Diet May Influence Relapse in Ulcerative Colitis

Laurie Barclay, MD

September 20, 2004

Sept. 20, 2004 — Potentially modifiable dietary factors, such as high meat or alcoholic beverage intake, may increase the likelihood of relapse for patients with ulcerative colitis (UC), according to the results of a prospective cohort study published in the September issue of Gut.

"The causes of relapses of UC are unknown," write Sarah L. Jowett, MRCP, from the University of Newcastle upon Tyne, U.K., and colleagues. "Dietary factors have been implicated in the pathogenesis of UC."

To determine the effect of customary diet on likelihood of relapse, 191 patients in remission were recruited from two district general hospitals and followed for one year. Relapse was defined using a validated disease activity index; a food frequency questionnaire determined nutrient intake; and multivariate logistic regression, controlling for nondietary factors, determined adjusted odds ratios for relapse.

Of the 191 patients, 96% completed the study, and 52% relapsed. Compared with the lowest tertile of meat consumption, the highest tertile was associated with triple the risk of relapse (odds ratio [OR], 3.2; 95% confidence interval [CI], 1.3 - 7.8. Intake of red and processed meat was an even greater risk factor (OR, 5.19; 95% CI, 2.1 - 12.9. The top tertile of intake for protein (OR, 3.00; 95% CI, 1.25 - 7.19) and alcohol (OR, 2.71; 95% CI, 1.1 - 6.67) also increased the likelihood of relapse, as did high intake of sulfur (OR, 2.76; 95% CI, 1.19 - 6.4) or sulphate (OR, 2.6 (95% CI, 1.08 - 6.3).

Contrary to commonly held beliefs, increased intake of milk or dairy products did not increase risk of relapse, and increased intake of dietary fiber did not appear to protect against relapse.

Study limitations include potential criticisms of the dietary assessment tool; assessment of habitual diet at only one time point for each individual; failure to perform sigmoidoscopy or analysis of stool samples; and incomplete data for sulfur and sulphate content of the diet.

"Potentially modifiable dietary factors, such as a high meat or alcoholic beverage intake, have been identified that are associated with an increased likelihood of relapse for UC patients," the authors write. "Further studies are needed to determine if it is the sulphur compounds within these foods that mediates the likelihood of relapse and if reducing their intake would reduce relapse frequency."

Northumbria Healthcare Trust funded Dr. Jowett.

In an accompanying commentary, Herbert Tilg, from University Hospital Innsbruck in Austria, and Arthur Kaser, from Brigham and Women's Hospital and Harvard Medical School in Boston, Massachusetts, note that the role of dietary factors in UC relapse may be mediated by hydrogen sulfide production.

"This provocative and clinically important report by Jowett et al reopens the topic of diet and relapsing UC," Drs. Tilg and Kaser write. "The findings are well taken and may offer a new perspective for potential intervention by practical lifestyle modifications, and as such are eagerly awaited by our patients. Despite this excitement, interventional studies are now needed, setting the scene for specific dietary recommendations and for further defining the role of sulphur/sulphate which may even lead to novel therapies."

Gut. 2004;53:1399-1401, 1479-1484

Reviewed by Michael W. Smith, MD

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