Fatty acid linked to increased risk for UC flare in mesalamine-treated patients

SAN DIEGO — High consumption of certain fatty acids, including myristic fatty acid found in dairy fat and coconut oil, was found to be associated with an increased risk for relapse in patients with ulcerative colitis who were treated with mesalamine, according to data presented at DDW 2016.

“Despite increased interest in the role that a ‘Western diet’ may play in the development of inflammatory bowel disease and the subsequent disease course of patients with established IBD, the majority of the studies that have evaluated the relationship between diet and the risk of flare in patients with ulcerative colitis have been retrospective or cross-sectional in nature,” Edward L. Barnes, MD, from the division of gastroenterology, hepatology and endoscopy at Brigham and Women’s Hospital in Boston, told Healio Gastroenterology. “Our goal was to perform a prospective study evaluating the relationship between dietary intake and the risk of flare among a relatively homogenous group of patients with UC.”

Edward L. Barnes

The Diet’s Role in Exacerbations of Mesalamine Maintenance, or DREAM, study involved 412 patients with mild-to-moderate UC, all of whom were in remission and receiving a stable dose of mesalamine, sulfasalazine or balsalazide at enrollment. Patients from 25 centers completed validated food frequency questionnaires and were contacted every 3 months for 1 year for disease activity data.

The researchers evaluated the relationship between food consumption and disease activity in terms of macro and micronutrient groups and in food groups previously linked to UC flare.

Within a year, 11% of patients experienced a flare. Patients with the highest tertiles of consumption of certain food groups and macronutrients showed an increased risk for flare. These included certain groups of fatty acids, dairy protein, lysine and alanine.

Multivariate analyses showed higher consumption of lactose (OR = 3.02; 95% CI, 1.2-7.8), alpha linolenic fatty acid (OR = 7.03; 95% CI, 1.9-25.6), and myristic fatty acid (OR = 3.89; 95% CI, 1.3-11.3) was associated with increased risk for flare in an apparent dose-dependent manner.

The researchers observed no such association with other foods previously implicated in risk for UC flare, including processed meat, alcohol and foods high in sulfur.

“We found that higher intake of myristic acid, which is commonly found in coconut oil, was associated with increased odds of flare among patients with UC in remission on aminosalicylates, a relationship that has not previously been described,” Barnes said. “Our findings may lead to further work to understand the underlying pathophysiology and role that fatty acids play in the disease course of patients with UC, as well as the development of potential dietary interventions for patients with established UC.” – by Adam Leitenberger

Reference:

Barnes EL, et al. Abstract #17. Presented at: Digestive Disease Week; May 21-24, 2016; San Diego.

Disclosures: Barnes reports no relevant financial disclosures. Please see the DDW disclosure list for all other researchers’ relevant financial disclosures.