Burden of Fatigue Among Patients with Ulcerative Colitis and Crohn's Disease: Results from a Global Survey of Patients and Gastroenterologists.

INTRODUCTION: To assess the prevalence of fatigue and its association with disease activity and patient-reported outcomes among patients with ulcerative colitis (UC) or Crohn's disease (CD). METHODS: Data from a cross-sectional survey conducted with gastroenterologists and their consulting adult patients with UC or CD were analyzed. Data were collected via gastroenterologist-completed patient record forms and patient-self completion forms. Patient demographics, clinical characteristics, disease activity and medication use were reported by the gastroenterologist, while current symptoms (fatigue, rectal urgency, abdominal pain, sleep disturbance), work productivity and the Short Inflammatory Bowel Disease Questionnaire (SIBDQ) were reported by the patient. Logistic regression models were used to identify measures associated with fatigue and expressed as odds ratio (OR) with 95% confidence interval. p < 0.05 was considered statistically significant. RESULTS: A total of 1057 patients with UC and 1228 patients with CD were included in this analysis. Fatigue was reported in 22.6% of UC and 26.0% of patients with CD. Higher proportion of patients with UC and fatigue had moderate/severe disease activity (p = 0.0001), had a higher Mayo score (5.0 vs. 4.0, p < 0.0001) and were unemployed (5.6% vs. 3.9%, p = 0.0149) compared to those without fatigue. In patients with CD reporting fatigue, a higher proportion were female (55.9% vs. 48.2%, p = 0.0193), were unemployed (5.8% vs. 4.9%, p = 0.0069), had moderate/severe disease (p < 0.0001) and had a higher mean Crohn's Disease Activity Index score (145.0 vs. 96.2, p < 0.0001) than patients without fatigue. Patients with UC and fatigue had higher mean level of pain (p < 0.0001) and sleep disturbance (p < 0.0001), whereas patients with CD and fatigue had lower SIBDQ scores (p < 0.0001) and greater work impairment (p = 0.0015) than patients without fatigue. Abdominal pain (OR: 2.01, p = 0.001) and use of immunomodulators (OR: 1.69, p = 0.006) increased the odds of having fatigue in patients with UC. In patients with CD, abdominal pain (OR: 2.29, p < 0.001) and use of biologics or biosimilars (OR: 2.02, p = 0.003) increased the odds of having fatigue. CONCLUSION: Fatigue is a common symptom among patients with UC or CD that is associated with higher levels of disease activity and decreased work productivity and is driven by various factors. A multidisciplinary approach may be needed to manage fatigue.

Plasma Fatty Acid Composition and Estimated Desaturase Activities Reflect Dietary Patterns in Subjects with Metabolic Syndrome.

Changes in plasma fatty acid (FA) composition and desaturase activities are observed in metabolic syndrome (MS). However, whether these changes are a reflection of dietary intakes of fats and FAs is not well established. The current study was aimed at assessing plasma FA composition and desaturase enzyme activities as biomarkers of dietary intakes in subjects with MS. Case control study was done on 41 MS patients and was compared with age matched 45 controls. Dietary intakes, anthropometric and clinical parameters were measured. FA composition was analysed using gas chromatography-flame ionisation detector and desaturase enzyme activities were estimated as ratios of product to precursor FAs. Higher levels of 14:0, 16:0, 16:1, 18:1, D9D-18 activity and lower levels of 18:0 and 18:2 n-6 were seen in MS group when compared to controls (p < 0.05). Strong positive correlations were seen between plasma triglyceride (TG) levels and 14:0, 16:0, 16:1, 18:1, total saturated fatty acid, total monounsaturated fatty acid, and D9D activities, while 18:0, 18:2 n-6 and total polyunsaturated fatty acid were negatively correlated with TG. Positive correlations were seen between plasma 14:0, 18:1 and D9D-18 activity with total energy intake and carbohydrate (CHO) intakes but not with fat intake. Plasma FA profile appears to be a better index of total energy intake and CHO intake than fat intake, suggesting it might be a good reflection of endogenous FA metabolism. Changes in FA composition may therefore serve as an early index of dysregulation of FA metabolism, resulting in increased risk of MS.