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Mo1347 Intake of Dietary Fat and Risk of Crohn's Disease and Ulcerative Colitis Among Women
was associated with both preterm birth (OR = 1.68, 95 % CI: 1.55, 1.82) and IBD (OR = 1.48, 95 % CI: 1.13, 1.96). Using weight gain as a continuous variable, we found that gaining weight during pregnancy was a protecting factor for preterm delivery among maternal IBD (OR = 0.94, 95 % CI: 0.91, 0.98). The odds of preterm birth was reduced with 6 % per each extra kg (95 % CI: 2 %, 9%) weight gain during pregnancy. Conclusion: Maternal IBD was associated with preterm birth. The risk for preterm birth increased in mothers with IBD who failed to gain sufficient weight during pregnancy. Further studies will reveal any differences between maternal CD and UC. Mo1349 Sleep Disturbance and Risk of Relapse in Crohn's Disease and Ulcerative Colitis Ashwin N. Ananthakrishnan, Millie D. Long, Christopher F. Martin, Robert S. Sandler, Michael Kappelman Introduction: Despite our understanding that external environment plays an important role in Crohn's disease (CD) and ulcerative colitis (UC), such factors remain poorly studied. Impairment of sleep quality is common in patients with inflammatory bowel diseases. Prior studies support the biological plausibility that disturbed sleep may be a modifiable behavioral risk factor for disease relapse in IBD patients by triggering inflammatory pathways. Prospective studies examining the effect of sleep disturbance on risk of relapse in IBD are lacking. Methods: Patients were included from the CCFA Partners study, a longitudinal internetbased IBD cohort. All participants completed a baseline survey and optional modules on various patient-reported outcomes. They also completed a follow-up questionnaire at 6 months after enrollment. Sleep disturbance was measured using the Patient Reported Outcomes Measurement Information Systems (PROMIS) sleep disturbance questionnaire, and cross-validated with the Pittsburgh Sleep Quality Index (PSQI) in a subset (correlation coefficient 0.80, p,0.0001). Impaired sleep was defined as a PROMIS sleep T-score . 50. Disease activity was assessed using the short Crohn's disease activity index (SCDAI) and simple clinical colitis activity index (SCCAI) for CD and UC respectively, with an SCDAI . 150 or SCCAI . 2 representing active disease. Logistic regression was used to examine effect of sleep quality at baseline among patients in remission on risk of disease relapse at 6 months. Results: The study included 3,173 IBD patients; nearly two-thirds had sleep disturbance at baseline. Such patients were more likely to be female, have CD, have a history of smoking, currently using systemic corticosteroids, narcotics, or anti-TNF biologic therapies, and were more likely to have ever required an IBD-related hospitalization or surgery. Half of the 1,291 patients with CD in remission at baseline had disturbed sleep (n = 651, 50%). Among those in remission, 22% of those with disturbed sleep had active disease at month 6 compared to 12% of those without disturbed sleep (OR 1.92, 95% CI 1.40 - 2.63) (Table 1). On multivariate analysis, presence of sleep disturbance was associated with twofold increase in risk of disease flare at 6 months (OR 1.91, 95%CI 1.40 - 2.62). Each 10 point (1 standard deviation) increase in the PROMIS sleep T-score was associated with a 50% increase in risk of disease flare (OR 1.58, 95% CI 1.31 - 1.91). No effect was seen for UC (OR 1.12, 95% CI 0.74 - 1.70). These findings persisted in a number of sensitivity analyses. Conclusion: Sleep disturbance while in remission was associated with an increased risk of disease flares in CD but not UC. These findings suggest that the evaluation and treatment of sleep disturbance in CD patients may have a role in improving patient outcomes. Table 1: Multivariate analysis of effect of sleep disturbance on risk of disease flare in Crohns disease and Ulcerative colitis
Mo1347 Intake of Dietary Fat and Risk of Crohn's Disease and Ulcerative Colitis Among Women Ashwin N. Ananthakrishnan, Hamed Khalili, Leslie M. Higuchi, Punyanganie S. de Silva, Charles Fuchs, James M. Richter, Andrew T. Chan Introduction: Crohn's disease (CD) and ulcerative colitis (UC) are chronic immunological diseases that develop as a result of a dysregulated immune response to intestinal flora in a genetically susceptible host. Diet, as a source of luminal antigens, may play a crucial role in the immunopathogenesis of these disorders, possibly through interactions with gut flora. A particularly important component of diet may be intake of fatty acids which appear to influence intestinal inflammation and regulate mucosal immunity. However, data regarding the association between dietary fat and risk of CD or UC are limited and conflicting Methods: We conducted a prospective study of women, enrolled in the Nurses Health Study cohorts (NHS I & II), since 1976 (NHS I) and 1989 (NHS II) and followed through detailed biennial questionnaires with a . 90% follow up rate. Dietary information was prospectively ascertained using a validated semi-quantitative food frequency questionnaire (SFFQ) every four years. Self-reported CD and UC were confirmed through blinded review of medical records by two gastroenterologists. We examined the effect of energy-adjusted total cumulative fat intake as well as intake of specific fatty acids on the risk of CD and UC between 1984-2008 in NHS I and 1991-2007 in NHS II. Cox proportional hazards models adjusting for potential confounders were used to calculate hazard ratios (HR) and 95% confidence intervals (CI). Results: Among 170,797 women, we confirmed 248 incident cases of CD (incidence 8/100,000 p-y) and 308 incident cases of UC (incidence 10/100,000 p-y) over 24 years and 3,195,955 person-years (p-y) of follow-up. The median age of diagnosis was 53 for CD and 50 for UC. According to the quintile distribution of total dietary fat, the median intake was 47grams/day in the lowest quintile and 73 grams/day in the highest quintile. Intake of total dietary fat, saturated fats, and unsaturated fats (mono or polyunsaturated) was not associated with risk of CD (p(trend) 0.86) or UC (p(trend) 0.89). However, a higher ratio of dietary n-3/n-6 fatty acid intake was associated with a reduced incidence of UC (HR (for highest vs. lowest quintile) 0.68, 95% CI 0.47 - 0.97, p(trend) 0.03) but not CD (HR 0.94, 95% CI 0.59 - 1.48). There was also a trend towards lower incidence of UC with higher intake of long chain fatty acids (LCN) (HR 0.73, 95% CI 0.51 - 1.05, p(trend) 0.10). Conclusion: A higher ratio of n-3/n-6 fatty acid consumption was associated with a reduced incidence of UC but not CD. Further studies regarding the biological mechanisms behind this association are warranted. Mo1348 IBD in Pregnancy and Environmental Factors - The Norwegian Mother and Child Cohort Study May-Bente Bengtson, Geir Aamodt, Anne Lise Brantsaeter, Morten H. Vatn Background and aims: Several studies have linked maternal IBD to preterm birth. The pathogenesis of preterm birth and IBD both involve genetic and environmental factors influencing the microbiota and the immune system. We hypothesize that environmental factors influencing these pathways of pathogenesis, like weight gain during pregnancy, BMI, probiotica and vitamin D modify the impact of maternal and paternal IBD on preterm birth. Methods: The Norwegian Mother and Child Cohort Study (MoBa) includes 107 000 pregnancies enrolled from 1999 to 2008. The pregnant women were included in 17 - 18 week of pregnancy by the first questionnaire for the pregnant women, as well as a questionnaire for the father. Additional two questionnaires were mailed out during pregnancy, as well as a forth questionnaire 6 months after the delivery. The MoBa cohort was connected to the Norwegian Medical Birth Registry. The association between IBD and preterm birth ( , 37 weeks) was calculated by binary logistic regression analysis, adjusting for plural birth, mother's disease and smoking history. Weight gain was defined as the difference between weight at the end of pregnancy and weight before pregnancy, reported in the forth and the first questionnaire, respectively. Results: The cohort included 436 and 648 pregnancies of paternal and maternal IBD, respectively. Of these cases, 20.2 % and 17.4 % used immunomodulators; corticosteroid and azathioprine. Only 15 and 4 cases of paternal and maternal IBD, received biologic treatment. There were no differences between mothers with IBD (30.5 years) and controls (30.0 years) regarding median age of pregnancy, or numbers of children (1.85) when included in this study. Paternal IBD was not associated with preterm birth (OR = 1.01, 95 % CI: 0.73, 1.39). Maternal IBD was a risk factor for preterm birth (OR =1.34, 95 % CI: 1.06, 1.70). The use of immunomodulators did not influence these associations. We further explored the effects of probiotica, BMI, daily vitamin D supply and weight gain during pregnancy. Only weight gain during pregnancy affected the association between IBD and preterm birth. Weight gain below 12 kg during pregnancy, compared to above 20 kg,
Disturbed sleep was defined as having a PROMIS sleep T-score . 50 Crohn's disease multivariate model adjusted for age, gender, prior CD related surgery and hospitalization, disease behavior and location, current use of steroids, and smoking status Ulcerative colitis model adjusted for age, gender, prior UC related hospitalization, smoking status, and current use of steroids Expanded definition of disease flare comprised symptomatic flare (SCDAI . 150 or SCCAI . 2) or new initiation of IBD therapy, new IBD hospitalization or surgery. Mo1350 Obesity Is Associated With Severity of Clinical and Mucosal Activity in Crohn's Disease Talha A. Malik, Camille A. Sommer, J. Matthew R. Pierce, Ioana B. Smith, Ashish Manne, C. Mel Wilcox, Frederick H. Weber Introduction: Published data suggest a link between obesity and adverse outcomes in Crohn's disease (CD). We previously reported a significant association between obesity and active CD in a small retrospective case control study (36 CD active patients compared with 68 CD patients in remission). In this current study, we aimed to test the robustness of this observation in a much larger sample. Methods: Sample for this retrospective cohort study was obtained from UAB IBD Center's clinical and surgical database. The patients were seen between 2002 and 2012. Eligible patients were .19 years old, followed for at least one year, had initial BMI documented, and had data that allowed calculation of clinical and
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AGA Abstracts
AGA Abstracts
A total of 2,136 pts were identified for inclusion (mean [SD] age = 46 [16] years, % female = 54%). IS therapies included azathioprine (46% of pts), 6-MP (28%), methotrexate (13%) and cyclosporine (13%). Mean [SD] duration of index IS therapy was 466 [449] days, which covered 64% of the 2-year follow-up period. Therapy duration was notably lower for cyclosporine initiators: mean [SD] = 186 [256] days (26% of follow-up). Overall, 41% of pts changed therapy via switch or augmentation. Switching from the index IS to another therapy class occurred in 21% of pts, with 5-ASA being the most frequent next agent used (48% of switchers), followed by oral corticosteroids (21%) and biologics (17%). Among switchers, median time to switch was 72 days. Augmentation occurred in 25% of pts, with 5-ASA being the most frequent agent added to the index IS (72% of augmenters), followed by biologics (14% of augmenters) and oral corticosteroids (11% of augmenters). Among augmenters, median time to augmentation was 153 days. Nearly two-thirds (65%) of pts experienced a complication. Arthralgia, blood disorders, and nausea/vomiting were among the most common complications observed (26%, 24%, and 18%, respectively). Nearly three-quarters (73%) of pts relapsed during follow-up, including 28% undergoing surgery. Conclusions: This large scale assessment of IS treatments for UC demonstrated high rates of disease relapse and complications and frequent changes to therapy, including switching to and augmenting with alternative agents. These findings reflect opportunities for improvement in disease management for UC pts.
Mo1347 Intake of Dietary Fat and Risk of Crohn's Disease and Ulcerative Colitis Among Women Ashwin N. Ananthakrishnan, Hamed Khalili, Leslie M. Higuchi, Punyanganie S. de Silva, Charles Fuchs, James M. Richter, Andrew T. Chan Introduction: Crohn's disease (CD) and ulcerative colitis (UC) are chronic immunological diseases that develop as a result of a dysregulated immune response to intestinal flora in a genetically susceptible host. Diet, as a source of luminal antigens, may play a crucial role in the immunopathogenesis of these disorders, possibly through interactions with gut flora. A particularly important component of diet may be intake of fatty acids which appear to influence intestinal inflammation and regulate mucosal immunity. However, data regarding the association between dietary fat and risk of CD or UC are limited and conflicting Methods: We conducted a prospective study of women, enrolled in the Nurses Health Study cohorts (NHS I & II), since 1976 (NHS I) and 1989 (NHS II) and followed through detailed biennial questionnaires with a . 90% follow up rate. Dietary information was prospectively ascertained using a validated semi-quantitative food frequency questionnaire (SFFQ) every four years. Self-reported CD and UC were confirmed through blinded review of medical records by two gastroenterologists. We examined the effect of energy-adjusted total cumulative fat intake as well as intake of specific fatty acids on the risk of CD and UC between 1984-2008 in NHS I and 1991-2007 in NHS II. Cox proportional hazards models adjusting for potential confounders were used to calculate hazard ratios (HR) and 95% confidence intervals (CI). Results: Among 170,797 women, we confirmed 248 incident cases of CD (incidence 8/100,000 p-y) and 308 incident cases of UC (incidence 10/100,000 p-y) over 24 years and 3,195,955 person-years (p-y) of follow-up. The median age of diagnosis was 53 for CD and 50 for UC. According to the quintile distribution of total dietary fat, the median intake was 47grams/day in the lowest quintile and 73 grams/day in the highest quintile. Intake of total dietary fat, saturated fats, and unsaturated fats (mono or polyunsaturated) was not associated with risk of CD (p(trend) 0.86) or UC (p(trend) 0.89). However, a higher ratio of dietary n-3/n-6 fatty acid intake was associated with a reduced incidence of UC (HR (for highest vs. lowest quintile) 0.68, 95% CI 0.47 - 0.97, p(trend) 0.03) but not CD (HR 0.94, 95% CI 0.59 - 1.48). There was also a trend towards lower incidence of UC with higher intake of long chain fatty acids (LCN) (HR 0.73, 95% CI 0.51 - 1.05, p(trend) 0.10). Conclusion: A higher ratio of n-3/n-6 fatty acid consumption was associated with a reduced incidence of UC but not CD. Further studies regarding the biological mechanisms behind this association are warranted. Mo1348 IBD in Pregnancy and Environmental Factors - The Norwegian Mother and Child Cohort Study May-Bente Bengtson, Geir Aamodt, Anne Lise Brantsaeter, Morten H. Vatn Background and aims: Several studies have linked maternal IBD to preterm birth. The pathogenesis of preterm birth and IBD both involve genetic and environmental factors influencing the microbiota and the immune system. We hypothesize that environmental factors influencing these pathways of pathogenesis, like weight gain during pregnancy, BMI, probiotica and vitamin D modify the impact of maternal and paternal IBD on preterm birth. Methods: The Norwegian Mother and Child Cohort Study (MoBa) includes 107 000 pregnancies enrolled from 1999 to 2008. The pregnant women were included in 17 - 18 week of pregnancy by the first questionnaire for the pregnant women, as well as a questionnaire for the father. Additional two questionnaires were mailed out during pregnancy, as well as a forth questionnaire 6 months after the delivery. The MoBa cohort was connected to the Norwegian Medical Birth Registry. The association between IBD and preterm birth ( , 37 weeks) was calculated by binary logistic regression analysis, adjusting for plural birth, mother's disease and smoking history. Weight gain was defined as the difference between weight at the end of pregnancy and weight before pregnancy, reported in the forth and the first questionnaire, respectively. Results: The cohort included 436 and 648 pregnancies of paternal and maternal IBD, respectively. Of these cases, 20.2 % and 17.4 % used immunomodulators; corticosteroid and azathioprine. Only 15 and 4 cases of paternal and maternal IBD, received biologic treatment. There were no differences between mothers with IBD (30.5 years) and controls (30.0 years) regarding median age of pregnancy, or numbers of children (1.85) when included in this study. Paternal IBD was not associated with preterm birth (OR = 1.01, 95 % CI: 0.73, 1.39). Maternal IBD was a risk factor for preterm birth (OR =1.34, 95 % CI: 1.06, 1.70). The use of immunomodulators did not influence these associations. We further explored the effects of probiotica, BMI, daily vitamin D supply and weight gain during pregnancy. Only weight gain during pregnancy affected the association between IBD and preterm birth. Weight gain below 12 kg during pregnancy, compared to above 20 kg,
Disturbed sleep was defined as having a PROMIS sleep T-score . 50 Crohn's disease multivariate model adjusted for age, gender, prior CD related surgery and hospitalization, disease behavior and location, current use of steroids, and smoking status Ulcerative colitis model adjusted for age, gender, prior UC related hospitalization, smoking status, and current use of steroids Expanded definition of disease flare comprised symptomatic flare (SCDAI . 150 or SCCAI . 2) or new initiation of IBD therapy, new IBD hospitalization or surgery. Mo1350 Obesity Is Associated With Severity of Clinical and Mucosal Activity in Crohn's Disease Talha A. Malik, Camille A. Sommer, J. Matthew R. Pierce, Ioana B. Smith, Ashish Manne, C. Mel Wilcox, Frederick H. Weber Introduction: Published data suggest a link between obesity and adverse outcomes in Crohn's disease (CD). We previously reported a significant association between obesity and active CD in a small retrospective case control study (36 CD active patients compared with 68 CD patients in remission). In this current study, we aimed to test the robustness of this observation in a much larger sample. Methods: Sample for this retrospective cohort study was obtained from UAB IBD Center's clinical and surgical database. The patients were seen between 2002 and 2012. Eligible patients were .19 years old, followed for at least one year, had initial BMI documented, and had data that allowed calculation of clinical and
S-643
AGA Abstracts
AGA Abstracts
A total of 2,136 pts were identified for inclusion (mean [SD] age = 46 [16] years, % female = 54%). IS therapies included azathioprine (46% of pts), 6-MP (28%), methotrexate (13%) and cyclosporine (13%). Mean [SD] duration of index IS therapy was 466 [449] days, which covered 64% of the 2-year follow-up period. Therapy duration was notably lower for cyclosporine initiators: mean [SD] = 186 [256] days (26% of follow-up). Overall, 41% of pts changed therapy via switch or augmentation. Switching from the index IS to another therapy class occurred in 21% of pts, with 5-ASA being the most frequent next agent used (48% of switchers), followed by oral corticosteroids (21%) and biologics (17%). Among switchers, median time to switch was 72 days. Augmentation occurred in 25% of pts, with 5-ASA being the most frequent agent added to the index IS (72% of augmenters), followed by biologics (14% of augmenters) and oral corticosteroids (11% of augmenters). Among augmenters, median time to augmentation was 153 days. Nearly two-thirds (65%) of pts experienced a complication. Arthralgia, blood disorders, and nausea/vomiting were among the most common complications observed (26%, 24%, and 18%, respectively). Nearly three-quarters (73%) of pts relapsed during follow-up, including 28% undergoing surgery. Conclusions: This large scale assessment of IS treatments for UC demonstrated high rates of disease relapse and complications and frequent changes to therapy, including switching to and augmenting with alternative agents. These findings reflect opportunities for improvement in disease management for UC pts.