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P236. High intake of fermentable carbohydrates and food sugars associated with increased disease activity in inflammatory bowel disease

S. James1, J. Barrett1, P. Gibson1

1Box Hill Hospital, Department of Medicine, Level 5, Clive Ward Building, Victoria, Australia

Background: The role of diet in the generation or relief of inflammatory and functional gut symptoms in inflammatory bowel disease (IBD) remains highly topical. Carbohydrates influence gut function and microbiota, via both dietary fibre and poorly absorbed short-chain carbohydrates (FODMAPs), which trigger functional gut symptoms. This study aimed to apply a newly validated food frequency questionnaire (FFQ) (Barrett & Gibson JADA 2010) to determine associations of carbohydrate intake with disease activity and with functional gut symptoms in quiescent IBD.

Methods: 121 subjects with IBD (64 ulcerative colitis (UC), 57 Crohn's disease (CD)) and 72 normal, age- and gender-matched healthy controls completed questionnaires examining food intake (FFQ), disease activity according to colitis activity index (CAI) for UC or Harvey–Bradshaw Index (HBI) for CD, and for functional gut symptoms (Rome III). The FFQ data were analysed using Foodworks software and expressed quantitatively or via quartiles of intake.

Results: 78 (64%) IBD subjects were in remission (CAI <4, HBI <3) and of these, 44% fitted Rome III criteria for IBS (47% UC, 37% CD). Few differences were evident between subjects with IBD and controls; intake of fibre and FODMAPs were similar. Likewise, those with or without functional gut symptoms had similar intake. Patients with active IBD consumed more protein, fat, carbohydrate, total sugar and glucose than controls and those with inactive IBD, and their intakes of fructose (mean 8 g/d greater), total FODMAPs (19 g/day greater) and dietary fibre (4 g/d greater) were all higher in active IBD (p < 0.05, ANOVA). When ranked into quartiles, intakes of fructose and dietary fibre was greater in those with active IBD (p = 0.0074 and 0.033, respectively; Chi-square).

Conclusions: Functional bowel symptoms are common in patients with IBD in remission, but dietary intake was similar to that of controls with or without symptoms. However, active IBD was associated with greater FODMAP and fibre intake, both of which might potentially contribute to symptomatology. These observations may provide insights into the role of dietary carbohydrates in the management of IBD.