Brief Article
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World J Gastroenterol. Oct 14, 2013; 19(38): 6458-6464
Published online Oct 14, 2013. doi: 10.3748/wjg.v19.i38.6458
Diet of patients after pouch surgery may affect pouch inflammation
Orit Ianco, Hagit Tulchinsky, Michal Lusthaus, Amos Ofer, Erwin Santo, Nachum Vaisman, Iris Dotan
Orit Ianco, Amos Ofer, Erwin Santo, Iris Dotan, Comprehensive Pouch Clinic, IBD Center, Department of Gastroenterology and Liver Diseases, Tel Aviv Sourasky Medical Center, Tel Aviv 64239, Israel
Hagit Tulchinsky, Comprehensive Pouch Clinic and the Proctology Unit, Department of Surgery, Tel Aviv Sourasky Medical Center, Tel Aviv 64239, Israel
Michal Lusthaus, Nachum Vaisman, Unit of Clinical Nutrition, Tel Aviv Sourasky Medical Center, Tel Aviv 64239, Israel
Orit Ianco, Hagit Tulchinsky, Michal Lusthaus, Amos Ofer, Erwin Santo, Nachum Vaisman, Iris Dotan, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv 64239, Israel
Author contributions: Ianco O significantly contributed to data acquisition and drafting the manuscript; Lusthaus M contributed to data acquisition; Ofer A contributed to the study design; Vaisman N contributed to the study design and the interpretation of the results; Santo E contributed to data analysis and manuscript revision; Tulchinsky H and Dotan I planned and designed the study, recruited patients, assessed their clinical status, and contributed to data analysis and the writing of the manuscript.
Supported by A generous grant from the Leona M and Harry B Helmsley Charitable Trust (Partially)
Correspondence to: Iris Dotan, MD, Comprehensive Pouch Clinic, IBD Center, Department of Gastroenterology and Liver Diseases, Tel Aviv Sourasky Medical Center, 6 Weizmann Street, Tel Aviv 64239, Israel. irisd@tasmc.health.gov.il
Telephone: +97-23-6947305 Fax: +97-23-6974184
Received: June 12, 2013
Revised: August 6, 2013
Accepted: August 20, 2013
Published online: October 14, 2013
Processing time: 125 Days and 2.7 Hours
Abstract

AIM: To investigate the diet of pouch patients compared to healthy controls, and to correlate pouch patients’ diet with disease behavior.

METHODS: Pouch patients were recruited and prospectively followed-up at the Comprehensive Pouch Clinic at the Tel Aviv Sourasky Medical Center. Pouch behavior was determined based on clinical, endoscopic and histological criteria. Healthy age- and sex-matched volunteers were selected from the “MABAT” Israeli Nutrition and Public Health Governmental Study and served as the control group. All the participants completed a 106-item food frequency questionnaire categorized into food groups and nutritional values based on those used in the United States Department of Agriculture food pyramid and the Israeli food pyramid. Data on Dietary behavior, food avoidance, the use of nutritional supplements, physical activity, smoking habits, and body-mass index (BMI) were also obtained. Pouch patients who had familial adenomatous polyposis (n = 3), irritable pouch syndrome (n = 4), or patients whose pouch surgery took place less than one year previously (n = 5) were excluded from analysis.

RESULTS: The pouch patients (n = 80) consumed significantly more from the bakery products food group (1.2 ± 1.4 servings/d vs 0.6 ± 1.1 servings/d, P < 0.05) and as twice as many servings from the oils and fats (4.8 ± 3.4 servings/d vs 2.4 ± 2 servings/d, P < 0.05), and the nuts and seeds food group (0.3 ± 0.6 servings/d vs 0.1 ± 0.4 servings/d, P < 0.05) compared to the controls (n = 80). The pouch patients consumed significantly more total fat (97.6 ± 40.5 g/d vs 84.4 ± 39 g/d, P < 0.05) and fat components [monounsaturated fatty acids (38.4 ± 16.4 g/d vs 30 ± 14 g/d, P < 0.001), and saturated fatty acids (30 ± 15.5 g/d vs 28 ± 14.1 g/d, P < 0.00)] than the controls. In contrast, the pouch patients consumed significantly fewer carbohydrates (305.5 ± 141.4 g/d vs 369 ± 215.2 g/d, P = 0.03), sugars (124 ± 76.2 g/d vs 157.5 ± 90.4 g/d, P = 0.01), theobromine (77.8 ± 100 mg/d vs 236.6 ± 244.5 mg/d, P < 0.00), retinol (474.4 ± 337.1 μg/d vs 832.4 ± 609.6 μg/d, P < 0.001) and dietary fibers (26.2 ± 15.4 g/d vs 30.7 ± 14 g/d, P = 0.05) than the controls. Comparisons of the food consumption of the patients without (n = 23) and with pouchitis (n = 45) showed that the former consumed twice as many fruit servings as the latter (3.6 ± 4.1 servings/d vs 1.8 ± 1.7 servings/d, respectively, P < 0.05). In addition, the pouchitis patients consumed significantly fewer liposoluble antioxidants, such as cryptoxanthin (399 ± 485 μg/d vs 890.1 ± 1296.8 μg/d, P < 0.05) and lycopene (6533.1 ± 6065.7 μg/d vs 10725.7 ± 10065.9 μg/d, P < 0.05), and less vitamin A (893.3 ± 516 μg/d vs 1237.5 ± 728 μg/d, P < 0.05) and vitamin C (153.3 ± 130 mg/d vs 285.3 ± 326.3 mg/d, P < 0.05) than the patients without pouchitis. The mean BMI of the pouchitis patients was significantly lower than the BMI of the patients with a normal pouch: 22.6 ± 3.2 vs 27 ± 4.9 (P < 0.001).

CONCLUSION: Decreased consumption of antioxidants by patients with pouchitis may expose them to the effects of inflammatory and oxidative stress and contribute to the development of pouchitis.

Keywords: Ulcerative colitis; Dietary reference intake; Body mass index; Ileal-pouch anal anastomosis; Pouch surgery; Food frequency questionnaire

Core tip: The diet of patients who had pouch surgery differed significantly from that of healthy individuals. Patients with pouchitis consumed significantly fewer fruit servings and antioxidants than patients with normal pouches, thus possibly exposing the former to inflammatory and oxidative stress. The body mass index of patients with pouchitis was significantly lower than patients with normal pouches, probably as a result of the continuous inflammatory burden.