A7 THERAPEUTIC DIETARY INTERVENTION IN ADULT CROHN’S DISEASE PATIENTS: EFFECTS ON REMISSION MARKERS, QUALITY OF LIFE, AND PHYSICAL ACTIVITY

Abstract Background Current evidence recognizes diet and physical activity as important factors in influencing the natural history of Crohn’s disease (CD); however, the relationship between dietary components and disease relapse remains unclear. Patients with active CD have a lower quality of life (QoL) compared to healthy controls. Aims The aims of this study were threefold: 1) to explore the effect of a CD specific therapeutic dietary intervention (CD-TDI) upon clinical and biochemical remission in adults with active, mild luminal CD, 2) to investigate outcomes related to patient-reported health QoL, and 3) to investigate the relationship between IBD parameters and physical activity. We hypothesized that a CD-TDI would be more effective when compared to conventional management (CM) to induce clinical and biochemical remission and improve patient-reported QoL in symptomatic and asymptomatic patients with active, mild luminal CD. Methods This was a randomized controlled trial whereby 51 participants were randomly allocated in a 2:1 ratio to the intervention group (CD-TDI) or CM for 13 weeks. Patients receiving the CD-TDI, an anti-inflammatory diet developed specifically for CD with foundational principles rooted in the Mediterranean diet, were offered patient-centered counseling by a Registered Dietitian for 12 weeks. QoL was measured using the 12-item short form health survey (SF-12). Physical activity was measured using ActivPAL® inclinometers (PAL Technologies, Glasgow). The Harvey Bradshaw Index (HBI) and fecal calprotectin (mcg/g) were used to assess clinical and biochemical remission. Results The CD-TDI group experienced both significant decreases in HBI from baseline to week 13 (Wk0: 3.0, IQR:1.0-5.3; Wk13: 2.0, IQR:0-3.0; p=0.05) and FCP from 130 ug/g (IQR: 38-411) at baseline to 72 ug/g (IQR:3-153) at week 13 (p= 0.01). The CM group saw no change in HBI and there was an increase in FCP by 337 ug/g or 55% from baseline to week 13. The SF-12 yielded two summary scores, the mental component score (MCS-12) and physical component score (PCS-12). The CD-TDI group experienced an increase in both the PCS-12 from 46.9 (SEM: 2.0) to 50.0 (SEM: 1.6) (p=0.10) and the MCS-12 from 49.2 (SEM: 1.8) to 50.9 (SEM: 1.8) (p=0.17), moving both scores to the mean healthy population score of 50, but the changes were not significant. Linear modelling revealed that both FCP (F(1, 58), p<0.001) and CRP (F(1, 62), p<0.001) act as significant predictors of the MCS-12 change score from baseline to week 13. There was no significant change in step count (p=0.41) within the CD-TDI group from baseline to week 13. Conclusions It can be concluded that the CD-TDI group experienced a significant decrease in gut inflammation and improved symptoms. Deeper analysis is underway to examine the influence of physical activity parameters on QoL. Funding Agencies CIHRNSERC CREATE, University of Calgary