Fruit may prevent inflammation in IBD patients with ileal pouch

SAN DIEGO — Fruit consumption may have a protective effect against intestinal inflammation in inflammatory bowel disease patients with ileal pouch-anal anastomosis by altering gut microbial composition, according to data presented at DDW 2016.

“Dietary fiber consumption has been associated in several studies ... with a decreased risk for development of IBD,” Lihi Godny, RD, a dietitian from the IBD Center at Tel Aviv Sourasky Medical Center in Israel, said during her presentation. “We hypothesized that dietary components are associated with dysbiosis, microbial composition and intestinal inflammation, and that changes in nutritional consumption may expose patients to a change in the microbiome and consequent inflammation.”

Lihi Godny

They chose to study the “very unique” population of patients who develop pouchitis after pouch surgery. “We think [they] may serve as a key to understanding Crohn’s disease,” she said.

Godny and colleagues performed a longitudinal cohort study of 172 pouch patients (52% women; mean age, 44.9 years; mean time since ileostomy closure, 9.1 years) who were prospectively followed at the Comprehensive Pouch Clinic. Patients completed food frequency questionnaires, and the researchers analyzed their fecal samples for microbial composition using 16S rRNA gene pyrosequencing.

At the beginning of follow-up, 22.6% of these patients had normal pouch behavior. Within 1 year, 12.8% of those with normal pouch behavior developed pouchitis.

They found no significant difference between adequate and inadequate consumption of dietary fiber and risk for pouchitis. Further analysis of different types of dietary fiber revealed that consuming more than 1.45 servings of fruit per day was associated with a reduced risk for developing pouchitis compared with lower fruit consumption (3.8% vs. 30.8%; P = .02).

Consuming fruit also correlated with microbial diversity (P = .001) and abundance of certain microbial groups, and remained so after adjusting for pouch behavior and antibiotic use, positively correlating with Faecalibacterium (P = .01), Lachnospira (P = .005) and two un-annotated genera from the families Lachnospiraceae (P = .03) and Ruminococcaceae (P = .01).

Notably, 10 patients who developed active disease during follow-up significantly decreased their fruit consumption (P = .02) and had corresponding reductions in microbial diversity.

These findings suggest “fruit consumption may be protective against the development of intestinal inflammation,” Godny said. “This affect is possibly mediated via modification of the microbiome.”

She also acknowledged the study’s small sample size and recall bias are limitation, “and of course we can’t rule out reverse causality,” she added. – by Adam Leitenberger

Reference:

Godny L, et al. Abstract #79. Presented at: Digestive Disease Week; May 21-24, 2016; San Diego.

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

Editor's Note: This item has been updated to reflect Godny's correct title.