A novel Monash Pouch diet in patients with an ileoanal pouch is tolerable and has favorable metabolic luminal effects

Author:

Ardalan Zaid S1,Yao Chu K1ORCID,Green Kraig2ORCID,Probert Chris2,Gill Paul A1,Rosella Sam1,Muir Jane G1,Sparrow Miles P1,Gibson Peter R1ORCID

Affiliation:

1. Department of Gastroenterology, Central Clinical School Monash University and Alfred Health Melbourne Victoria Australia

2. Department of Molecular and Clinical Cancer Medicine University of Liverpool Liverpool UK

Abstract

AbstractAimsTo evaluate a whole‐food diet strategy (the Monash Pouch diet [MPD]) designed based on the interacting roles dietary factors play with pouch health. Specifically, its tolerability and acceptability, whether it achieved its dietary and metabolic goals, and the effects on symptoms and inflammation were examined.MethodsIn a 6‐week open‐label trial, patients with ileoanal pouches educated on the MPD were assessed regarding diet tolerability and acceptance, food intake (7‐day food diaries), pouch‐related symptoms (clinical pouchitis disease activity index), and, in 24‐h fecal samples, calprotectin, fermentative biomarkers, and volatile organic compounds (VOC).ResultsOf 12 patients, 6 male, mean (SD) age 55 (5) and pouch age 13 (2) years, one withdrew with partial small bowel obstruction. Tolerability was excellent in 9 (75%) and acceptance was high (81%). Targeted changes in dietary intake were achieved. Fecal branched‐ to short‐chain fatty acid ratio increased by median 60 [IQR: 11–80]% (P = 0.02). Fecal VOCs for 3 compounds were also increased, 2‐methyl‐5‐propan‐2‐ylcyclohexa‐1,3‐diene (Fold‐change [FC] 2.08), 1,3,3‐trimethyl‐2‐oxabicyclo[2.2.2]octane (FC 3.86), propan‐2‐ol (FC 2.10). All six symptomatic patients achieved symptomatic remission (P = 0.03). Fecal calprotectin at baseline was 292 [176–527] μg/g and at week 5 was 205 [148–310] μg/g (P = 0.72).ConclusionWell tolerated and accepted, the MPD achieved targeted changes in intakes and fermentation of carbohydrates relative to that of protein. There were signals of improvement in symptoms. These results indicate the need for a randomized‐controlled trial. (Trial registration: ACTRN12621000374864; https://www.anzctr.org.au/ACTRN12621000374864.aspx).

Funder

Crohn's and Colitis Australia

Publisher

Wiley

Subject

Gastroenterology,Hepatology

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