Nutrition and Lifestyle Factors Associated with Inflammatory Bowel Disease

Objective Many dietary and lifestyle factors are found to be associated with the pathogenesis of IBD. The purpose of this study is to review the dietary and lifestyle factors associated with IBD. In addition, too, this review attempts to investigate the association between dietary patterns and IBD risk and compare lifestyle factors among IBD patients. Methods Google Scholar and PubMed were searched together with relevant journals for Englishstudies from September 2018 to August 2020. The original studies which evaluated the lifestyle factors and dietary patterns as risk factors for inflammatory bowel disease were included. Results Several studies in IBD were discussed and highlighted the independent effects of various dietary and lifestyle factors on the risk of IBD. Forty-nine articles met the inclusion criteria and indicated that dietary factors tend to play a pivotal role in the disease etiopathogenesis and course. However, research on food and IBD is contradictory. Conclusion An excessive intake of sugar and animal fat is considered a risk factor for the development of IBD, whereas a high fiber diet and high intake of fruits and vegetables may play a protective effect. The role of lifestyle factors in IBD is crucial. Amply of evidence suggested that smoking is a causative agent in CD while it is protective against UC. Stress, depression, vitamin D deficiency, and impaired sleep have all been associated with incident IBD. A diet with a modified carbohydrate composition, a semi-vegetarian diet, a diet low in protein and fat, and a diet low in fermentable oligosaccharides, disaccharides, monosaccharides, and polyols should be taken into consideration for IBD patient

Dietary Patterns and the Risk of Inflammatory Bowel Disease: Findings from a Case-Control Study

Scientific evidence shows that dietary patterns are associated with the risk of IBD, particularly among unhealthy and Western dietary patterns. However, Western dietary patterns are not exclusive to Western countries, as Jordanians are steadily moving towards a Western lifestyle, which includes an increased consumption of processed foods. This study aims to investigate the association between dietary patterns and the risk factors for IBD cases among Jordanian adults. This case-control study was conducted between November 2018 and December 2019 in the largest three hospitals in Jordan. Three hundred and thirty-five Jordanian adults aged between 18-68 years were enrolled in this study: one hundred and eighty-five IBD patients who were recently diagnosed with IBD ( = 100 for ulcerative colitis (UC) and = 85 for Crohn's disease (CD)) and 150 IBD-free controls. Participants were matched based on age and marital status. In addition, dietary data was collected from all participants using a validated food frequency questionnaire. Factor analysis and principal component analysis were used to determine the dietary patterns. Odds ratios (OR) and their 95% confidence interval (CI) were calculated using a multinomial logistic regression model. Two dietary patterns were identified among the study participants: high-vegetable and high-protein dietary patterns. There was a significantly higher risk of IBD with high-protein intake at the third (OR, CI: 0.136 (0.068-0.271)) and fourth (OR, CI: 0.126 (0.064-0.248)) quartiles in the non-adjusted model as well as the other two adjusted models. In contrast, the high-vegetable dietary pattern shows a significantly protective effect on IBD in the third and fourth quartiles in all the models. Thus, a high-vegetable dietary pattern may be protective against the risk of IBD, while a high-protein dietary pattern is associated with an increased risk of IBD among a group of the Jordanian population

The Frequency of Asymptomatic Sacroiliitis in Jordanian Patients with Crohn’s Disease. Assessment by Magnetic Resonance Enterography

Background: our aim was to assess frequency of asymptomatic sacroiliitis (SI) in patients with Crohns disease referred for magnetic resonant enterography (MRE) as a part of small bowel evaluation. Methods: this was a retrospective study of all patients with Crohns disease who were referred for MRE between January of 2016 to October of 2017 to Jordan University Hospital. All MRE were reviewed by an experienced radiologist and SI was diagnosed and graded based on predefined MRI criteria. All patients were contacted and assessed for symptomatic SI based on Assessment of SpondyloArthritis international Society (ASAS) criteria of 2009 for axial spondyloarthropathy. All patients were included in the final analysis.Results: a total of 60 patients were included, overall 18 (30%) showed evidence of SI, two patients were symptomatic and another two were diagnosed with ankylosing spondylitis as assessed by ASAS criteria. Those were excluded. Fourteen (23%) patients were included in the final analysis, with an average age of 36.7 years, 71% males. The average disease duration was 7.25 years. The percentage of ASA used by patients was 50%, Azathioprine 71%, Biologic agents in 36% in combination and single drug was used in 36% of patients.Conclusion: The prevalence of asymptomatic SI based on predefined MRI criteria was 23%, the importance of this finding and future course progression needs further studies

Dietary patterns associated with the risk of pancreatic cancer: Case-control study findings

Diet is an important modifiable lifestyle factor, but epidemiological studies evaluating the association between dietary patterns and pancreatic cancer (PC) have reported inconsistent findings. This study aimed to evaluate the impact of several dietary choices on the risk of PC among newly diagnosed Jordanian patients. A case-control study was conducted at major teaching and general hospitals, including a Jordanian oncology center. The study included 101 patients with incident pancreatic cancer and 314 controls. Data was collected using interview-based questionnaires. Dietary intake was estimated using a validated Arabic and reproducible food-frequency questionnaire. Dietary patterns were derived using Principal Component Analysis. Multinomial logistic regression was used to estimate the association between dietary patterns and PC. Four dietary patterns were identified. The "Traditional"dietary pattern, which presented a diet rich in fresh fruits, vegetables, milk, yogurt, and lentils, was associated with a significant decrease in the odds of PC (OR = 0.42, 95% CI = 0.21-0.84) for the third quartile compared to first one. The "High-fruit"dietary pattern, which was loaded with strawberry, melon, watermelon, and other fruits, significantly reduced the odds of PC (OR = 0.38, 95% CI = 0.19-0.75) for the second quartile compared to the first one. The "Soup"dietary pattern was mainly composed of vermicelli soup, vegetable soup, lentil soup, and mushroom soup, which decreased the odds of PC (OR = 0.18, 95% CI = 0.07-0.38). There was no relation between PC and the "Western"dietary pattern, loaded with beer, wine, roasted lamb, meat, chicken sandwich, beefsteak, and fried fish. The "Traditional,""High-fruit,"and "Soup"dietary patterns were associated with reduced risk of PC among Jordanians. 2022 the Author(s). Published by Wolters Kluwer Health, Inc.This article was supported by Qatar University Internal grant No. QUEST-2-CHS-2022-495. The findings achieved herein are solely the responsibility of the author.Scopu

Prevalence of anxiety and depressive symptoms in ulcerative colitis patients in Jordan and its relationship to patient-reported disease activity

Inflammatory bowel disease is associated with higher rates of anxiety and depression compared to the general population. We aimed to determine the prevalence of anxiety and depressive symptoms among patients with ulcerative colitis and correlation to disease activity. In this cross-sectional study, we collected data from 70 consecutive ulcerative colitis patients over one year at our inflammatory bowel disease outpatient clinic through an interview and a questionnaire containing patient demographics and disease characteristics. Anxiety and depressive symptoms were characterized using the Generalized Anxiety Disorder-7 questionnaire and Patient Health Questionnaire-9, respectively, with ulcerative colitis disease severity assessed by the Partial Mayo scoring system. The majority of our patients were females (68.6%) and the mean age was 39.3 years. Rates of anxiety and depressive symptoms among ulcerative colitis patients were 65.7% and 58.6%, respectively. Depressive symptoms were significantly associated with patient-reported disease activity (r = 0.361; p = 0.010). Significant percentages of ulcerative colitis patients were appreciated to have anxiety and depressive symptoms, and there was a correlation between patient-reported disease activity and depressive symptoms. At this high rate of prevalence, it is justified to screen patients for the presence of psychiatric comorbidities

Clinical Characteristics of Autoimmune Hepatitis in a Middle Eastern Population: A Tertiary Care Center Experience

Autoimmune hepatitis (AIH) is an immune-mediated inflammatory liver disease of uncertain cause, and its manifestations appear to vary by race and ethnicity. The literature on AIH in the Middle East, including Jordan, is scarce; therefore, this study aimed to determine the clinical characteristics of AIH in an understudied population. This retrospective chart review study was conducted on AIH patients who presented to Jordan University Hospital over a seven-year period (2014–2020). Retrieved data included sociodemographics, liver function tests, autoimmune serologic markers, viral hepatitis serology, findings on liver biopsies, treatment regimens, post-therapy outcomes and treatment-related complications. The total number of AIH patients included in the study was 30, divided as follows: type 1 AIH (n = 17, 56.7%), type 2 AIH (n = 2, 6.7%), seronegative AIH (n = 9, 30.0%), and two patients who had AIH-primary biliary cirrhosis overlap syndrome (6.7%). The mean age at diagnosis was 44 years (standard deviation: 17 years), with a female predominance (n = 25, 83.3%). Acute presentation was seen among 18 patients (60.0%). Mild to moderate fibrosis (F1 and F2 on METAVIR scoring system) without cirrhosis was observed among patients who underwent liver biopsies (10/19, 52.6%). The majority of patients (73.3%) were initially treated with prednisone, with azathioprine combination in 16.7% of the patients. At 6 months post initial treatment, twenty patients (66.7%) achieved biochemical remission, four patients had incomplete response, two patients failed to improve (one died during the induction of remission period due to AIH-related complications), and four patients were lost to follow-up. This study provided an updated overview of AIH in Jordan. The results showed typical female predominance, and interestingly high rates of acute presentation and seronegative disease. Future longitudinal studies are recommended to address the nature and long-term prognosis of AIH in Jordan

Probiotic supplementation induces remission and changes in the immunoglobulins and inflammatory response in active ulcerative colitis patients: A pilot, randomized, double-blind, placebo-controlled study

Background & AimsClinical studies of using probiotics for managing ulcerative colitis (UC) in Jordan are rare. Therefore, we aimed to evaluate the effect of probiotic supplementation on the clinical disease activity and biochemical parameters in patients with mild-to-moderately active UC.Methods: thirty mild-to-moderate ulcerative colitis patients were included and randomly assigned to participate in a double-blinded randomized study to receive the treatment (3×1010 of probiotic capsules [containing nine Lactobacillus and five Bifidobacterium species], or a placebo), and included in the intention-to-treat analysis. Only 24 completed the study and were included in the per-protocol analysis. Both groups were compared in terms of clinical disease activity and biochemical parameters at the beginning and the end of the study. Registered under ClinicalTrials.gov Identifier no. NCT04223479. ResultsThere was a significant induction of remission in the probiotic group presented by improvement in the partial mayo score (PMS). Probiotic group had significantly lower stool frequency (0.00 ± 0.00 vs. 1.17± 1.19), global assessment (0.42 ± 0.51 vs. 1.00 ± 0.74, p = 0.035), and total PMS score (1.33 ± 0.49 vs. 3.42 ± 1.78). In terms of mean and percent of change in post-to pre-treatment values, there was a significant reduction in C-reactive protein, and an increase in hemoglobin, hematocrit, and RBC levels in the probiotic group (p<0.05). Additionally, there was a significant reduction in the IgA level and an increase in IL-10 levels among the probiotic group compared to the placebo group (p= 0.039). ConclusionsThe use of probiotic therapy had significantly induced remission in UC patients, this was evidenced by the improvement in the Partial Mayo score. Furthermore, probiotic therapy had an appropriate effect on changes in hemoglobin, hematocrit, C-reactive protein, IgA, and IL-10 levels.This study was registered at ClinicalTrials.gov with the number NCT04223479

Does probiotic supplementation improve quality of life in mild-to-moderately active ulcerative colitis patients in Jordan? A secondary outcome of the randomized, double-blind, placebo-controlled study

Purpose: Recent findings revealed a potential effect of a probiotic in improving quality of life (QoL) in ulcerative colitis (UC). In Jordan, there is scarce data about UC patients and QoL. Methods: Twenty-four UC patients were included in the study and were randomly allocated into probiotic (3 × 1010 probiotic capsules containing nine Lactobacillus and five Bifidobacterium species) and placebo control groups (containing polysaccharide supplied in an identical bottle) 3 times daily/6 weeks. A short inflammatory bowel disease questionnaire (SIBDQ) was used to assess the change in the quality of life in both groups at the beginning and the end of the intervention; The study was completed during the COVID-19 pandemic. Results: Patients treated with probiotics showed a higher score of social (6.92 ± 0.29, p = 0.019), bowel (6.31 ± 0.46, p = 0.001), emotional (6.47 ± 0.46, p < 0.001), and total SIBDQ scores (6.54 ± 0.29, p < 0.001) compared to the placebo group (5.75 ± 1.57, 4.72 ± 1.34, 4.42 ± 1.67 and 4.96 ± 1.27; respectively). Also, the probiotic group had significantly better scores in the systemic, social, bowel, emotional, and total SIBDQ scores in terms of pre- to post-treatment (p < 0.001). Conclusions: The use of probiotic therapy containing Lactobacillus and Bifidobacterium species had significantly improved the quality of life among UC patients, this was shown by the improvement in the scores of the systemic domain, social domain, bowel domain, emotional domain, and total SIBDQ. This study is part of a registered study at ClinicalTrials.gov with the number NCT04223479

Mediterranean Dietary Pattern is Associated with Lower Odds of Gastric Cancer: A Case–Control Study

Background: Diet pattern is an important modifiable lifestyle factor. However, epidemiological studies show that the association between dietary patterns and gastric cancer (GC) is conflicting. This study aims to assess the impact of several dietary choices on the risk of GC among newly diagnosed Jordanian patients. Methods: A case–control study was conducted at major oncology centers and hospitals in Jordan. Study participants included 172 patients with incident gastric cancer and 314 controls. Data was collected using interview-based questionnaires. Dietary intake was estimated using a validated Arabic and reproducible food-frequency questionnaire (FFQ). Dietary patterns were derived using Principal Component Analysis (PCA). Multinomial logistic regression was used to estimate the association between dietary patterns and GC. Results: Four dietary patterns were itemized; “Mediterranean”, “Prudent”, “Unhealthy” and “High-fruit” dietary patterns. The “Mediterranean” dietary pattern, which includes a diet rich in fresh fruits, vegetables, milk, yogurt, lentils, and olive oil was associated with a significant decrease in the odds ratio (OR) of GC for the third and fourth quartiles (OR, 0.394 (confidence interval (CI): 0.211– 0.736); 0.212 (CI: 0.107– 0.419), respectively) after adjusting for age, gender, body mass index, smoking, marital status, total energy intake, education level, and physical activity. While the “Unhealthy” and “Prudent” dietary patterns enhance the risk of developing GC, this risk was insignificant at any quartile. Additionally, the “High-Fruit” dietary pattern shows an insignificant protective effect against the risk of GC. Conclusion: The “Mediterranean” dietary pattern was associated with a reduced risk of GC among Jordanians. However, the other three identified dietary patterns were not significantly associated with the risk of GC.The authors would like to thank Hashemite University for funding the research project (Grant number AM/16/13/10/1403938)