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Publications // 2024

Vagianos K, Dolovich C, Witges K, Graff LA, Bernstein CN. Ultra-processed food, disease activity and inflammation in Ulcerative Colitis: The Manitoba Living with IBD Study. American Journal of Gastroenterology 2024; in press


We aimed to investigate the relationship between ultra-processed food (UPF) consumption and: 1) symptomatic disease and 2) intestinal inflammation among adults with IBD. We identified participants (Crohn’s Disease [CD]; Ulcerative Colitis [UC]) from the Manitoba Living with IBD Study. Active disease was defined using the IBD Symptom Inventory (score greater than 14 for CD; and greater than 13 for UC); Fecal Calprotectin (FCAL) was measured for intestinal inflammation (greater than 250 ug/g). Diet data were collected using the Harvard Food Frequency Questionnaire. UPF consumption was determined by the NOVA classification system. The percentage of energy consumption from UPFs was calculated and divided into 3 tertiles or thirds from lowest to highest third (T1 = low; T3 = high). Multiple linear regression analysis was used for active disease and inflammation predicted by UPF. Results: Among 135 participants (65% CD, 35% UC), the mean number of episodes of active disease (14.2 vs. 6.21) and active inflammation (1.6 vs 0.6) was significantly higher among UC in the T3 compared to the T1 of UPF consumption (p<0.05). When adjusting for age, gender, disease type and duration, the number of episodes of active disease was lower in the T1 compared to T3 (Beta = -7.11, p = 0.02); similarly, the number of episodes of intestinal inflammation was lower in the T1 (Beta = -0.95, p=0.03). No significant differences were observed among CD.  We concluded that UPF consumption may be a predictor of active symptomatic disease and inflammation among persons with UC. Reducing UPF consumption is a dietary strategy that can be suggested for minimizing symptoms and inflammation among people living with IBD.

Bernstein CN, Fisk JD, Dolovich C, Hitchon CA, Graff LA, El-Gabalawy R, Lix LM, Bolton JM, Patten SB, Marrie RA. Understanding predictors of fatigue over time in persons with IBD: The importance of depressive and anxiety symptoms. American Journal of Gastroenterology 2024; in press.

Fatigue is a complex and frequent symptom in persons with IBD, with detrimental impact. We aimed to determine predictors of fatigue over time. 247 adults with IBD participated in a prospective study conducted in Manitoba, Canada, providing data at baseline and annually for 3 years. Participants reported fatigue impact (Daily Fatigue Impact Scale [DFIS]), depression and anxiety symptoms (Hospital Anxiety and Depression Scale [HADS]) and pain (Pain Effects Scale [PES]). Physician-diagnosed comorbidities, IBD characteristics, physical and cognitive functioning were also assessed. We tested factors associated with fatigue using multivariable generalized linear models that estimated within-person and between-person effects. Results: Most participants were women (63.2%), White (85.4%) and had Crohn's disease (62%). At baseline, 27.9% reported moderate-severe fatigue impact,16.7% had clinically elevated anxiety (HADS-A ≥11) and 6.5% had clinically elevated depression (HADS-D ≥11). Overall fatigue burden was stable over time though approximately half the participants showed improved or worsening fatigue impact between annual visits during the study. On multivariable analysis, participants with a one-point higher HADS-D score had, on average, a 0.63-point higher DFIS score, while participants with a one-point higher PES score had a 0.78-point higher DFIS score. Within-individuals, a one-point increases in HADS-D score was associated with a 0.61-point higher DFIS scores, in HADS-A scores with a 0.23-point higher DFIS scores, and in PES scores with 0.38-point higher DFIS scores. No other variables predicted fatigue. Conclusions: Anxiety, depression and pain predicted fatigue impact over time in IBD, suggesting that targeting psychological factors and pain for intervention may lessen fatigue burden.

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