Copyright
©The Author(s) 2017. Published by Baishideng Publishing Group Inc. All rights reserved.
Dietary and metabolomic determinants of relapse in ulcerative colitis patients: A pilot prospective cohort study
Ammar Hassanzadeh Keshteli, Floris F van den Brand, Karen L Madsen, Rupasri Mandal, Rosica Valcheva, Karen I Kroeker, Beomsoo Han, Rhonda C Bell, Janis Cole, Thomas Hoevers, David S Wishart, Richard N Fedorak, Levinus A Dieleman
Ammar Hassanzadeh Keshteli, Floris F van den Brand, Karen L Madsen, Rosica Valcheva, Karen I Kroeker, Thomas Hoevers, Richard N Fedorak, Levinus A Dieleman, Department of Medicine, Division of Gastroenterology and CEGIIR, University of Alberta, Edmonton, AB T6G 2X8, Canada
Rupasri Mandal, Beomsoo Han, David S Wishart, Department of Biological Sciences, University of Alberta, Edmonton, AB T6G 2E9, Canada
Rhonda C Bell, Janis Cole, Department of Agricultural, Food and Nutritional Science, Faculty of Agricultural, Life and Environmental Sciences, University of Alberta, Edmonton, AB T6G 2E1, Canada
David S Wishart, Department of Computing Science, University of Alberta, Edmonton, AB T6G 2E8, Canada
Author contributions: Madsen KL, Bell RC, Wishart DS and Dieleman LA were involved in study design; Keshteli AH, van den Brand FF, Kroeker KI, Cole J, Fedorak RN, and Dieleman LA were responsible for recruiting participants, data collection and performing the follow-ups; Keshteli AH, Han B and Mandal R did the metabolomic analysis; Keshteli AH prepared the first draft of the manuscript and did statistical analysis; van den Brand FF and Valcheva R did the FCP assay; all authors read and approved the final manuscript; This study was funded by Alberta Innovates-Bio Solutions.
Supported by Alberta Innovates-Bio Solutions; a graduate studentship from Alberta Innovates-Health Solutions (to Keshteli AH).
Institutional review board statement: the study protocol was approved by the Health Research Ethics Board-Biomedical Panel, University of Alberta, Edmonton, Canada (Pro00032213).
Informed consent statement: An informed written consent was obtained from all participants.
Conflict-of-interest statement: The authors have no conflicts of interest to disclose.
Data sharing statement: No additional data are available.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Levinus A Dieleman, MD, PhD, Department of Medicine, Division of Gastroenterology and CEGIIR, University of Alberta, 130 University Campus, 2-24 Zeidler Ledcor Bldg, Edmonton, AB T6G 2X8, Canada. l.dieleman@ualberta.ca
Telephone: +1-780-4928691 Fax: +1-780-4928121
Received: March 10, 2017
Peer-review started: March 11, 2017
First decision: March 30, 2017
Revised: April 5, 2017
Accepted: May 4, 2017
Article in press: May 4, 2017
Published online: June 7, 2017
AIM
To identify demographic, clinical, metabolomic, and lifestyle related predictors of relapse in adult ulcerative colitis (UC) patients.
METHODS
In this prospective pilot study, UC patients in clinical remission were recruited and followed-up at 12 mo to assess a clinical relapse, or not. At baseline information on demographic and clinical parameters was collected. Serum and urine samples were collected for analysis of metabolomic assays using a combined direct infusion/liquid chromatography tandem mass spectrometry and nuclear magnetic resolution spectroscopy. Stool samples were also collected to measure fecal calprotectin (FCP). Dietary assessment was performed using a validated self-administered food frequency questionnaire.
RESULTS
Twenty patients were included (mean age: 42.7 ± 14.8 years, females: 55%). Seven patients (35%) experienced a clinical relapse during the follow-up period. While 6 patients (66.7%) with normal body weight developed a clinical relapse, 1 UC patient (9.1%) who was overweight/obese relapsed during the follow-up (P = 0.02). At baseline, poultry intake was significantly higher in patients who were still in remission during follow-up (0.9 oz vs 0.2 oz, P = 0.002). Five patients (71.4%) with FCP > 150 μg/g and 2 patients (15.4%) with normal FCP (≤ 150 μg/g) at baseline relapsed during the follow-up (P = 0.02). Interestingly, baseline urinary and serum metabolomic profiling of UC patients with or without clinical relapse within 12 mo showed a significant difference. The most important metabolites that were responsible for this discrimination were trans-aconitate, cystine and acetamide in urine, and 3-hydroxybutyrate, acetoacetate and acetone in serum.
CONCLUSION
A combination of baseline dietary intake, fecal calprotectin, and metabolomic factors are associated with risk of UC clinical relapse within 12 mo.
Core tip: This was a pilot prospective cohort study to evaluate the determinants of clinical relapse in adult ulcerative colitis patients. We found that different dietary, anthropometric, and metabolomic factors at baseline were associated with the risk of disease relapse within 12 mo of follow-up.
