Dietary and metabolomic determinants of relapse in ulcerative colitis patients: A pilot prospective cohort study

Abstract

Aim: To identify demographic, clinical, metabolomic, and lifestyle related predictors of relapse in adult ulcerative colitis (UC) patients.

Methods: In this prospective pilot study, UC patients in clinical remission were recruited and followed-up at 12 mo to assess a clinical relapse, or not. At baseline information on demographic and clinical parameters was collected. Serum and urine samples were collected for analysis of metabolomic assays using a combined direct infusion/liquid chromatography tandem mass spectrometry and nuclear magnetic resolution spectroscopy. Stool samples were also collected to measure fecal calprotectin (FCP). Dietary assessment was performed using a validated self-administered food frequency questionnaire.

Results: Twenty patients were included (mean age: 42.7 ± 14.8 years, females: 55%). Seven patients (35%) experienced a clinical relapse during the follow-up period. While 6 patients (66.7%) with normal body weight developed a clinical relapse, 1 UC patient (9.1%) who was overweight/obese relapsed during the follow-up (P = 0.02). At baseline, poultry intake was significantly higher in patients who were still in remission during follow-up (0.9 oz vs 0.2 oz, P = 0.002). Five patients (71.4%) with FCP > 150 μg/g and 2 patients (15.4%) with normal FCP (≤ 150 μg/g) at baseline relapsed during the follow-up (P = 0.02). Interestingly, baseline urinary and serum metabolomic profiling of UC patients with or without clinical relapse within 12 mo showed a significant difference. The most important metabolites that were responsible for this discrimination were trans-aconitate, cystine and acetamide in urine, and 3-hydroxybutyrate, acetoacetate and acetone in serum.

Conclusion: A combination of baseline dietary intake, fecal calprotectin, and metabolomic factors are associated with risk of UC clinical relapse within 12 mo.

Keywords: Diet; Fecal calprotectin; Metabolomics; Relapse; Ulcerative colitis.

Figure 1

Receiver operating characteristic curve for fecal calprotectin concentration in predicting ulcerative colitis relapse. The area under the curve was 0.78 (95%CI: 0.55-1.0). ROC: Receiver operating characteristic.

Figure 2

Partial least squares discriminant analysis plot showing a clear separation of the metabolomic fingerprints of ulcerative colitis patients in clinical remission who developed a Relapse or stayed in Remission within 12 mo of follow-up (R² = 0.84, Q² = 0.59, P = 0.04).