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

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.

Medical,behavioural and social preconception and interconception risk factors among pregnancy planning and recently pregnant Canadian women

Objectives The objective of this study is to describe the clustering of medical,behavioural and social preconception and interconception health risk factors and determine demographic factors associated with these risk clusters among Canadian women.Design Cross-sectional data were collected via an online questionnaire assessing a range of preconception risk factors.Prevalence of each risk factor and the total number of risk factors present was calculated.Multivariable logistic regression models determined which demographic factors were associated with having greater than the mean number of risk factors.Exploratory factor analysis determined how risk factors clustered,and Spearman’s r determined how demographic characteristics related to risk factors within each cluster.Setting Canada.Participants Participants were recruited via advertisements on public health websites,social media,parenting webpages and referrals from ongoing studies or existing research datasets.Women were eligible to participate if they could read and understand English,were able to access a telephone or the internet,and were either planning a first pregnancy(preconception)or had≥1 child in the past 5 years and were thus in the interconception period.Results Most women(n=1080)were 34 or older,and were in the interconception period(98%).Most reported risks in only one of the 12 possible risk factor categories(55%),but women reported on average 4 risks each.Common risks were a history of caesarean section(33.1%),miscarriage(27.2%)and high birth weight(13.5%).Just over 40%had fair or poor eating habits,and nearly half were not getting enough physical activity.Three-quarters had a body mass index indicating overweight or obesity.Those without a postsecondary degree(OR 2.35;95%CI 1.74 to 3.17)and single women(OR 2.22,95%CI 1.25 to 3.96)had over twice the odds of having more risk factors.Those with two children or more had 60%lower odds of having more risk factors(OR 0.68,95%CI 0.52 to 0.86).Low education and being born outside Canada were correlated with the greatest number of risk clusters.Conclusions Many of the common risk factors were behavioural and thus preventable.Understanding which groups of women are prone to certain risk behaviours provides opportunities for researchers and policy-makers to target interventions more efficiently and effectively.