The significance of nutritional strategies in patients with inflammatory bowel disease in the context of malnutrition and the development of malnourished obesity.

Inflammatory bowel diseases (IBD), including Crohn's disease and ulcerative colitis, despite the increasing incidence, still do not have a specific etiology. Diet seems to be an important factor, modifying the occurrence of the disease and its course. Diet can affect the symptoms of IBD both directly, e.g., by alleviating diarrhea, bloating and constipation, and indirectly by shaping the microbiota. Bacterial metabolites produced under the influence of supplied nutrients may contribute to the modulation of pro- and anti-inflammatory pathways, depending on the diet used. So far, IBD has been associated with weight loss and malnutrition. In recent years, a trend of sarcopenic obesity with concomitant malnutrition has been observed. The new phenomenon is called malnubesity. This work aims to review the most commonly used diets in IBD in order to evaluate them in terms of alleviating ailments, but also maintaining proper nutritional status and lack of obesity. Low-fiber, low FODMAPs, Mediterranean diet and Crohn's Disease Exclusion Diet diet were considered. We assume that diet is modifiable factor that is related to nutritional status and healthy body weight. In addition, the current knowledge on the relationship between nutrition strategies, obesity and IBD will be demonstrated.

Serum level of lactadherin (MFGE8) in inflamatory bowel disease.

OBJECTIVE: Evaluation of serum lactadherin level, its correlation with disease activity and certain biochemical parameters in IBD patients. METHODS: The study involved adult IBD patients, comprising 50 with ulcerative colitis (UC), 68 with Crohn's disease (CD), and 29 healthy controls. RESULTS: The MFGE8 median concentration was significantly higher in UC versus controls (1914.54 vs. 1392.21; p = 0.017), but not in CD. The median MFGE8 levels in UC and CD patient groups didn't significantly differ. There was a significant inverse correlation between MFGE8 and CRP (r = -0.283; p = 0.044) and fibrinogen (r = -0.362, p = 0.017) in UC. In active UC, MFGE8 median concentration was higher versus controls (1974.36 vs. 1392.21; p = 0.04) and negatively correlated with CRP (r = -0.482; p = 0.005), WBC (r = -0.391; p = 0.027), and fibrinogen (r = -0.473; p = 0.015). Inactive UC showed negative correlation only with fibrinogen (r = -0.567; p = 0.018). No correlations were found with disease activity measured using appropriate scales, age, BMI, or gender. CONCLUSIONS: Active UC patients show higher MFGE8 levels. These increase inversely with inflammatory markers (CRP, WBC, fibrinogen) in active UC, but not in CD.

Association between fecal levels of Short-Chain Fatty Acids and serum Pro- and Anti-Inflammatory Cytokines in patients with Inflammatory Bowel Disease.

INTRODUCTION: Inflammatory bowel disease (IBD) represents a group of chronic inflammatory disorders characterized by dysbiosis and altered short-chain fatty acid (SCFA) level. The association between individual SCFA levels and cytokine levels is unknown. OBJECTIVES: We aimed to determine the fecal SCFA levels in patients with IBD in relation to disease severity and the serum levels of pro- and anti-inflammatory cytokines. PATIENTS AND METHODS: The study included 61 patients with IBD (inactive, 22; active, 39) and 16 controls. Fecal levels of organic acids (acetic, lactic, propionic, butyric, isovaleric, isobutyric, and valeric), serum levels of tumor necrosis factor-alpha (TNF-α), interleukin-10 (IL-10), IL-17, and IL-22, complete blood count and C-reactive protein (CRP) were measured. RESULTS: Patients with active IBD had reduced butyric, acetic, valeric, and isovaleric acid levels and elevated lactic acid levels in stool. Hemoglobin levels were positively correlated with the levels of acetic and butyric acids (R = 0.266 and R = 0.346, respectively; P <0.05). In addition, CRP levels were inversely correlated with butyric acid levels (R = -0.573; P <0.05). Higher serum TNF-α levels were observed in patients with active IBD compared with controls (6.64 pg/ml vs 2.05 pg/ml, P <0.05). No relationship was noted between the SCFA profile and cytokine levels. CONCLUSIONS: The study showed that determination of SCFA levels can be used to evaluate the activity of IBD. The relationship between individual SCFA and cytokine levels seems to be complex and requires further studies.

Effect of selected personality traits and stress on symptoms of irritable bowel syndrome.

Irritable bowel syndrome (IBS) is a chronic functional gastrointestinal disorder diagnosed on the basis of Rome IV criteria. Stress is an important contributor to the development of IBS symptoms, while personality, perceived self-efficacy, resilience, and coping strategies may be indirectly involved in the modulation of the body's response to various stressors. The aim of this study was to assess the effect of selected personality traits and stress with IBS symptoms. We enrolled 129 participants (59 men and 70 women) aged from 18 to 61 years. The study group included 94 patients with IBS, while the control group comprised 35 participants without a diagnosed psychosomatic disorder and chronic comorbidities. Participants were assessed using a self-designed questionnaire as well as the Coping Inventory for Stressful Situations, NEO-Five Factor Inventory, 25-item Resilience Coping Scale (Skala Pomiaru Preznosci - SPP-25), and General Self-Efficacy Scale. We observed a significant effect of personality, perceived self-efficacy, resilience, and coping strategies in patients with IBS. Moreover, stress was shown to be associated with disease severity, while the type of a coping strategy was related to the frequency of symptoms. The groups differed in terms of personality traits such as resilience, self-efficacy, extraversion, and neuroticism. Our study confirms the significant effect of personality traits and coping strategies in patients with IBS.

Ferric reducing ability of plasma and assessment of selected plasma antioxidants in adults with celiac disease.

INTRODUCTION: Oxidative stress with an excessive free radical production and a reduction in the activity of protective antioxidants is considered as one of the mechanisms responsible for gluten toxicity. However, its role in celiac disease (CD) is unclear. OBJECTIVES: Evaluation of plasma nonenzymatic antioxidant capacity in patients with CD (both untreated patients and those receiving gluten-free diet [GFD]) by measuring the ferric reducing ability of plasma (FRAP) as well as assessing selected plasma antioxidants. PATIENTS AND METHODS: The study included 169 adult patients: 48 patients with untreated active CD, 72 patients with CD on a GFD, and 49 healthy controls. In each group, we measured the serum levels of selected antioxidants (uric acid, bilirubin, albumin, and vitamin E) and used the FRAP assay to assess the total antioxidant capacity (TAC) of plasma. In each patient, serological and histopathological activity of CD was also evaluated. RESULTS: There were no significant differences in the TAC of plasma measured with the FRAP assay between the study groups. Patients with CD had higher uric acid levels compared with controls (p <0.001), while bilirubin levels were lower in patients with active disease than in controls (p <0.05). Serum vitamin E levels were lower in all patients with CD compared with controls (p <0.01). CONCLUSIONS: The FRAP assay is not the method of choice for assessing the TAC of plasma in patients with CD. Owing to high serum uric acid levels, the FRAP assay results in these patients may be overestimated despite the reduced levels of other plasma antioxidants.

Ghrelin, pancreatic polypeptide plasma concentrations and gastric myoelectric activity in celiac disease.

BACKGROUND/AIMS: The aim of the study was to analyze the effect of celiac disease(CED) on the upper-gut motility and release of enteral hormones (ghrelin and pancreatic peptide (PP)). MATERIALS AND METHODS: the study included 25 patients diagnosed with CED and 30 healthy controls. Gastric myoelectric activities (EGG) in a fasted and fed state were recorded. The plasma concentrations of ghrelin and PP were determined. R e s u l t s: CED patients presented in a fasted state a decreased percentage of normogastria 54.8 ± 24.5 vs. 86 ± 12.3%, p = 0.02 and slow wave coupling (SWC) 52.7 ± 13.4 vs. 77.4 ± 11.9%; p = 0.00001 with increased dominant power (DP) 11.6 ± 1.5 vs. 11.1 ± 1.1. Contrary to the controls, they did not show an improvement in the percentage of normogastria, DP and SWC when examined in a fed state (p 〈0.05). Furthermore, CED patients presented with significantly lower fasting plasma concentrations of ghrelin 156.8 ± 86.7 vs. 260.2 ± 87.6 pg/ml, p = 0.0002 and significantly higher fasting PP levels than did the controls 265.2 ± 306.3 vs. 54.1 ± 54.6 pg/ml, p = 0.0005. C o n c l u s i o n: CED affects gastric myoelectric activity (decreasing normogastria and coupling) and causes changes in fasting concentrations of enteral hormones (decrease in ghrelin and an increase in PP). Gastric myoelectric response to food is abolished in CED patients, probably due to the neurohormonal changes induced by primary inflammation associated with this disease.

Moderate exercise training attenuates the severity of experimental rodent colitis: the importance of crosstalk between adipose tissue and skeletal muscles.

Although progress has been recently made in understanding of inflammatory bowel diseases (IBD), their etiology is unknown apart from several factors from adipose tissue and skeletal muscles such as cytokines, adipokines, and myokines were implicated in the pathogenesis of ulcerative colitis. We studied the effect high-fat diet (HFD; cholesterol up to 70%), low-fat diet (LFD; cholesterol up to 10%), and the normal diet (total fat up to 5%) in rats with TNBS colitis forced to treadmill running exercise (5 days/week) for 6 weeks. In nonexercising HFD rats, the area of colonic damage, colonic tissue weight, the plasma IL-1ß, TNF-α, TWEAK, and leptin levels, and the expression of IL-1ß-, TNF-α-, and Hif1α mRNAs were significantly increased and a significant fall in plasma adiponectin and irisin levels was observed as compared to LFD rats. In HFD animals, the exercise significantly accelerated the healing of colitis, raised the plasma levels of IL-6 and irisin, downregulated the expression of IL-1ß, TNF-α, and Hif1α, and significantly decreased the plasma IL-1ß, TNF α, TWEAK, and leptin levels. We conclude that HFD delays the healing of colitis in trained rats via decrease in CBF and plasma IL-1ß, TNF-α, TWEAK, and leptin levels and the release of protective irisin.

Clinical course of primary sclerosing cholangitis and concomitant ulcerative colitis - a preliminary report of retrospective study among patients from Southern Poland.

UNLABELLED: Both ulcerative colitis (UC) and primary sclerosing cholangitis (PSC) are chronic and progressive diseases of uncertain etiology, that may affect one patient. Approximately 70% of PSC cases are also diagnosed with UC, whereas in the group of UC the prevalence of PSC is about 2-5%. The aim of the study was to compare clinical courses of PSC and UC in patients diagnosed with both diseases to those with the confirmed diagnosis of either PSC or UC. Three groups were distinguished and evaluated: patients with PSC and UC (n = 17) and two control groups: patients with PSC (n = 4) and with UC (n = 13). Clinical data, symptoms, laboratory tests, results of the magnetic resonance cholangiopancreatography and colonoscopy were analyzed to compare clinical courses of these diseases between the groups. CONCLUSION: there is no correlation between clinical course of simultaneous PSC and UC. However, it may differ depending on co-occurrence of the other disease.

Levofloxacin resistance of Helicobacter pylori strains isolated from patients in southern Poland, between 2006-2012.

An increasing resistance of Helicobacter pylori (H. pylori) to antimicrobial agents leads to the need of regional monitoring of the prevalence resistant strains (according to the Maastricht/Florence consensus report, 2012). The aim of the study was to assess the resistance to levofloxacin of H. pylori strains isolated from adult patients of Malopolska region in Poland. Bioptates taken from gastric mucosa during gastroscopy constituted the material for the study. Two hundred ten H. pylori strains were isolated from 811 patients. A majority of strains (171) came from patients before the treatment of H. pylori infections while the remaining 39 strains were isolated from patients after the failed therapy. Susceptibility of H. pylori to levofloxacin was determined by strips impregnated with antibiotic gradient (E-test, bioMerieux). The obtained minimum inhibitory concentration (MIC) values ranged from 0.002 mg/L to 32 mg/L. The percentage of strains resistant to levofloxacin amounted to 8.10% (17/210). Among the group of strains isolated from patients before the treatment, 5.85% (10/171) of H. pylori strains were resistant to levofloxacin. In the group of strains isolated from patients after the treatment 17.95% (7/39) of strains were resistant. The difference in the frequency of H. pylori strains resistant to levofloxacin in patients before and after the treatment of the infection due to H. pylori was statistically significant (p = 0.0297). The low percentage of H. pylori strains resistant to levofloxacin justify that the introduction of a triple therapy with levofloxacin is a good alternative in the treatment of H. pylori infections, especially in regions with high prevalence of H. pylori strains resistant to clarithromycin (> 20%).

[Antibodies against alfa-enolase as an indication of inflammatory process in patients with celiac disease--preliminary results]. / Przeciwciala przeciw alfa enolazie, jako wskaznik stanu zapalnego u chorych na celiakie-doniesienie wstepne.

INTRODUCTION: Celiac disease (CD) is an autoimmunological gluten sensitive enteropathy occuring to genetically predisposed individuals. Active CD is accompanied by presence of multiple antibodies. Anti alpha enolase antibodies were reported in several autoimmunological disorders like rheumatoid arthritis, primary sclerosing cholangitis. Data about its presence and role in CD is avaricious. AIM: The aim of this study was to determine presence of anti alpha enolase antibodies in CD, correlation with gluten exposure, presence of anti tranglutaminase antibodies and Marsh scale. METHODS: Sera from 31 patients with CD (21 females, 10 males) and 6 healthy subjects were collected. Evaluation of CD activity and adherence to gluten free diet were obtained by serology tests (presence of endomyslum antibodies and/or anti transglutamineses in IgA or IgG classes) and histological hallmarks. Anti alpha enolase antibodies were identified in sera using ELISA kit. Titres of anti alpha enolase antibodies were identified among patients with newly diagnosed CD, CD patients non adhering to gluten free diet (GFD), adhering to GFD and among healthy subjects. RESULTS: Mean titre of anti alpha enolase antibodies was higher in CD patients (both treated and non treated) in comparison to control group, respectively 1.1 ng/mL, and 0.795 ngl mL. Among CD patients non adhering to gluten free diet mean titre was 1.4 ng/mL. CONCLUSIONS: Higher anti alpha enolase antibodies titres in non treated CD suggest usefulness of its measurement. These antibodies might be a novel marker of chronic inflammation among CD patients non adhering to GFD.

[Endoscopic and histopathological findings of the upper gastrointestinal tract in patients with functional and organic dyspepsia]. / Zmiany endoskopowe i histopatologiczne górnego odcinka przewodu pokarmowego u chorych z dyspepsja organiczna i czynnosciowa.

INTRODUCTION: Endoscopic examination of the upper gastrointestinal tract (upper GI) with macroscopic and histopathological evaluation provides essential tool to differentiate the organic and functional causes of dyspepsia. The distinction, however, is often smooth and not fully defined. The aim of this study was to assess the frequency and type of the macroscopic and histopathological changes in the upper GI endoscopy in patients with symptoms of dyspepsia. MATERIAL AND METHODS: A retrospective study was performed on 212 patients with dyspepsia, at the age of 18-84 years, including 60 patients to 45 years of age (group I) and 152 patients older than 45 (group II) who underwent gastroscopy. The severity of esophagitis was classified according to the Los Angeles Classification and gastritis according the updated Sydney system. Biopsy specimens were taken from the gastric and duodenum for histopathological examination. The presence of H. pylori infection has been established on the basis of histopathological examination and positive rapid urease test. RESULTS: Reflux esophagitis was found in 18 patients (8.5%), slightly more common in people over 45 years of age (group I--5%, group II--9.2%). The mild forms of esophagitis occurred most frequently. A more advanced form of inflammation and Barrett's esophagus was found only in patients over 45 years of age. Normal gastric and duodenal mucosa was revealed in 30% of patients in group I and 9.2% in group II. The most common endoscopic lesion was gastritis, mostly erythematous-exudative and less often atrophic. The presence of H. pylori infection was varied in the different types of inflammation. H. pylori infection occurred most frequently in the case of erosive and follicular gastropathy. The most common location of H. pylori infec- frequent in older patients. Peptic ulcer was found in 4.7% of patients (group I--5%, group II--4.6%). In one patient (61 years old) stomach cancer was diagnosed and in one patient (<45 years old) Crohn's disease of the upper GI was diagnosed. The majority of patients had normal duodenal mucosa. In 3.3% of patients (group I--8.3%, group II--1.3%), who had not previously diagnosed celiac disease, histopathological changes typical of celiac disease has been shown. In all patients, in whom biopsy specimens were taken from normal duodenal mucosa (14% of patients), histopathological examination revealed the presence of non-specific inflammation, regardless of the coexistence of H. pylori infection. CONCLUSION: Regardless of the severity of lesions of the upper GI endoscopy in patients with dyspepsia, it is advisable to take biopsy from the gastric and duodenal mucosa, which allows for an individualized management of these patients. Celiac disease should be considered in the diagnosis of the causes of dyspepsia. Further studies of microscopic duodenitis in patients with dyspepsia are needed.

Possible role of Escherichia coli in propagation and perpetuation of chronic inflammation in ulcerative colitis.

BACKGROUND: This study investigated a possible role of Escherichia coli in propagation and perpetuation of the chronic inflammation in ulcerative colitis (UC). The lesions of UC are located superficially on the rectal and/or colonic mucosa. It is suggested that the commensal bacteria of the digestive tract may play a role in the pathogenesis of UC. Several studies have demonstrated proliferation of E. coli in the gut of UC patients. An increase in the number of E. coli in the inflamed tissue is most probably related to the abundance of iron ions produced by the bacteria. METHODS: Colon mucosal biopsies were collected from 30 patients with acute-phase UC, both from tissues with inflammatory changes (n = 30) and unchanged tissue with no inflammatory changes (n = 30) from the same patient. Biopsies were also taken from 16 patients with irritable bowel syndrome diarrhea who comprised the control group. Quantitative and qualitative analysis of the biopsy specimens was performed using culture methods and real-time polymerase chain reaction (PCR). Genotyping of the E. coli isolates was done using pulsed-field gel electrophoresis. Multiplex PCR was used to compare the E. coli strains for the presence of genes responsible for synthesis of iron acquisition proteins: iroN, iutA, iha, ireA, chuA, and hlyA. RESULTS: We demonstrated that there was a significant increase in the number of E. coli at the sites of inflammation in patients with UC compared to the control group (P = 0.031). Comparative analysis of the restriction patterns of E. coli isolated from inflammatory and unchanged tissues showed that the local inflammatory changes did not promote specific E. coli strains. There was a significant difference in the frequency of the iroN gene in E. coli isolated from patients with UC as compared to the control group. CONCLUSIONS: The increase in the numbers of E. coli in the inflammatory tissues is related to the presence of chuA and iutA genes, which facilitate iron acquisition during chronic intestinal inflammatory processes.

Ustekinumab in the treatment of acute disseminated pyoderma gangrenosum in a patient with Crohn's disease.

Pyoderma gangrenosum (PG) is an auto-inflammatory dermatosis characterized by lesions that often cause ulcers. We present a case of successful ustekinumab treatment for acute general PG in a 31-year-old woman with coexisting Crohn's disease (CD). For a month, the patient suffered from skin ulcers, two of them deep and necrotic; a histopathological examination revealed PG. Treatment included: methylprednisolone, azathioprine, betamethasone, gentamicin and zincic ointments, antiseptic compresses, and adalimumab therapy. Due to resistance to the implemented treatment, the patient was enrolled in a clinical trial that included the administration of an anti-cytokines drug, ustekinumab. Subsequently, a significant reduction was observed in the severity of symptoms of PG with no relapse. The use of ustekinumab in patients with PG who have an inadequate response to current treatment or cannot receive first-line treatment can be considered. This applies especially to patients with accompanying autoimmune diseases such as CD.

Postprandial effect of gastrointestinal hormones and gastric activity in patients with irritable bowel syndrome.

Altered gut regulation, including motor and secretory mechanisms, is characteristic of irritable bowel syndrome (IBS). The severity of postprandial symptoms in IBS patients is associated with discomfort and pain; gas-related symptoms such as bloating and abdominal distension; and abnormal colonic motility. The aim of this study was to assess the postprandial response, i.e., gut peptide secretion and gastric myoelectric activity, in patients with constipation-predominant IBS. The study was conducted on 42 IBS patients (14 males, 28 females, mean age 45.1 ± 15.3 years) and 42 healthy participants (16 males, 26 females, mean age 41.1 ± 8.7 years). The study assessed plasma gut peptide levels (gastrin, CCK-Cholecystokinin, VIP-Vasoactive Intestinal Peptide, ghrelin, insulin) and gastric myoelectric activity obtained from electrogastrography (EGG) in the preprandial and postprandial period (meal-oral nutritional supplement 300 kcal/300 ml). Mean preprandial gastrin and insulin levels were significantly elevated in IBS patients compared to the control group (gastrin: 72.27 ± 26.89 vs. 12.27 ± 4.91 pg/ml; p < 0.00001 and insulin: 15.31 ± 12.92 vs. 8.04 ± 3.21 IU/ml; p = 0.0001), while VIP and ghrelin levels were decreased in IBS patients (VIP: 6.69 ± 4.68 vs. 27.26 ± 21.51 ng/ml; p = 0.0001 and ghrelin: 176.01 ± 88.47 vs. 250.24 ± 84.55 pg/ml; p < 0.0001). A nonsignificant change in the CCK level was observed. IBS patients showed significant changes in postprandial hormone levels compared to the preprandial state-specifically, there were increases in gastrin (p = 0.000), CCK (p < 0.0001), VIP (p < 0.0001), ghrelin (p = 0.000) and insulin (p < 0.0001). Patients with IBS showed reduced preprandial and postprandial normogastria (59.8 ± 22.0 vs. 66.3 ± 20.2%) compared to control values (83.19 ± 16.7%; p < 0.0001 vs. 86.1 ± 9.4%; p < 0.0001). In response to the meal, we did not observe an increase in the percentage of normogastria or the average percentage slow-wave coupling (APSWC) in IBS patients. The postprandial to preprandial power ratio (PR) indicates alterations in gastric contractions; in controls, PR = 2.7, whereas in IBS patients, PR = 1.7, which was significantly lower (p = 0.00009). This ratio reflects a decrease in gastric contractility. Disturbances in the postprandial concentration of gut peptides (gastrin, insulin and ghrelin) in plasma may contribute to abnormal gastric function and consequently intestinal motility, which are manifested in the intensification of clinical symptoms, such as visceral hypersensitivity or irregular bowel movements in IBS patients.

Diagnostic and therapeutic recommendations on Helicobacter pylori infection. Recommendations of the Working Group of the Polish Society of Gastroenterology.

Helicobacter pylori remains a major health problem worldwide, causing considerable morbidity and mortality due to peptic ulcer disease and gastric cancer. These guidelines constitute an update of the previous "Recommendations on the diagnosis and management of Helicobacter pylori infection" issued in 2014. They have been developed by a Task Force organized by the Governing Board of the Polish Society of Gastroenterology. They discuss, with particular emphasis on new scientific data covering papers published since 2014: the epidemiology, clinical presentation, diagnostic principles and criteria for the diagnosis, and recommendations for the treatment of H. pylori infection. The guidelines in particular determine which patients need to be tested and treated for infection. The Task Force also discussed recommended treatment algorithms. Accordingly, a combination of available evidence and consensus-based expert opinion were used to develop these best practice advice statements. It is worth noting that guidelines are not mandatory to implement but they offer advice for pragmatic, relevant and achievable diagnostic and treatment pathways based on established key treatment principles and using local knowledge and available resources to guide regional practice.

[Hereditary hemochromatosis and mild unconjugated hyperbilirubinemia in patient with ulcerative colitis]. / Wrodzona hemochromatoza i lagodna niezwiazana hiperbilirubinemia u chorego z wrzodziejacym zapaleniem jelita grubego.

We present the case of 51 year old man with 10 year history of ulcerative colitis. Results of laboratory test revealed increased serum levels of iron, ferritin as well as moderate hiperbilirubinemia. Transferrin saturation index was high, 98,7% (N< 50%). Long lasting remission of inflammatory bowel disease, including lack of bleeding from gastrointestinal tract disclosed hereditary hemochromatosis presence in that patient.

The risk of essential fatty acid insufficiency in patients with inflammatory bowel diseases: fatty acid profile of phospholipids in serum and in colon biopsy specimen.

Introduction: The aim of the study was to address the fatty acid (FA) status and its relationship with disease activity in patients with inflammatory bowel disease (IBD). Methods: FA levels of the phospholipid fraction in serum and a colon biopsy specimen were measured in 17 patients with IBD. Results: A negative correlation between the histological activity of inflammation of the disease and the ratio of polyunsaturated FAs/no polyunsaturated FAs was observed. Moreover, the level of that ratio was lower in patients with IBDs as compared to controls. Conclusions: The FA profile in serum and in a colon biopsy specimen in patients with IBD is characteristic for essential fatty acid insufficiency.

Association between Fecal Short-Chain Fatty Acid Levels, Diet, and Body Mass Index in Patients with Inflammatory Bowel Disease.

Disturbances in the production of bacterial metabolites in the intestine have been reported in diseases associated with dysbiosis, such as inflammatory bowel diseases (IBDs) that include two conditions: Crohn disease (CD) and ulcerative colitis (UC). Short-chain fatty acids (SCFAs) are the main dietary-fiber-derived bacterial metabolites associated with the course of intestinal inflammation. In this study, we assessed the relationship between body mass index (BMI), the type of diet used, and changes in fecal SCFA levels in patients with IBD. We performed nutritional assessments using a nutritional questionnaire and determined fecal SCFA levels in 43 patients with UC, 18 patients with CD, and 16 controls. Our results revealed that subjects with a BMI > 24.99 kg/m2 had higher levels of isobutyric acid, whereas those with a BMI < 18.5 kg/m2 had lower level of butyric, isovaleric, and propionic acids. Furthermore, we observed higher levels of valeric acid in controls than in IBD patients. We did not reveal a relationship between a specific SCFA and the type of diet, but eating habits appear to be related to the observed changes in the SCFA profile depending on BMI. In conclusion, we demonstrated that BMI is associated with SCFA levels in patients with IBD.

Application of the Clustering Technique to Multiple Nutritional Factors Related to Inflammation and Disease Progression in Patients with Inflammatory Bowel Disease.

Diet and nutritional status affect intestinal inflammation in patients with inflammatory bowel disease (IBD). The aim of this study was to use a cluster analysis to assess structural similarity between different groups of parameters including short-chain fatty acid (SCFA) levels in stool as well as hematological and inflammatory parameters (such as serum C-reactive protein (CRP) and proinflammatory and anti-inflammatory cytokines). We also assessed similarity between IBD patients in terms of various biochemical features of disease activity and nutritional status. A total of 48 participants were enrolled, including 36 patients with IBD and 12 controls. We identified four main meaningful clusters of parameters. The first cluster included all SCFAs with strong mutual correlations. The second cluster contained red blood cell parameters and albumin levels. The third cluster included proinflammatory parameters such as tumor necrosis factor-α, CRP, platelets, and phosphoric, succinic, and lactic acids. The final cluster revealed an association between zonulin and interleukins IL-10, IL-17, and IL-22. Moreover, we observed an inverse correlation between IL-6 and body mass index. Our findings suggest a link between nutritional status, diet, and inflammatory parameters in patients with IBD, which contribute to a better adjustment of the nutritional treatment.

The Importance of Nutritional Aspects in the Assessment of Inflammation and Intestinal Barrier in Patients with Inflammatory Bowel Disease.

Intestinal inflammation in inflammatory bowel disease (IBD) is closely linked to nutrition. This study aimed to evaluate associations between nutritional, inflammatory, and intestinal barrier parameters in patients with IBD. We assessed nutritional status, fecal short-chain fatty acid profile, serum cytokine levels, and mRNA expression of enzymes and tight junction proteins in intestinal biopsies obtained from 35 patients, including 11 patients with inactive IBD, 18 patients with active IBD, and six controls. Patients with active IBD were characterized by hypoalbuminemia, fluctuations in body weight, and restriction of fiber-containing foods. In addition, they had significantly reduced levels of isovaleric acid and tended to have lower levels of butyric, acetic, and propionic acids. Patients with active IBD had higher mRNA expression of peroxisome proliferator-activated receptor γ and inducible nitric oxide synthase, and lower mRNA expression of claudin-2 and zonula occludens-1, compared with patients with inactive IBD. Moreover, patients with a body mass index (BMI) of ≥25 kg/m2 had higher median tumor necrosis factor-α levels that those with a lower BMI. We comprehensively evaluated inflammatory parameters in relation to IBD activity and nutritional status. The discrepancies between proinflammatory and anti-inflammatory parameters depending on IBD activity may be related to nutritional factors, including diet and abnormal body weight.