of Calgary, 6D26, Teaching Research and Wellness Building, 3280 Hospital Drive NW, Calgary, Alberta T2N 4N1, Canada,Address correspondence to: Maitreyi Raman, MD, FRCPC, Room 6D33, 3280 Hospital Drive NW, Calgary, AB T2N 4N1, Canada ()
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Clermont-Dejean NM, Schwenger KJP, Salazar E, Colombo FF, Lu Z, Lou W, Gramlich L, Whittaker S, Armstrong D, Jurewitsch B, Raman M, Duerksen DR, McHattie JD, Murthy S, Allard JP. Home parenteral nutrition patients on mixed oil lipid emulsion have a higher rate of hospitalizations compare to those on soybean oil- a prospective 2-year cohort study. Clin Nutr 2021; 40:4616-4623. [PMID: 34229267 DOI: 10.1016/j.clnu.2021.06.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2021] [Revised: 06/03/2021] [Accepted: 06/07/2021] [Indexed: 11/16/2022]
Abstract
BACKGROUND & AIMS Mixed oil intravenous lipid emulsion (MO ILE) that contains 30% soybean oil (SO), 30% medium chain triglycerides, 25% olive oil and 15% fish oil can benefit hospitalized patients receiving parenteral nutrition (PN) but there are very few studies on its long-term use. Our goal was to evaluate the clinical outcomes of adults receiving home PN (HPN) with MO versus those receiving SO ILE over a 2-year period. METHOD This is a retrospective analysis of data collected prospectively from a cohort of patients recorded in the Canadian HPN Registry over a 2-year period. HPN patients from academic programs across Canada were entered in the Registry according to a validated protocol. For this study, demographic, nutritional, laboratory and clinical data were extracted from January 1st 2015, when MO lipid emulsion became available in Canada, to July 24th 2019. Clinical data for each patient included: number of hospitalizations, number of hospitalizations related to HPN and number of hospitalization days related to HPN, over a year; incidence of line sepsis per 1000 catheter days and mortality. Data are presented as median (1st, 3rd quartile) for continuous variables and frequency (percentage) for categorical variables. Comparisons between groups were performed using two sample t-test or Wilcoxon Rank Sum tests for continuous variables and Chi-square tests or Fisher's exact tests for categorical variables. Univariate and multiple linear regressions were also carried out. Statistical significance is set at a p-value <0.05. RESULTS A total of 120 patients were included (MO n = 68, SO n = 52). Significant differences at baseline between the two groups were a higher use of Hickman line (62.12% vs 42%, p = 0.038) and more western Canada based hospital care with MO (75% vs 42.31%, p = 0.0002). The MO group had significantly more hospitalizations (p = 0.001), more hospitalizations related to HPN (p = 0.012) and more hospitalization days related to HPN (p = 0.016) per patient per year compared to SO patients. There was no significant difference between groups for line sepsis per 1000 catheter days (MO: 0.05 (0.0, 1.0) vs SO: 0.0 (0.0, 0.22), p = 0.053) or mortality. All other variables, including biochemical variables, were similar between groups. In a multiple regression analysis, the following factors were significantly associated with a greater number of hospitalizations per patient per year: use of MO, high blood glucose from the last recorded value and having died by the end of the study period. CONCLUSION This 2-year prospective cohort study suggests an increased risk of hospitalization in HPN patients receiving MO lipid emulsion. The long-term effect of using MO lipid emulsion in HPN patients should be further evaluated using a large randomized controlled trial. THE STUDY WAS REGISTERED IN CLINICALTRIALS.GOV: (NCT02299466).
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Affiliation(s)
| | | | | | | | - Zihang Lu
- Department of Public Health Sciences, Queen's University, ON, Canada
| | - Wendy Lou
- Dalla Lana Public Health Department, University of Toronto, Ontario, Canada
| | - Leah Gramlich
- Department of Medicine, University of Alberta, Edmonton, Alberta, Canada
| | - Scott Whittaker
- Department of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | - David Armstrong
- Division of Gastroenterology & Farncombe Family Digestive Health Research Institute, McMaster University, Hamilton, Ontario, Canada
| | - Brian Jurewitsch
- Department of Pharmacy, St Michael's Hospital, University of Toronto, Toronto, Ontario, Canada
| | - Maitreyi Raman
- Division of Gastroenterology and Hepatology, University of Calgary, Alberta, Canada
| | - Donald R Duerksen
- Department of Medicine, University of Manitoba, Winnipeg, Manitoba, Canada
| | | | - Sanjay Murthy
- Department of Medicine, University of Ottawa, Ottawa, Ontario, Canada
| | - Johane P Allard
- Department of Medicine, Toronto General Hospital, University of Toronto, Ontario, Canada.
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Chiu E, Oleynick C, Raman M, Bielawska B. Optimizing Inpatient Nutrition Care of Adult Patients with Inflammatory Bowel Disease in the 21st Century. Nutrients 2021; 13:nu13051581. [PMID: 34065070 PMCID: PMC8151132 DOI: 10.3390/nu13051581] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2021] [Revised: 05/03/2021] [Accepted: 05/05/2021] [Indexed: 12/16/2022] Open
Abstract
Malnutrition is highly prevalent in inflammatory bowel disease (IBD) patients and disproportionately affects those admitted to hospital. Malnutrition is a risk factor for many complications in IBD, including prolonged hospitalization, infection, greater need for surgery, development of venous thromboembolism, post-operative complications, and mortality. Early screening for malnutrition and prompt nutrition intervention if indicated has been shown to prevent or mitigate many of these outlined risk factors. There are many causes of malnutrition in IBD including reduced oral food intake, medications, active inflammation, and prior surgical resections. Hospitalization can further compound pre-existing malnutrition through inappropriate diet restrictions, nil per os (NPO) for endoscopy and imaging, or partial bowel obstruction, resulting in “post-hospital syndrome” after discharge and readmission. The aim of this article is to inform clinicians of the prevalence and consequences of malnutrition in IBD, as well as available screening and assessment tools for diagnosis, and to offer an organized approach to the nutritional care of hospitalized adult IBD patients.
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Affiliation(s)
- Elaine Chiu
- Division of Gastroenterology, University of Calgary, Calgary, AB T2N 1N4, Canada;
| | - Chris Oleynick
- Division of Internal Medicine, University of Calgary, Calgary, AB T2N 1N4, Canada;
| | - Maitreyi Raman
- Division of Gastroenterology, University of Calgary, Calgary, AB T2N 1N4, Canada;
- Correspondence:
| | - Barbara Bielawska
- Department of Medicine, Division of Gastroenterology, University of Ottawa, Ottawa, ON K1H 8L6, Canada;
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Zhang Z, Taylor L, Shommu N, Ghosh S, Reimer R, Panaccione R, Kaur S, Hyun JE, Cai C, Deehan EC, Hotte N, Madsen KL, Raman M. Erratum to: A Diversified Dietary Pattern Is Associated With a Balanced Gut Microbial Composition of Faecalibacterium and Escherichia/Shigella in Patients With Crohn's Disease in Remission. J Crohns Colitis 2021; 15:875. [PMID: 33152074 DOI: 10.1093/ecco-jcc/jjaa212] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Affiliation(s)
- Zhengxiao Zhang
- Department of Medicine, University of Alberta, Edmonton, Canada
| | - Lorian Taylor
- Department of Medicine, University of Calgary, Calgary, Canada
| | - Nusrat Shommu
- Department of Medicine, University of Calgary, Calgary, Canada
| | - Subrata Ghosh
- Institute of Translational Medicine, NIHR Biomedical Research Centre, University of Birmingham and Birmingham University Hospitals, Birmingham, UK
| | - Raylene Reimer
- Faculty of Kinesiology, University of Calgary, Calgary, Canada
| | - Remo Panaccione
- Department of Medicine, University of Calgary, Calgary, Canada
| | - Sandeep Kaur
- Department of Medicine, University of Calgary, Calgary, Canada
| | - Jae Eun Hyun
- Department of Medicine, University of Alberta, Edmonton, Canada
| | - Chenxi Cai
- Program for Pregnancy and Postpartum Health, Women and Children's Health Research Institute, University of Alberta, Edmonton, Canada
| | - Edward C Deehan
- Department of Agricultural, Food and Nutritional Science, University of Alberta, Edmonton,Canada
| | - Naomi Hotte
- Department of Medicine, University of Alberta, Edmonton, Canada
| | - Karen L Madsen
- Department of Medicine, University of Alberta, Edmonton, Canada
| | - Maitreyi Raman
- Department of Medicine, University of Calgary, Calgary, Canada
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Chiu E, Zhang Z, Taylor L, Kaur S, Ghosh S, Panaccione R, Reimer R, Raman M. A18 DIETARY PREDICTORS OF BIOLOGICAL ACTIVITY IN CROHN’S DISEASE: A RETROSPECTIVE COHORT STUDY. J Can Assoc Gastroenterol 2021. [DOI: 10.1093/jcag/gwab002.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Abstract
Background
Patients with Crohn’s disease (CD) often seek advice on optimizing their diet to reduce gut inflammation. The relationship between dietary patterns, major food groups and individual nutrients, with disease activity in Crohn’s disease (CD) is incompletely understood and warrants further investigation.
Aims
1.To determine whether a diversified (DD) or nondiversified (NDD) dietary pattern is related to biological activity in CD (BACD) in long-term follow up.
2.To determine if specific foods or nutrients are associated with increased BACD.
Methods
In this retrospective cohort study, forty-six CD patients (52% male) in remission completed 3-day food records between 2015–2017 for a 3-month intervention study and were classified as DD or NDD. Remission was defined by a Harvey Bradshaw Index <5 and no endoscopic ulcerations within 6 months of baseline data collection. Patients were classified as NDD if dietary fibre was ≤15 g/day or total fruit/vegetable servings ≤3/week, and if they consumed ≥3 servings/week of red and processed meat. Patients were otherwise defined as DD. A retrospective chart review captured BACD data. BACD was defined as one of either fecal calprotectin (FCP) ≥250 ug/g, hospitalization for CD flare, bowel resection for active CD, biologic dose escalation/switch due to non-response (not therapeutic drug monitoring), corticosteroid use, endoscopic evidence of apthous or large ulcers, or active disease on contrast enhanced ultrasound or magnetic resonance enterography. Machine learning methods with random forest prediction models assessed if diet composition was associated with BACD followed by univariate Mann-Whitney tests to compare differences between high and low disease activity.
Results
Sixteen patients (35%) had BACD during the mean 42 month follow up (31–54 months,SD ± 6.6). See Table 1 for additional demographics. Based on the random forest prediction model, both vitamins and minerals, food groups and Mediterranean diet cut-points could predict disease activity responses (ROC-AUC = 0.68 and 0.75, respectively). For these models, baseline intake of vitamins E, D, B1, and C and leafy greens, and fruit intake were the most important predictors of BACD. For the univariate analysis, the high disease group had lower intakes of fiber, vitamin E, and C (p = 0.047, 0.066, and 0.09, respectively). A higher proportion of patients consumed a NDD with BACD compared to those without BACD (50% vs. 23.3%, p=0.07).
Conclusions
To our knowledge, this is the first study to assess if dietary patterns, foods and nutrients are able to predict disease activity over a mean 42 month follow up. Further research into the dietary determinants of BACD in CD is warranted. With higher baseline FCP observed in the BACD, multivariate analyses to assess the independent effect of diet to predict BACD is required.
Funding Agencies
Litwin IBD Pioneers Foundation, Alberta’s Collaboration of Excellence for Nutrition in Digestive Diseases (Ascend)
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Affiliation(s)
- E Chiu
- University of Calgary, Calgary, AB, Canada
| | - Z Zhang
- University of Alberta, Edmonton, AB, Canada
| | - L Taylor
- University of Calgary, Calgary, AB, Canada
| | - S Kaur
- University of Calgary, Calgary, AB, Canada
| | - S Ghosh
- University of Calgary, Calgary, AB, Canada
| | | | - R Reimer
- University of Calgary, Calgary, AB, Canada
| | - M Raman
- University of Calgary, Calgary, AB, Canada
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Daoud D, Cartagena EMS, Somlaw N, Schwenger K, Gramlich L, Armstrong D, Raman M, Duerksen D, Whittaker S, Jurewitsch B, Marliss E, Allard J. A240 HOME PARENTERAL NUTRITION IN OLDER VERSUS YOUNGER PATIENTS: CLINICAL CHARACTERISTICS AND OUTCOMES. J Can Assoc Gastroenterol 2021. [DOI: 10.1093/jcag/gwab002.238] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Background
There is a demographic shift toward older patients receiving home parenteral nutrition (HPN) but there is little data on their clinical characteristics and outcomes versus younger HPN patients.
Aims
The objective of this study was to determine if there are any differences between older (> 60 years) and younger (18–59 years) HPN patients in regard to HPN indications, prescriptions and outcomes over the first 2 years receiving HPN.
Methods
This was a retrospective analysis of prospectively collected data from HPN adult patients entered in the password protected web-based Canadian HPN Registry. New HPN patients enrolled between 2003 and 2017 and receiving HPN for 2 years were selected from 8 participating programs across Canada. Data included demographics, anthropometrics, PN prescriptions, line sepsis events, survival and quality of life based on the Karnofsky Performance Status (KPS).
Results
402 patients met the inclusion criteria: 184 patients were 60 years old or above (older group) and 219 patients were between 18 and 59 years old (younger group). Around 64% of both groups were female. There were no significant differences in the main indications for HPN, body mass index (BMI), and PN prescriptions at baseline. At 2-years, younger patients received more calories from PN than older patients (27.88 vs 19.56 Kcal/kg respectively, p <0.001) but BMI remained comparable between groups. There were less line sepsis in the older group versus the younger group (20% vs 36%, p=0.0023) but 78% of younger patients remained alive versus 69 % in the older group (p=0.0401). In those alive, the proportion of patients remaining on HPN was comparable (older group: 77%; younger; group 81%, p=0.4709) and the proportion of patients with a reasonable quality of life (KPS > 60) was similar (older group: 58%; younger group: 63%, p=0.2156).
Conclusions
Older HPN patients have similar clinical characteristics as younger patients but with reduced line sepsis events and higher 2-year mortality.
Funding Agencies
Ontario Medical Supply, Takeda, Fresenius Kabi and Baxter Inc
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Affiliation(s)
- D Daoud
- Centre Hospitalier de l’Université de Montréal - CHUM, Montréal, QC, Canada
| | | | - N Somlaw
- Chulalongkorn University, Bangkok, Bangkok, Thailand
| | | | - L Gramlich
- Community Services Centre, Edmonton, AB, Canada
| | | | - M Raman
- University of Calgary, Calgary, AB, Canada
| | - D Duerksen
- University of Manitoba, Winnipeg, MB, Canada
| | - S Whittaker
- The University of British Columbia Faculty of Medicine, Vancouver, BC, Canada
| | | | - E Marliss
- McGill University Faculty of Medicine, Montreal, QC, Canada
| | - J Allard
- Toronto General Hospital, Toronto, ON, Canada
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Sasson AN, Ananthakrishnan AN, Raman M. Diet in Treatment of Inflammatory Bowel Diseases. Clin Gastroenterol Hepatol 2021; 19:425-435.e3. [PMID: 31812656 DOI: 10.1016/j.cgh.2019.11.054] [Citation(s) in RCA: 47] [Impact Index Per Article: 15.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/25/2019] [Revised: 11/19/2019] [Accepted: 11/22/2019] [Indexed: 02/07/2023]
Abstract
There has been an alarming increase in the incidence of inflammatory bowel diseases (IBDs) worldwide over the past several decades. The pathogenesis of IBD involves genetic and environmental factors. Diet is a potentially modifiable environmental risk factor for IBD onset and severity. Diet can promote intestinal inflammation by dysregulating the immune system, altering intestinal permeability and the mucous layer, contributing to microbial dysbiosis, and other mechanisms. Dietary changes therefore might be incorporated into therapeutic strategies for IBD. Enteral nutrition is effective in the treatment of pediatric patients with luminal Crohn's disease, but there have been few studies of the effects of dietary interventions with whole foods-most of these have been studies of exclusion diets in patients with Crohn's disease. We review findings from studies of the effects of dietary patterns, single micronutrients, and food additives in inducing and maintaining remission in patients with IBD. We discuss future directions for research and propose a framework for studies of dietary interventions in the treatment of IBD.
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Affiliation(s)
- Alexa N Sasson
- Division of Gastroenterology, University of Toronto, Toronto, Ontario, Canada
| | - Ashwin N Ananthakrishnan
- Division of Gastroenterology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
| | - Maitreyi Raman
- Division of Gastroenterology, University of Calgary, Calgary, Alberta, Canada.
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47
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Abstract
With the increasing global prevalence of inflammatory bowel diseases, research in this field is expanding to better understand the multifactorial etiologies of this complex disease. Nutrition and diet, as modifiable risk factors, have been shown to play an important role in disease activity and prognosis. This article reviews the role of nutrition in inflammatory bowel disease, including appropriate nutrition screening in this at-risk population, and associated micronutrient deficiencies. We provide recommendations on dosing supplementation. We briefly review diet as a risk factor for inflammatory bowel disease and the currently proposed published dietary intervention studies.
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Affiliation(s)
- Alexa N Sasson
- Division of Gastroenterology, University of Toronto, 27 King's College Circle, Toronto, Ontario M5S 2E4, Canada
| | - Richard J M Ingram
- Division of Gastroenterology, University of Calgary, 6D27 TRW Building, 3280 Hospital Drive Northwest, Calgary, Alberta T2N 4Z6, Canada
| | - Maitreyi Raman
- Division of Gastroenterology, University of Calgary, 6D33 TRW Building, 3280 Hospital Drive Northwest, Calgary, Alberta T2N 4Z6, Canada
| | - Ashwin N Ananthakrishnan
- Division of Gastroenterology, Massachusetts General Hospital and Harvard Medical School, 165 Cambridge Street, 9th Floor, Boston, MA 02114, USA.
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48
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Ma C, Congly SE, Novak KL, Belletrutti PJ, Raman M, Woo M, Andrews CN, Nasser Y. Epidemiologic Burden and Treatment of Chronic Symptomatic Functional Bowel Disorders in the United States: A Nationwide Analysis. Gastroenterology 2021; 160:88-98.e4. [PMID: 33010247 PMCID: PMC7527275 DOI: 10.1053/j.gastro.2020.09.041] [Citation(s) in RCA: 29] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/29/2020] [Revised: 08/10/2020] [Accepted: 09/24/2020] [Indexed: 02/08/2023]
Abstract
BACKGROUND & AIMS Functional bowel disorders (FBDs) are the most common gastrointestinal problems managed by physicians. We aimed to assess the burden of chronic symptomatic FBDs on ambulatory care delivery in the United States and evaluate patterns of treatment. METHODS Data from the National Ambulatory Medical Care Survey were used to estimate annual rates and associated costs of ambulatory visits for symptomatic irritable bowel syndrome, chronic functional abdominal pain, constipation, or diarrhea. The weighted proportion of visits associated with pharmacologic and nonpharmacologic (stress/mental health, exercise, diet counseling) interventions were calculated, and predictors of treatment strategy were evaluated in multivariable multinomial logistic regression. RESULTS From 2007-2015, approximately 36.9 million (95% CI, 31.4-42.4) weighted visits in patients of non-federally employed physicians for chronic symptomatic FBDs were sampled. There was an annual weighted average of 2.7 million (95% CI, 2.3-3.2) visits for symptomatic irritable bowel syndrome/chronic abdominal pain, 1.0 million (95% CI, 0.8-1.2) visits for chronic constipation, and 0.7 million (95% CI, 0.5-0.8) visits for chronic diarrhea. Pharmacologic therapies were prescribed in 49.7% (95% CI, 44.7-54.8) of visits compared to nonpharmacologic interventions in 19.8% (95% CI, 16.0-24.2) of visits (P < .001). Combination treatment strategies were more likely to be implemented by primary care physicians and in patients with depression or obesity. The direct annual cost of ambulatory clinic visits alone for chronic symptomatic FBDs is approximately US$358 million (95% CI, 233-482 million). CONCLUSIONS The management of chronic symptomatic FBDs is associated with considerable health care resource use and cost. There may be an opportunity to improve comprehensive FBD management because fewer than 1 in 5 ambulatory visits include nonpharmacologic treatment strategies.
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Affiliation(s)
- Christopher Ma
- Division of Gastroenterology and Hepatology, Department of Medicine, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada; Department of Community Health Sciences, University of Calgary, Calgary, Alberta, Canada.
| | - Stephen E. Congly
- Division of Gastroenterology and Hepatology, Department of Medicine, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada,O’Brien Institute for Public Health, University of Calgary, Calgary, Alberta, Canada
| | - Kerri L. Novak
- Division of Gastroenterology and Hepatology, Department of Medicine, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Paul J. Belletrutti
- Division of Gastroenterology and Hepatology, Department of Medicine, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Maitreyi Raman
- Division of Gastroenterology and Hepatology, Department of Medicine, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada,Department of Community Health Sciences, University of Calgary, Calgary, Alberta, Canada
| | - Matthew Woo
- Division of Gastroenterology and Hepatology, Department of Medicine, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Christopher N. Andrews
- Division of Gastroenterology and Hepatology, Department of Medicine, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Yasmin Nasser
- Division of Gastroenterology and Hepatology, Department of Medicine, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
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49
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Zhang Z, Taylor L, Shommu N, Ghosh S, Reimer R, Panaccione R, Kaur S, Hyun JE, Cai C, Deehan EC, Hotte N, Madsen KL, Raman M. A Diversified Dietary Pattern Is Associated With a Balanced Gut Microbial Composition of Faecalibacterium and Escherichia/Shigella in Patients With Crohn's Disease in Remission. J Crohns Colitis 2020; 14:1547-1557. [PMID: 32343765 DOI: 10.1093/ecco-jcc/jjaa084] [Citation(s) in RCA: 37] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
BACKGROUND AND AIMS Crohn's disease [CD] is associated with alterations in gut microbial composition and function. The present controlled-intervention study investigated the relationship between patterns of dietary intake and baseline gut microbiota in CD patients in remission and examined the effects of a dietary intervention in patients consuming a non-diversified diet [NDD]. METHODS Forty outpatients with quiescent CD were recruited in Calgary, Alberta, Canada. Based on 3-day food records, patients consuming a lower plant-based and higher red and processed meat-based diet were assigned to the NDD group [n = 15] and received a 12-week structured dietary intervention; all other patients were assigned to the diversified diet [DD] control group [n = 25] and received conventional management. Faecal microbiota composition, short chain fatty acids [SCFAs] and calprotectin were measured. RESULTS At baseline the NDD and DD groups had a different faecal microbial beta-diversity [p = 0.003, permutational multivariate analysis of variance]. The NDD group had lower Faecalibacterium and higher Escherichia/Shigella relative abundances compared to the DD group [3.3 ± 5.4% vs. 8.5 ± 10.6%; 6.9 ± 12.2% vs. 1.6 ± 4.4%; p ≤ 0.03, analysis of covariance]. These two genera showed a strong negative correlation [rs = -0.60, q = 0.0002]. Faecal butyrate showed a positive correlation with Faecalibacterium [rs = 0.52, q = 0.002], and an inhibitory relationship with Escherichia/Shigella abundance [four-parameter sigmoidal model, R = -0.83; rs = -0.44, q = 0.01], respectively. After the 12 weeks of dietary intervention, no difference in microbial beta-diversity between the two groups was observed [p = 0.43]. The NDD group demonstrated an increase in Faecalibacterium [p < 0.05, generalized estimated equation model], and resembled the DD group at the end of the intervention [p = 0.84, t-test with permutation]. We did not find an association of diet with faecal SCFAs or calprotectin. CONCLUSIONS Dietary patterns are associated with specific gut microbial compositions in CD patients in remission. A diet intervention in patients consuming a NDD modifies gut microbial composition to resemble that seen in patients consuming a DD. These results show that diet is important in shaping the microbial dysbiosis signature in CD towards a balanced community.
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Affiliation(s)
- Zhengxiao Zhang
- Department of Medicine, University of Alberta, Edmonton, AB, Canada
| | - Lorian Taylor
- Department of Medicine, University of Calgary, Calgary, AB, Canada
| | - Nusrat Shommu
- Department of Medicine, University of Calgary, Calgary, AB, Canada
| | - Subrata Ghosh
- Institute of Translational Medicine, NIHR Biomedical Research Centre, University of Birmingham and Birmingham University Hospitals, Birmingham, UK
| | - Raylene Reimer
- Faculty of Kinesiology, University of Calgary, Calgary, Canada
| | - Remo Panaccione
- Department of Medicine, University of Calgary, Calgary, AB, Canada
| | - Sandeep Kaur
- Department of Medicine, University of Calgary, Calgary, AB, Canada
| | - Jae Eun Hyun
- Department of Medicine, University of Alberta, Edmonton, AB, Canada
| | - Chenxi Cai
- Program for Pregnancy and Postpartum Health, Women and Children's Health Research Institute, University of Alberta, Edmonton, Canada
| | - Edward C Deehan
- Department of Agricultural, Food and Nutritional Science, University of Alberta, Edmonton, Canada
| | - Naomi Hotte
- Department of Medicine, University of Alberta, Edmonton, AB, Canada
| | - Karen L Madsen
- Department of Medicine, University of Alberta, Edmonton, AB, Canada
| | - Maitreyi Raman
- Department of Medicine, University of Calgary, Calgary, AB, Canada
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50
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Abstract
The aim of this state-of-the-art narrative review is to evaluate the current evidence about the effectiveness of yoga as therapy for IBS and explore its potential mechanisms of action. The current literature suggests yoga is effective and safe and may target multiple mechanisms involved in treatment of IBS. Evidence from randomized controlled trials identified yoga as more effective compared to pharmacological treatment and equally effective as dietary interventions or moderate-intensity walking. Improvements were seen in both physical health (IBS symptom severity, gastric motility, autonomic and somatic symptom scores, and physical functioning) and mental health outcomes (depression, anxiety, gastrointestinal-specific anxiety, and quality of life). Given favorable changes in IBS-related physical and mental health outcomes, preliminary data supports yoga as beneficial in this population. However, the relatively low-quality evidence resulting from heterogeneity of study designs, interventions, and outcome measures limit our ability to make specific recommendations about the use of yoga as therapy for patients with IBS.
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Affiliation(s)
- Adrijana D'Silva
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, 3280 Hospital Drive NW, Calgary, AB, T2N 4Z6, Canada
| | - Glenda MacQueen
- Mathison Centre for Mental Health Research and Education, University of Calgary, 3280 Hospital Drive NW, Calgary, AB, T2N 4Z6, Canada.,Department of Psychiatry, Cumming School of Medicine, University of Calgary, 3280 Hospital Drive NW, Calgary, AB, T2N 4Z6, Canada
| | - Yasmin Nasser
- Division of Gastroenterology and Hepatology, Department of Medicine, Cumming School of Medicine, University of Calgary, 3330 Hospital Drive NW, Calgary, AB, T2N 4N1, Canada
| | - Lorian M Taylor
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, 3280 Hospital Drive NW, Calgary, AB, T2N 4Z6, Canada
| | - Jeff K Vallance
- Faculty of Health Disciplines, Athabasca University, 1 University Drive, Athabasca, AB, T9S 3A3, Canada
| | - Maitreyi Raman
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, 3280 Hospital Drive NW, Calgary, AB, T2N 4Z6, Canada. .,Division of Gastroenterology and Hepatology, Department of Medicine, Cumming School of Medicine, University of Calgary, 3330 Hospital Drive NW, Calgary, AB, T2N 4N1, Canada. .,University of Calgary, 6D33 TRW Building, 3280 Hospital Drive NW, Calgary, AB, T2N 4N1, Canada.
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