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P882 Dietary interventions may modify intestinal inflammation via altering microbial composition—a cross-over trial

L. Godny1,2*, L. Reshef3, T. Pfeffer-Gik1,2, K. Yadagar1, K. Zonensain1, I. Goren1,2, R. Barkan1, H. Yanai1,2, U. Gophna3, H. Tulchinsky4, I. Dotan1,2

1Rabin Medical Center, Division of Gastroenterology, Petah-Tikva, Israel, 2Tel Aviv University, Sackler Faculty of Medicine, Tel Aviv, Israel, 3Tel Aviv University, Department of Molecular Microbiology and Biotechnology, George S. Wise Faculty of Life Sciences, Tel Aviv, Israel, 4Tel Aviv Sourasky Medical Center, Proctology Unit, Department of Surgery, Tel Aviv, Israel

Background

Diet may play a role in the pathophysiology of inflammatory bowel diseases (IBD) via several mechanisms including altering the gut microbiome. Here we evaluated the short-term effect of two dietary regimens, Mediterranean diet (MED) and the specific carbohydrate diet (SCD) on clinical parameters, inflammatory markers and gut microbial composition of IBD patients after pouch surgery.

Methods

We performed a cross-over trial with two short (1 week) dietary interventions and a one-week wash-out period in between. Both diets were provided to patients during intervention periods and both excluded industrialised and processed food. Food and symptoms diaries were documented daily and blood and fecal samples were collected before and after each diet. Gut microbial composition was assessed using 16S r-RNA deep sequencing.

Results

We recruited 28 patients (male gender: 50%, mean age: 49 ± 13 years, mean pouch age: 12 ± 9 years), of those 15 had a normal pouch, 12 had pouchitis and 1 patient had familial adenomatous polyposis. All patients completed both investigated dietary regimens. Both diets resulted in significant improvement in Pouchitis Disease Activity Index (PDAI) clinical sub-score (ΔMedian; MED, −1; SCD, −1, both p < 0.05). C Reactive protein (CRP) and fecal calprotectin before and after MED were comparable. However increased CRP and decreased fecal calprotectin were observed after SCD (ΔMedian; CRP mg/l, +3.04; fecal calprotectin μg/g, −33, both p < 0.05). Both diets resulted in significant weight loss (ΔMedian kg; MED, −0.5; SCD, −0.6, both p < 0.001) and a decrease in triglycerides levels (ΔMedian mg/dl, MED, −29; SCD −46.5, both p < 0.05). No significant changes in the clinical parameters or inflammatory markers were noticed in both dietary interventions. Rapid changes in the abundance of several microbial taxa were noted, specifically a decrease in Cetobacterium after MED and Haemophilus after SCD. Interestingly, abundance of a Klebsiella/Enterobacter genus from the Enterobacteriaceae family increased after SCD and was higher in the baseline microbial samples of patients who reported greater improvement on SCD.

Conclusion

In this cross-over trial two unindustrialised dietary interventions (MED and SCD) rapidly improved clinical and metabolic parameters in patients with IBD. However, effect of SCD on inflammatory markers was ambiguous and may be related to increased abundance of Enterobacteriaceae, previously shown to be associated with a high-fat diet.