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    Home > Active Ingredient News > Digestive System Information > DDW: These ultra-processed foods you love are destroying your intestines step by step

    DDW: These ultra-processed foods you love are destroying your intestines step by step

    • Last Update: 2021-06-01
    • Source: Internet
    • Author: User
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    It is only for medical professionals to read and discuss the relationship between diet, living habits and IBD.

    This year’s American Digestive Disease Week (DDW) was held online on May 21-23.
    The conference brought together outstanding physicians, researchers and scholars in the field of digestion from world-renowned places.
    The world’s top experts will discuss gastroenterology and hepatology.
    The latest developments in the fields of, endoscopy and gastrointestinal surgery will be discussed in depth.

    "Digestive Liver Disease Channel of the Medical Circle" specially invited Dr.
    Xing Xiaocun from the Department of Gastroenterology, West China Hospital of Sichuan University to bring us wonderful conference reports.

    The incidence of inflammatory bowel disease (IBD) in China has increased significantly in recent years.

    With the deepening of research, the relationship between diet and IBD has gradually attracted people's attention.

    The two top-level abstracts of the DDW discussed the relationship between processed foods and the development of IBD and the role of obesity in IBD.

    01 Attention! Excessive intake of ultra-processed food may increase the risk of CD.
    In the past few decades, the incidence of IBD in westernized regions has increased in line with the increase in ultra-processed food (UPF) consumption.

    According to the NOVA classification of foods, foods can be divided into four categories: unprocessed or rough processed foods, processed cooking ingredients, processed foods, and UPF.

    Previous studies have shown that high intake of UPF can increase the risk of all-cause mortality, cardiovascular disease, metabolic syndrome, obesity and all cancers.

    In addition, studies have also found that dietary emulsifiers can induce colitis.

    Table 1: NOVA classification system [1] This study aims to explore the relationship between UPF and food intake rich in emulsifiers/thickeners and the risk of Crohn’s disease (CD) and ulcerative colitis (UC) .

    The study included participants from the Nurses’ Health Study (1986-2014), Nurses’ Health Study II (1991-2017), and Health Professionals Follow-up Study (1986-2012).

    The dietary intake was assessed by a semi-quantitative food frequency questionnaire, and the diagnosis of CD and UC was confirmed by consulting medical records.

    A total of 241,525 participants were included in the study.
    During a follow-up of 5,437,239 person-years, 368 CD and 488 UC patients were recorded.

    The median age of patients at diagnosis was 56 years (29-85 years).

    Compared with participants in the lowest quartile of UPF intake, participants in the highest quartile had an increased risk of developing CD [multivariate HR 1.
    72; 95% confidence interval 1.
    24-2.
    38; (P=0.
    0006)].

    In addition, compared with participants in the lowest quartile, participants in the highest quartile of food intake rich in emulsifiers/thickeners had an increased risk of developing CD (HR 1.
    40; 95% confidence interval 1.
    03-1.
    88) ;P Trend 0.
    01).

    However, there is no consistent link between UPF and food intake rich in emulsifiers/thickeners and the risk of UC.

    In the different UPF subgroups, fats and sauces, sweets, and over-processed grains were positively correlated with CD risk, while ready-to-eat/hot mixed dishes were negatively correlated with CD risk.

    Figure 1: The results of the study.
    The study shows that high UPF intake is associated with an increased risk of CD.

    In addition, large intake of foods rich in emulsifiers or thickeners may also be associated with an increased risk of CD.

    For confirmed patients, whether avoiding these foods is beneficial remains to be further studied.

    02 Poor efficacy of biological agents? It may be too fat.
    In recent years, a variety of biological agents in the field of IBD treatment have been approved for the market, providing more and more drug options for the treatment of IBD patients; a considerable number of IBD patients will have primary or secondary biological agents.
    The reason for the failure to respond is unclear. Studies have shown that more visceral adipose tissue (VAT) is associated with poorer clinical outcomes in patients with CD, but there are fewer relevant literature and retrospective studies, while fewer studies are related to UC.

    The research from AJYarur et al.
    has conducted a more in-depth discussion on this issue.

    This study is a prospective cohort study designed to assess the correlation between baseline visceral adipose tissue (VAT)% and other body composition (BC) parameters of patients with moderate to severe IBD and the response to three different biological agents ; Also assessed the difference in body composition between active IBD patients and normal healthy controls.

    Inclusion criteria: ①CD or UC with moderate to severe activity under endoscopy.
    ②Start using infliximab (IFX), vedolizumab (VDZ) or utekimab according to the instructions (Ustekinumab, UST), matched by age, and included in the healthy control group to compare the differences between BC and IBD patients.
    Exclusion criteria: ①Use of parenteral nutrition in the past 12 months ②Urgent need for surgery ③Oostomy ④Short bowel syndrome ⑤ Main comorbidities: active malignant tumors within 5 years, grade III or IV heart failure, liver cirrhosis, chronic kidney disease grade 3 and above; patients with endocrine diseases at baseline, 14 weeks, and 30 weeks.
    The following variables were collected respectively : Demographics and disease phenotypes, biomarkers (C-reactive protein and calprotectin), Harvey Bradshaw Index (HBI) and CD Simplified Endoscopic Score (SES-CD) in CD patients, some Mayo in UC patients Score (PMS) and Mayo Endoscopy Score (EMS); Simultaneously measure the trough level of IFX and VDZ at 14 and 30 weeks, and the trough level of UST at 16 and 32 weeks.

    Use GE iDXA scans to measure patient body composition parameters (weight, total fat and lean mass, VAT mass and body mass index).

    The primary end point was corticosteroid-free deep remission (SFDR) at week 14, defined as HBI<5 in CD patients, PMS<2 in UC patients, and normal CRP/FC after discontinuation of glucocorticoids.

    The secondary endpoints were SFDR and endoscopic remission at 30-46 weeks (EMS ≤ 1 or SES-CD ≤ 2 in UC patients).

    Multivariate analysis was used to determine the predictors of the primary and secondary endpoints, including some BC parameters.

    In the end, a total of 126 patients (94 IBD and 26 healthy controls) were enrolled.

    The results showed that there was no difference in body composition between the IBD group and the healthy control group.

    In the IBD group, patients with high quartile VAT% had significantly lower remission rates for the primary and secondary endpoints (all outcomes p<0.
    05).

    In univariate analysis, the primary non-response between VAT% and biological agents (p=0.
    016), higher body mass index (p=0.
    0005), and low drug level <50% percentile (by drug stratification p=0.
    015) Significant correlation.

    After adjusting for these variables in a multivariate analysis, the VAT% is still at week 14 (OR 0.
    31; 95% confidence interval 0.
    1-0.
    8; p=0.
    026) and week 30 (OR 0.
    28; 95% confidence interval 0.
    1-0.
    7 ;p=0.
    011) independent risk factors for SFDR.

    Among all the BC parameters, VAT% is the only variable that independently predicts the outcome (p=0.
    021).

    Figure 2: The results of the study The study showed that patients with inflammatory bowel disease with higher visceral fat content have a lower chance of obtaining deep remission without corticosteroids and endoscopic remission after receiving IFX, VDZ and UST treatment.

    Therefore, it is necessary to further explore measures to reduce VAT to improve the response of biological agents.

    In summary, life>
     Expert profile Zhang Yan Professor of Gastroenterology, West China Hospital, Sichuan University, Chief Physician, Ph.
    D.
    Supervisor, Sichuan Academic Technology Leader, Sichuan Provincial Health and Family Planning Commission Academic Technology Leader, Sichuan Province Overseas High-level Overseas Talents Washington University in St.
    Louis and University of the United States California, San Diego, Visiting Scholar, Chinese Medical Association Digestive Diseases Committee Member of the Tenth Committee Inflammatory Bowel Disease (IBD) Collaborative Group Member Wu Jieping Medical Foundation Standing Committee Member of China Inflammatory Bowel Disease Alliance, Sichuan Medical Association Digestive Disease Professional Committee Inflammatory Bowel The deputy leader of the disease professional group has received three National Natural Science Funds, two supported projects by the Sichuan Provincial Department of Science and Technology, and published dozens of sci papers.

    References: [1] Monteiro CA, Cannon G, Moubarac JC, Levy RB, Louzada MLC, Jaime PC.
    (2017).
    The UN Decade of Nutrition, the NOVA food classification and the trouble with ultra-processing.
    Public Health Nutr, 2018 Jan;21(1):5-17.
    doi:10.
    1017/S1368980017000234.
    Epub 2017 Mar 21.
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