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Adherence to the Mediterranean diet is associated with decreased fecal calprotectin in patients with ulcerative colitis after pouch surgery

European Journal of Nutrition volume 59, pages 3183–3190 (2020)Cite this article

Abstract

Background

Mediterranean diet (MED) is associated with health benefits, yet scarce data exist regarding the role of MED in inflammatory bowel diseases (IBD). Herein, we aimed to evaluate the association between MED and inflammatory markers in patients with IBD after pouch surgery.

Methods

Consecutive patients after pouch surgery due to ulcerative colitis (UC) were recruited at a comprehensive pouch clinic. Adherence to MED was calculated according to MED score, ranging from 0 (low adherence) to 9 (high adherence), based on food-frequency questionnaires. Pouch behavior was defined as normal pouch (NP) or pouchitis based on Pouchitis Disease Activity Index (PDAI) and disease activity was defined as active or inactive. C-reactive protein (CRP) and fecal calprotectin were assessed.

Results

Overall 153 patients were enrolled (male gender 47%; mean age 46 ± 14 years; mean pouch age 9.5 ± 7 years). MED scores were higher in patients with normal vs. elevated CRP and calprotectin levels (4.6 ± 1.8 vs. 4.4 ± 1.6, p = 0.28; 4.8 ± 1.8 vs. 4.07 ± 1.7, p < 0.05, respectively). In a multivariate regression, MED score was associated with decreased calprotectin levels (OR = 0.74 [0.56–0.99]). Adherence to MED was associated with dietary fiber and antioxidants intake. Finally, in a subgroup of patients with NP followed up for 8 years, higher adherence to MED trended to be inversely associated with the onset of pouchitis (log rank = 0.17).

Conclusions

In patients with UC after pouch surgery, adherence to MED is associated with decreased calprotectin levels. Thus, MED may have a role in modifying intestinal inflammation in IBD.

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Funding

This study was supported, in part, by a grant from the Leona M. and Harry B. Helmsley Charitable Trust.

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Authors and Affiliations

  1. Division of Gastroenterology, Rabin Medical Center (affiliated to the Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel), Petah-Tikva, Israel

    L. Godny, T. Pfeffer-Gik, I. Goren, H. Yanai & I. Dotan

  2. Department of Molecular Microbiology and Biotechnology, George S. Wise Faculty of Life Sciences, Tel Aviv University, Tel Aviv, Israel

    L. Reshef & U. Gophna

  3. Proctology Unit, Department of Surgery, Tel Aviv Sourasky Medical Center (affiliated to Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel), Tel Aviv, Israel

    H. Tulchinsky

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  1. L. Godny
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Correspondence to I. Dotan.

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Godny, L., Reshef, L., Pfeffer-Gik, T. et al. Adherence to the Mediterranean diet is associated with decreased fecal calprotectin in patients with ulcerative colitis after pouch surgery. Eur J Nutr 59, 3183–3190 (2020). https://doi.org/10.1007/s00394-019-02158-3

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