May 3, 2010 High protein intake may be associated with increased risk of inflammatory bowel disease, while fatty acids found in olive, peanut and grapeseed oils may protect against the development of ulcerative colitis, according to new data being presented at Digestive Disease Week® (DDW®) 2010. DDW is the largest international gathering of physicians and researchers in the field of gastroenterology, hepatology, endoscopy and gastrointestinal surgery.
"We know more now than we ever have about the effect of specific nutrients on GI health, and these studies bring us closer to treating, and perhaps even preventing some of these disorders," according to Kelly A. Tappenden, PhD, RD, University of Illinois. "Although there is more research to be done on these important issues, armed with these new data on the links between diet and GI disorders, we can continue to work toward better therapies and improved health outcomes."
Retinol Supplements Antiviral Action of Pegylated Interferon and Ribavirin Combination Therapy in Patients with Chronic Hepatitis C: Prospective Pilot Study (Abstract #T2004)
Vitamin A supplements increase the anti-viral effect of gold-standard treatment drugs for hepatitis C (HCV), according to a new study from Shimane University School of Medicine in Izumo, Japan. This is the first study in which vitamin A (retinol) was given during all 48 weeks with PegINFα2b and rivabirin in order to evaluate the early viral response and outcome (rate of sustained virological response, etc.) of patients with chronic HCV.
Previously, the number of patients with HCV who achieved a sustained virologic response after the standard therapy of peg-interferon and ribavirin was low, so investigators at Shimane University School of Medicine sought a way to enhance the anti-viral effect of interferon and ribavirin on HCV.
They found that retinol improved the antiviral effect of PegIFNα-2b/ribavirin in patients with chronic HCV. "Our findings show that it is possible to improve the poor results of the gold-standard treatment for hepatitis C with virtually no risk of side effects," said Shuichi Sato, MD, second department of internal medicine at Shimane University. "We believe that more patients will benefit from our findings."
Investigators studied 42 patients with chronic HCV as part of a multi-center prospective trial. Patients were automatically randomized between the control and retinol groups by the secretariat. The control group received pegylated interferon alpha-2b once a week intramuscularly, plus 600 or 800 mg per day of ribavirin orally for 48 weeks. In the retinol group, in addition to the above treatment, patients also received oral retinol at 30,000 units per day during the combination therapy.
The HCV negativity rate at eight weeks after starting pegylated interferon alpha-2b and ribavirin combination therapy was 61.7 percent for the retinol group and 23.8 percent for the control group. Also, the rates of sustained virological response were 66.7 percent and 42.9 percent, respectively. There were no differences for the rates of non-response and discontinued treatment between the groups, and no adverse event caused by retinol was observed in patients who received pegylated interferon plus ribavirin combination therapy.
Dr. Sato added that very often high doses of different vitamins are being used solo or alongside different drugs for various conditions, but that this should always be done under direct medical supervision.
Dr. Sato will present these data on Tuesday, May 4 at 8:00 a.m. CT in Hall F, Ernest N. Morial Convention Center.
Dietary Oleic Acid May Protect Against the Development of Ulcerative Colitis -- A UK Prospective Cohort Study (Abstract #100)
Oleic acid in one's diet may help reduce or prevent the development of ulcerative colitis (UC). Oleic acid, a monounsaturated fatty acid, is present in olive, peanut, and grapeseed oils and may prevent ulcerative colitis from developing by suppressing inflammation by blocking chemicals in the bowel that aggravate inflammation. UC affects men and women of all ages and is characterized by inflammation of the lining of the colon or large bowel, which can cause distressing symptoms such as abdominal pain, diarrhea and weight loss.
Researchers led by Andrew R. Hart, MD, senior lecturer in gastroenterology, University of East Anglia, Norwich, U.K., sought to determine whether people eating more oleic acid are protected against developing UC. They studied more than 25,000 men and women aged 40 to 65 years in Norfolk, England, who were recruited between 1993 and 1997 into a study called EPIC (European Prospective Investigation into Diet and Cancer). These participants, initially without UC, completed a diary of all the foods they ate for one week including foods eaten, the quantity and brands in detail.
The diaries were then coded by specially trained nutritionists using a specific computer program called DINER. The nutritionists, using DINER, calculated the dietary intake of different foods consumed by participants, including oleic acid. Patients were followed up to 2004 to identify those who were subsequently diagnosed with UC. Researchers compared any differences in diet, including oleic acid, between those who were diagnosed with UC and those who remained healthy.
The study found that individuals with the highest intake of oleic acid had a 90 percent lower risk of developing UC. Dr. Hart estimates that approximately half the cases of UC could be prevented if larger amounts of oleic acid were consumed -- as much as two to three tablespoons of olive oil per day could have a protective effect.
Dr. Hart said similar work in other countries is now required to determine if the results are reproducible and consistent in other groups. These are required to confirm whether oleic acid is truly protective. If so, researchers believe that dietary modifications may prevent this distressing illness and that the use of oleic acid supplements should be clinically assessed as treatment for patients with UC. Additionally, while most conditions are treated with drugs rather than dietary treatments, Hart noted that a proven complementary approach using both may be a research topic for the future to benefit more patients.
"If we could show that dietary treatments complement drug treatments then that could have a better outcome than either approach by itself," he said. "This is critical since many patients with UC have to take medications life-long, may need surgery and have an increased risk of complications including cancer and perforation of the large bowel."
Punya de Silva, MD will present these data on Sunday, May 2 at 11:45 a.m. CT in 295-296, Ernest N. Morial Convention Center.
Higher Resolution Rate of Clostridia Difficile Enteritis in Hospitalized Patients with Normal Vitamin D Levels (Abstract #T1793)
A new study shows that patients with low vitamin D levels who develop Clostridia difficile (C. diff) have a higher recurrence rate and possibly higher hospital mortality. C. diff is a bacterium that causes diarrhea and more serious intestinal conditions such as colitis, and often occurs after taking antibiotics.
Previous studies have shown that normal levels of vitamin D are associated with improved outcomes in hospitalized patients, and conversely, low levels of vitamin D have been associated with higher mortality rate in hospitalized patients. Investigators at New York Hospital Queens -Weill Cornell Medical College, led by Moshe Rubin, MD, director of gastroenterology, sought to determine whether vitamin D levels are associated with a persons' ability to resolve their infection.
Researchers tracked 83 patients who had been admitted to the hospital who were then diagnosed with C. diff. They measured vitamin D levels in all of the patients, then followed their hospital course. Researchers noted how many patients were still alive after 30 days, and compared the outcome of patients with normal vitamin D levels to those with low levels. They found that up to 40 percent of people, especially in an older age group with multiple illnesses, died from some cause if they developed C. diff during that hospitalization.
Furthermore, while they may not die from C. diff, Dr. Rubin said it definitely adds a major complication that contributes to high mortality.
Researchers found that those with normal levels of vitamin D had a higher resolution rate, and a lower recurrence rate than those with low vitamin D levels. These findings are consistent with what is currently understood about vitamin D -- it plays a role in immune function, may be an important factor in fighting infection, low levels seem to be a marker for not resolving diseases in general and it is associated with higher mortality rates.
Sixty-two patients were tracked for 30 days; 45 percent had normal vitamin D levels while 55 percent had low vitamin D levels. In the normal vitamin D group, they found 53 percent remained disease-free for 30 days, but in the group with low vitamin D levels, only 26 percent resolved their C. diff infections. Dr. Rubin noted that since this study was observational, it does not prove a cause and effect relationship between vitamin D levels and recurrence of C. diff, but it does identify an association.
Dr. Rubin said that since the study sample was relatively small, it should be repeated with a larger patient population to corroborate the data.
"We're starting to understand the importance of vitamin D in relation to overall health and to particular infections, like C. diff," said Dr. Rubin. "It's important to pay attention to nutritional issues and possibly even supplement vitamin D in patients with low levels to help fight serious infections."
Dr. Rubin will present these data on Tuesday, May 4 at 8 a.m. CT in Hall F, Ernest N. Morial Convention Center.
Animal Protein Intake and Risk of Inflammatory Bowel Disease: The E3N Prospective Study (Abstract #98)
For the first time, in a large prospective study, researchers have identified an association between high protein intake and a significantly increased risk of inflammatory bowel disease (IBD). While doctors have long suspected that diet contributes to IBD, little has been assessed, and the studies conducted have been retrospective, which are less informative because they rely on the study participants' ability to recall what they have consumed in the past. This study examined the effects of different sources and amounts of protein.
Using participants in France's E3N cohort study, researchers led by Prevost Jantchou, MD, of the Center for Research in Epidemiology and Population and colleagues identified 77 women ages 40 to 65 with validated cases of IBD. In each case, the onset of IBD occurred after the first dietary questionnaire was administered, thereby assuring that they could be studied prospectively.
Dr. Jantchou examined participants' macronutrient (protein, fat and carbohydrate) intake, and determined that more than two-thirds of them had elevated levels of protein intake. Participants were divided into three groups based on their mean protein intake: the lowest intake group had a mean daily protein intake of 1.08 grams/kg of body weight; the middle group had 1.52 grams/kg; and the highest group had 2.07 grams/kg. The FDA recommends a daily intake of 0.8 grams of protein per kilogram of body weight.
When examining the effects of specific types of protein, Jantchou found that animal protein represented a threefold risk of developing IBD in the highest group compared to the lowest group. Specifically, animal protein from meat and fish, not dairy, created an increased risk, while vegetable protein created no increased risk of developing IBD.
Researchers found that the increased risk from animal protein intake were the same for Crohn's disease and ulcerative colitis. They also found that smoking and hormonal therapy, two factors known to be related to the risk of IBD, did not change their results.
"Our findings represent a tremendous step forward in our understanding of inflammatory bowel disease," said Dr. Jantchou. "For years we've known there was a connection between diet and IBD, and we now know specifically which aspect of diet is related to disease occurrence. The next step is to look at the effect of animal protein in patients already diagnosed with IBD to be able to give them better dietary advice."
Dr. Jantchou will present these data on Sunday, May 2 at 11:15 a.m. CT in 295-296, Ernest N. Morial Convention Center.
Alcohol Consumption as a Modifiable Risk Factor in Elective Surgery (Abstract #791)
Alcohol consumption is a significant contributor to adverse outcomes in elective surgery, according to a new study from the University of Massachusetts Medical School.
Researchers studied more than 300,000 discharge records from the American College of Surgeons' National Surgical Quality Improvement Program (NSQIP) database for elective adult admissions. The database includes data from approximately 125 hospitals across the country. Because of its size, this study was able to account for internal biases and determine the independent effect of alcohol consumption on morbidity and mortality following surgery.
Patient records examined in the study were divided into two groups: those with active alcohol exposure, which was defined as at least two drinks per day everyday for two weeks prior to surgery, and those who did not have active alcohol exposure. Those with active alcohol exposure represented 2.5 percent of the records examined. Researchers measured outcomes including length of stay, wound infection, sepsis and death, and found that alcohol use was an independent predictor of pneumonia, sepsis, superficial surgical site infection, wound disruption and longer median hospital stays, and that acute alcohol consumption had a significant effect on mortality.
"This is important information for both patients and surgeons," said Shimul A. Shah, PhD, assistant professor of surgery at the University of Massachusetts Medical School and senior author of the study. "Based on the significant adverse effects on outcomes following surgery, patients who regularly consume this amount of alcohol may want to consider postponing elective surgery until they have abstained from drinking for at least two weeks prior to surgery. Or surgeons may want to consider delaying surgery until patients have shown abstinence from alcohol for at least two weeks to avoid some of the potential complications."
Dr. Shah added that his study's findings serve as a basis for further research that can be done on the local level to examine alcohol consumption trends in more depth to determine the potential that undiagnosed cirrhosis is contributing to these poor surgical outcomes.
Dr. Shah will present these data on May 4 at 2:45 p.m. CT in 243, Ernest N. Morial Convention Center.
Digestive Disease Week® 2010 (DDW®) is the largest international gathering of physicians, researchers and academics in the fields of gastroenterology, hepatology, endoscopy and gastrointestinal surgery. Jointly sponsored by the American Association for the Study of Liver Diseases, the AGA Institute, the American Society for Gastrointestinal Endoscopy and the Society for Surgery of the Alimentary Tract, DDW takes place May 1 -- May 5, 2010 in New Orleans, LA. The meeting showcases more than 5,000 abstracts and hundreds of lectures on the latest advances in GI research, medicine and technology.
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