Low-Fat, High-Fiber Diet Reduces Markers of Inflammation and Dysbiosis and Improves Quality of Life in Patients With Ulcerative Colitis
Low-Fat, High-Fiber Diet Reduces Markers of Inflammation and Dysbiosis and Improves Quality of Life in Patients With Ulcerative Colitis
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DOI：
10.1016/j.cgh.2020.05.026
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发表时间：
2021-05-08
影响因子：
12.6
通讯作者：
Abreu, Maria T.
中科院分区：
文献类型：
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作者：
Fritsch, Julia;Garces, Luis;Abreu, Maria T.
背景和目的：高脂肪饮食与溃疡性结肠炎（UC）风险增加有关。我们研究了低脂肪、高纤维饮食 (LFD) 与改进的标准美国饮食 (iSAD，包括比典型 SAD 更高数量的水果、蔬菜和纤维) 的效果。我们收集了 UC 患者的生活质量、炎症标志物和肠道菌群失调的粪便标志物的数据。方法：我们分析了 2015 年 2 月 25 日至 2018 年 9 月 11 日期间对 17 名处于缓解或轻度疾病（过去 18 个月内发作）的 UC 患者进行的平行组交叉研究的数据。参与者被随机分配到 2 组，并接受 LFD（10% 的卡路里来自脂肪）或 iSAD（35%-40% 卡路里来自脂肪）在前 4 周内，随后是 2 周的冲洗期，然后改用其他饮食 4 周。所有饮食均由患者提供并送到患者家中，每个参与者都作为自己的对照。在每种饮食的基线和第 4 周收集血清和粪便样本，并分析炎症标志物。我们对粪便样本进行了 16s 核糖体 RNA 测序以及非靶向和靶向代谢组学分析。主要结局是生活质量，通过基线和饮食第 4 周的简短炎症性肠病 (IBD) 问卷进行测量。次要结果包括 Short-Form 36 健康调查、部分 Mayo 评分、炎症标志物、微生物组和代谢组分析以及饮食依从性的变化。 结果：参与者的基线饮食比任一研究饮食都不健康。在整个研究期间，所有患者均保持缓解状态。与基线相比，根据简短 IBD 问卷和 Short-Form 36 健康调查评分，iSAD 和 LFD 均提高了生活质量（基线简短 IBD 问卷评分，4.98；iSAD，5.55；LFD，5.77；基线与 iSAD，P = .02；基线与 LFD，P = .001）。 LFD 后血清淀粉样蛋白 A 从基线的 7.99 mg/L 显着降低至 4.50 mg/L (P = .02)，但与 iSAD 相比没有显着降低 (7.20 mg/L；iSAD 与 LFD，P = .07)。 LFD 后，C 反应蛋白的血清水平从基线时的 3.23 mg/L 下降至 2.51 mg/L (P = .07)。粪便样本中放线菌的相对丰度从基线时的 13.69% 下降至 LFD 后的 7.82% (P = .017)，而拟杆菌门的相对丰度从基线时的 14.6% 增加至 LFD 后的 24.02% (P = .015)。 LFD 4 周后，普拉梭菌的相对丰度 (7.20%) 高于 iSAD (5.37%；P = .04)。粪便中乙酸盐（一种抗炎代谢物）的相对丰度从基线时的 40.37 增加到 iSAD 上的 42.52 和 LFD 上的 53.98（基线与 LFD，P = .05；iSAD 与 LFD，P = .09）。粪便色氨酸水平从基线时的相对丰度 1.33 降至 iSAD 的 1.08 (P= .43)，但 LFD 的相对丰度增加至 2.27（基线与 LFD，P = .04；iSAD 与 LFD，P = .08）； LFD 后粪便中的月桂酸水平下降（基线，203.4；iSAD，381.4；LFD，29.91；基线与 LFD，P = .04；iSAD 与 LFD，P = .02）。 结论：在一项针对缓解期 UC 患者的交叉研究中，我们发现，配合使用的 LFD 或 iSAD 均具有良好的耐受性，并提高了生活质量。然而，LFD 降低了粪便样本中的炎症标志物并减少了肠道菌群失调。因此，饮食干预可能有益于缓解期 UC 患者。
BACKGROUND & AIMS: A high-fat diet has been associated with an increased risk of ulcerative colitis (UC). We studied the effects of a low-fat, high-fiber diet (LFD) vs an improved standard American diet (iSAD, included higher quantities of fruits, vegetables, and fiber than a typical SAD). We collected data on quality of life, markers of inflammation, and fecal markers of intestinal dysbiosis in patients with UC.METHODS: We analyzed data from a parallel-group, cross-over study of 17 patients with UC in remission or with mild disease (with a flare within the past 18 mo), from February 25, 2015, through September 11, 2018. Participants were assigned randomly to 2 groups and received a LFD (10% of calories from fat) or an iSAD (35%-40% of calories from fat) for the first 4-week period, followed by a 2-week washout period, and then switched to the other diet for 4 weeks. All diets were catered and delivered to patients' homes, and each participant served as her or his own control. Serum and stool samples were collected at baseline and week 4 of each diet and analyzed for markers of inflammation. We performed 16s ribosomal RNA sequencing and untargeted and targeted metabolomic analyses on stool samples. The primary outcome was quality of life, which was measured by the short inflammatory bowel disease (IBD) questionnaire at baseline and week 4 of the diets. Secondary outcomes included changes in the Short-Form 36 health survey, partial Mayo score, markers of inflammation, microbiome and metabolome analysis, and adherence to the diet.RESULTS: Participants' baseline diets were unhealthier than either study diet. All patients remained in remission throughout the study period. Compared with baseline, the iSAD and LFD each increased quality of life, based on the short IBD questionnaire and Short-Form 36 health survey scores (baseline short IBD questionnaire score, 4.98; iSAD, 5.55; LFD, 5.77; baseline vs iSAD, P = .02; baseline vs LFD, P = .001). Serum amyloid A decreased significantly from 7.99 mg/L at baseline to 4.50 mg/L after LFD (P = .02), but did not decrease significantly compared with iSAD (7.20 mg/L; iSAD vs LFD, P = .07). The serum level of C-reactive protein decreased numerically from 3.23 mg/L at baseline to 2.51 mg/L after LFD (P = .07). The relative abundance of Actinobacteria in fecal samples decreased from 13.69% at baseline to 7.82% after LFD (P = .017), whereas the relative abundance of Bacteroidetes increased from 14.6% at baseline to 24.02% on LFD (P = .015). The relative abundance of Faecalibacterium prausnitzii was higher after 4 weeks on the LFD (7.20%) compared with iSAD (5.37%; P = .04). Fecal levels of acetate (an anti-inflammatory metabolite) increased from a relative abundance of 40.37 at baseline to 42.52 on the iSAD and 53.98 on the LFD (baseline vs LFD, P = .05; iSAD vs LFD, P = .09). The fecal level of tryptophan decreased from a relative abundance of 1.33 at baseline to 1.08 on the iSAD (P= .43), but increased to a relative abundance of 2.27 on the LFD (baseline vs LFD, P = .04; iSAD vs LFD, P = .08); fecal levels of lauric acid decreased after LFD (baseline, 203.4; iSAD, 381.4; LFD, 29.91; baseline vs LFD, P = .04; iSAD vs LFD, P = .02).CONCLUSIONS: In a cross-over study of patients with UC in remission, we found that a catered LFD or iSAD were each well tolerated and increased quality of life. However, the LFD decreased markers of inflammation and reduced intestinal dysbiosis in fecal samples. Dietary interventions therefore might benefit patients with UC in remission.