‘Promising’ low-calorie, plant-based diet may improve inflammation, therapy response in UC
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Key takeaways:
- At week 8, 50% of patients on the plant-based diet vs. 30.7% on the control diet achieved clinical response.
- The plant-based diet also improved well-being, urgency and presence of blood in stool.
WASHINGTON — “Even at short intervals,” an intermittent low-calorie, plant-based diet may improve inflammation and response to medical therapy among patients with moderately to severely active ulcerative colitis, according to a presenter.
“Diet plays a role in IBD inflammation but there are very few clinical trials that examine the impact of diet on UC and, to my knowledge, none that examine the effect of diet in active UC,” Oriana M. Damas, MD, MSCTI, associate professor of medicine and director of translational studies for the Crohn’s and Colitis Center at University of Miami Miller School of Medicine, told Healio. “Additionally, we were inspired to examine whether intervals of a 5-day diet could help disease inflammation, as patients and humans in general are more likely to follow a specific diet for a short period of time.”
In a study presented at Digestive Disease Week, Damas and colleagues enrolled 32 adult patients with moderately to severely active UC who started new advanced therapy, of whom 24 completed the study. Nineteen received medical treatment with tofacitinib, two with upadacitinib, two with infliximab and one with risankizumab.
Patients were randomly assigned 1:1 to two, 5-day intervals of a low-calorie, plant-based diet plus standard medical therapy (n = 10) or a low-residue control diet plus standard medical therapy (n = 14) for 8 weeks. Those on the plant-based diet were provided commercially available fasting mimicking diet kits.
On day 1, the diet provided about 1,090 kcal (10% protein, 56% fat, 34% carbs), while days 2 through 5 provided only 725 kcal (9% protein, 44% fat, 47% carbs). Additional low-calorie snacks were given and small adjustments to food were made based on tolerance and ability to keep a stable percentage of macronutrients.
Since the plant-based diet is low-calorie, Damas said, “we specifically excluded patients who we thought could not tolerate lower calorie intake, even if for a short period of time, such as patients with a low BMI, with significant comorbidities or above the age of 75.”
At baseline and during intervention, Damas and colleagues assessed diet and adherence and completed the Simple Clinical Colitis Activity Index (SCCAI) up to week 8. Blood and stool samples were also collected.
The primary outcome was clinical response at week 8, determined by SCCAI, Damas said. The mean baseline SCCAI among participants on the plant-based diet was 7.73 vs. 7.47 for the control group.
“We found that patients on the diet intervention improved in all components of the SCCAI index, including well-being, urgency and presence of blood in stool compared to the control diet,” Damas told Healio.
Results showed that at week 8, 50% of those on the plant-based diet had a clinical response to therapy compared with 30.7% of the control group. The mean drop in SCCAI in the plant-based diet group was 4.4 vs. 1.61 in the control group (P = .037).
“We also found improvement in fecal calprotectin, our secondary endpoint, although this did not reach statistical significance, perhaps due to lower numbers of samples,” Damas said. “We did find improvement in serum amyloid A protein, a sensitive marker of inflammation in the blood.”
She added, “I think it’s promising to know that diet, even in short intervals, can help with inflammation and response to medications in UC.”
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Damas OM, et al. Intervals of a plant-based, low-calorie diet improve clinical symptoms compared with usual diet in patients initiating advanced therapies for moderate to severe ulcerative colitis. Presented at: Digestive Disease Week; May 18-21, 2024; Washington (hybrid).
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