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Diet Study on Ulcerative Colitis

Primary Purpose

Ulcerative Colitis

Status
Completed
Phase
Not Applicable
Locations
United States
Study Type
Interventional
Intervention
LFD
SAD
Sponsored by
University of Miami
About
Eligibility
Locations
Arms
Outcomes
Full info

About this trial

This is an interventional supportive care trial for Ulcerative Colitis focused on measuring Inflammatory bowel disease, diet, low fat, UC, IBD

Eligibility Criteria

18 Years - 70 Years (Adult, Older Adult)All SexesDoes not accept healthy volunteers

Inclusion Criteria:

  1. Male or Female ≥18 and ≤70 years old
  2. History of UC of at least 3 months duration
  3. UC should be confirmed by colonoscopy within two years of entry into the study
  4. Patients with mild to moderate UC, or patients in remission that have had active disease within the past 18 months, regardless of treatment with mesalamines, immunosuppressants, anti-TNFs and/or vedolizumab

    • Patients on oral 5-aminosalicylates, mesalamine or sulfasalazine must be on a stable dose for ≥2 weeks prior to screening
    • Patients treated with anti-TNFs or immunosuppressants (AZA, 6-MP, or methotrexate) at screening must have been on a stable dose for ≥8 weeks and remain on the same dose during the treatment period
    • Patients on steroids can be on no more than prednisone 20mg daily or budesonide 9mg daily at screening. If clinically indicated, tapering of steroids after 4 weeks of intervention may occur. Prednisone may be tapered by no more than 2.5mg/week and budesonide by no more than 3mg/week.
    • Patients on infliximab, premedication may include intravenous corticosteroid
  5. No antibiotic use or probiotic use within 4 weeks prior to screening
  6. Signed written informed consent for enrollment into the study

Exclusion Criteria:

  1. Patients with Crohn's Disease and Celiac Disease
  2. History of colonic dysplasia except for adenoma on prior surveillance colonoscopy
  3. Patients with altered anatomy: prior colectomy or anticipated colectomy during the study period and presence of ileal pouch or ostomy
  4. Clinical manifestations concerning for fulminant disease or toxic megacolon
  5. Patients with stool sample positive at during screening period or at least <12 weeks for ova, parasites, or culture for aerobic pathogens including: Aeromonas, Plesiomonas, Shigella, Yersinia, Campylobacter and E.coli spp. or positive for Clostridium difficile B toxin in stools
  6. Use of cyclosporine, mycophenolate mofetil, sirolimus, thalidomide or tacrolimus within 2 months prior to screening
  7. Need for prednisone >20mg daily or budesonide >9mg daily at the time of screening
  8. Received intravenous corticosteroids within 2 weeks prior to screening, during screening, or during the study period, except as premedication for anti-TNFs
  9. Use of Total Parenteral Nutrition at the time of screening and during the study period
  10. Anti-diarrheal use within 2 weeks prior to screening
  11. Presence of any of the following laboratory abnormalities during screening period or at least <12 weeks

    • Hemoglobin <8.0g/dl
    • Albumin <2.8g/dl
  12. Conditions/situations such as:

    • Patients with short life expectancy
    • Uncooperative behavior or any condition that could make the patient potentially non-compliant to the study procedures
    • Patients with pacemaker
    • Other significant or life-threatening co-morbidities in which diet intervention could negatively affect
  13. Failure to meet any of the inclusion criteria
  14. Poor compliance with diet during the study period
  15. Failure to submit stool samples as indicated at each phase of the study
  16. The need for antibiotic use during the study period

Sites / Locations

  • University of Miami

Arms of the Study

Arm 1

Arm 2

Arm Type

Experimental

Experimental

Arm Label

Low Fat Diet (LFD) to Standard American Diet (SAD)

SAD to LFD

Arm Description

Week 1 to 4 participants will receive a LFD followed by a washout period of 2 weeks and then week 6 to 10 SAD.

Week 1 to 4 participants will receive a SAD followed by a washout period of 2 weeks and then week 6 to 10 LFD.

Outcomes

Primary Outcome Measures

Change in quality of life as measured by the Short Inflammatory Bowel Disease Questionnaire (sIBDQ).
sIBDQ is a 10-item shortened version of the original IBDQ assessing quality of life (QOL) with total scores ranging from 1 to 7 with a higher score indicating a better QOL.
Change in quality of life as measured by the Food-Related Quality of Life (FR-QoL-29) Questionnaire.
FR-QoL-29 is a 29-item questionnaire assessing quality of life (QOL) with total scores ranging from 29 to 145 with a score less than 90 suggesting poor food related QoL.
Change in quality of life as measured by the Medical Outcomes Short Form-36 (SF-36) Questionnaire.
SF-36 is a 36-item questionnaire assessing quality of life (QOL) with total scores ranging from 0 to 100 with a higher score indicating a better QOL.
Change in the expression of inflammatory markers in the colon.
Change in the expression of interleukin (IL)-1β, IL-6 and Tumor Necrosis Factor alpha (TNFa) evaluated in pg/mL.
Change in the expression of cytokine in the colon.
Change in the expression of cytokine high-sensitivity C-reactive protein (hsCRP) evaluted in mg/L.
Change in intestinal microbiota
Change in relative abundance of the microbial communities evaluated as a percentage.

Secondary Outcome Measures

Change in Ulcerative Colitis (UC) symptoms as measured by the partial Mayo score
The partial Mayo score ranges from 0 to 9 with a higher score indicating worsening UC symptoms.
Change in UC symptoms as measured by the Simple Clinical Colitis Activity Index (SCCAI)
SCCAI score ranges from 0 to 19 with a higher score indicating worsening UC symptoms.
Rate of adherence to fat intake
Adherence to fat intake is measured by the web-based daily food diary software Nutrihand.
Rate of adherence to diet items
Adherence to diet items is measured by the web-based daily food diary software Nutrihand.

Full Information

First Posted
October 30, 2019
Last Updated
October 30, 2019
Sponsor
University of Miami
Collaborators
Broad Medical Research Program Crohn's and Colitis Foundation
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1. Study Identification

Unique Protocol Identification Number
NCT04147598
Brief Title
Diet Study on Ulcerative Colitis
Official Title
Dietary Control of Fat to Modify Colonic Inflammation in Ulcerative Colitis
Study Type
Interventional

2. Study Status

Record Verification Date
October 2019
Overall Recruitment Status
Completed
Study Start Date
February 25, 2015 (Actual)
Primary Completion Date
September 11, 2018 (Actual)
Study Completion Date
September 11, 2018 (Actual)

3. Sponsor/Collaborators

Responsible Party, by Official Title
Principal Investigator
Name of the Sponsor
University of Miami
Collaborators
Broad Medical Research Program Crohn's and Colitis Foundation

4. Oversight

Studies a U.S. FDA-regulated Drug Product
No
Studies a U.S. FDA-regulated Device Product
No
Data Monitoring Committee
Yes

5. Study Description

Brief Summary
The primary purpose of this study is to determine the effectiveness of a low-fat or standard American diet (high in fat) in helping people with ulcerative colitis improve their symptoms and the signs of inflammation in blood tests and in bowel biopsies.

6. Conditions and Keywords

Primary Disease or Condition Being Studied in the Trial, or the Focus of the Study
Ulcerative Colitis
Keywords
Inflammatory bowel disease, diet, low fat, UC, IBD

7. Study Design

Primary Purpose
Supportive Care
Study Phase
Not Applicable
Interventional Study Model
Crossover Assignment
Masking
Participant
Allocation
Randomized
Enrollment
38 (Actual)

8. Arms, Groups, and Interventions

Arm Title
Low Fat Diet (LFD) to Standard American Diet (SAD)
Arm Type
Experimental
Arm Description
Week 1 to 4 participants will receive a LFD followed by a washout period of 2 weeks and then week 6 to 10 SAD.
Arm Title
SAD to LFD
Arm Type
Experimental
Arm Description
Week 1 to 4 participants will receive a SAD followed by a washout period of 2 weeks and then week 6 to 10 LFD.
Intervention Type
Other
Intervention Name(s)
LFD
Intervention Description
Participants will receive daily prepared food trays to achieve a diet with approximately 10% of total fat, 1-5% of calories from saturated fat, and 5-9% of MUFA and PUFA. This diet will contain an approximate ratio of 1:1 of omega-6/omega-3 fatty acids.
Intervention Type
Other
Intervention Name(s)
SAD
Intervention Description
Participants will receive daily prepared food trays to achieve a diet with approximately 35-40% of calories from fat, 10-11% of saturated fats, and 25-29% would be mono-unsaturated (MUFA) and PUFA. This diet will contain a 20-30:1 ratio of omega-6/omega-3 fatty acids, representing the current SAD.
Primary Outcome Measure Information:
Title
Change in quality of life as measured by the Short Inflammatory Bowel Disease Questionnaire (sIBDQ).
Description
sIBDQ is a 10-item shortened version of the original IBDQ assessing quality of life (QOL) with total scores ranging from 1 to 7 with a higher score indicating a better QOL.
Time Frame
Baseline, 4 weeks
Title
Change in quality of life as measured by the Food-Related Quality of Life (FR-QoL-29) Questionnaire.
Description
FR-QoL-29 is a 29-item questionnaire assessing quality of life (QOL) with total scores ranging from 29 to 145 with a score less than 90 suggesting poor food related QoL.
Time Frame
Baseline, 4 weeks
Title
Change in quality of life as measured by the Medical Outcomes Short Form-36 (SF-36) Questionnaire.
Description
SF-36 is a 36-item questionnaire assessing quality of life (QOL) with total scores ranging from 0 to 100 with a higher score indicating a better QOL.
Time Frame
Baseline, 4 weeks
Title
Change in the expression of inflammatory markers in the colon.
Description
Change in the expression of interleukin (IL)-1β, IL-6 and Tumor Necrosis Factor alpha (TNFa) evaluated in pg/mL.
Time Frame
Baseline, 4 weeks
Title
Change in the expression of cytokine in the colon.
Description
Change in the expression of cytokine high-sensitivity C-reactive protein (hsCRP) evaluted in mg/L.
Time Frame
Baseline, 4 weeks
Title
Change in intestinal microbiota
Description
Change in relative abundance of the microbial communities evaluated as a percentage.
Time Frame
Baseline, 4 weeks
Secondary Outcome Measure Information:
Title
Change in Ulcerative Colitis (UC) symptoms as measured by the partial Mayo score
Description
The partial Mayo score ranges from 0 to 9 with a higher score indicating worsening UC symptoms.
Time Frame
Baseline, 4 weeks
Title
Change in UC symptoms as measured by the Simple Clinical Colitis Activity Index (SCCAI)
Description
SCCAI score ranges from 0 to 19 with a higher score indicating worsening UC symptoms.
Time Frame
Baseline, 4 weeks
Title
Rate of adherence to fat intake
Description
Adherence to fat intake is measured by the web-based daily food diary software Nutrihand.
Time Frame
Baseline, 4 weeks
Title
Rate of adherence to diet items
Description
Adherence to diet items is measured by the web-based daily food diary software Nutrihand.
Time Frame
Baseline, 4 weeks

10. Eligibility

Sex
All
Minimum Age & Unit of Time
18 Years
Maximum Age & Unit of Time
70 Years
Accepts Healthy Volunteers
No
Eligibility Criteria
Inclusion Criteria: Male or Female ≥18 and ≤70 years old History of UC of at least 3 months duration UC should be confirmed by colonoscopy within two years of entry into the study Patients with mild to moderate UC, or patients in remission that have had active disease within the past 18 months, regardless of treatment with mesalamines, immunosuppressants, anti-TNFs and/or vedolizumab Patients on oral 5-aminosalicylates, mesalamine or sulfasalazine must be on a stable dose for ≥2 weeks prior to screening Patients treated with anti-TNFs or immunosuppressants (AZA, 6-MP, or methotrexate) at screening must have been on a stable dose for ≥8 weeks and remain on the same dose during the treatment period Patients on steroids can be on no more than prednisone 20mg daily or budesonide 9mg daily at screening. If clinically indicated, tapering of steroids after 4 weeks of intervention may occur. Prednisone may be tapered by no more than 2.5mg/week and budesonide by no more than 3mg/week. Patients on infliximab, premedication may include intravenous corticosteroid No antibiotic use or probiotic use within 4 weeks prior to screening Signed written informed consent for enrollment into the study Exclusion Criteria: Patients with Crohn's Disease and Celiac Disease History of colonic dysplasia except for adenoma on prior surveillance colonoscopy Patients with altered anatomy: prior colectomy or anticipated colectomy during the study period and presence of ileal pouch or ostomy Clinical manifestations concerning for fulminant disease or toxic megacolon Patients with stool sample positive at during screening period or at least <12 weeks for ova, parasites, or culture for aerobic pathogens including: Aeromonas, Plesiomonas, Shigella, Yersinia, Campylobacter and E.coli spp. or positive for Clostridium difficile B toxin in stools Use of cyclosporine, mycophenolate mofetil, sirolimus, thalidomide or tacrolimus within 2 months prior to screening Need for prednisone >20mg daily or budesonide >9mg daily at the time of screening Received intravenous corticosteroids within 2 weeks prior to screening, during screening, or during the study period, except as premedication for anti-TNFs Use of Total Parenteral Nutrition at the time of screening and during the study period Anti-diarrheal use within 2 weeks prior to screening Presence of any of the following laboratory abnormalities during screening period or at least <12 weeks Hemoglobin <8.0g/dl Albumin <2.8g/dl Conditions/situations such as: Patients with short life expectancy Uncooperative behavior or any condition that could make the patient potentially non-compliant to the study procedures Patients with pacemaker Other significant or life-threatening co-morbidities in which diet intervention could negatively affect Failure to meet any of the inclusion criteria Poor compliance with diet during the study period Failure to submit stool samples as indicated at each phase of the study The need for antibiotic use during the study period
Overall Study Officials:
First Name & Middle Initial & Last Name & Degree
Maria Abreu, MD
Organizational Affiliation
University of Miami
Official's Role
Principal Investigator
Facility Information:
Facility Name
University of Miami
City
Miami
State/Province
Florida
ZIP/Postal Code
33136
Country
United States

12. IPD Sharing Statement

Plan to Share IPD
No
Citations:
PubMed Identifier
32445952
Citation
Fritsch J, Garces L, Quintero MA, Pignac-Kobinger J, Santander AM, Fernandez I, Ban YJ, Kwon D, Phillips MC, Knight K, Mao Q, Santaolalla R, Chen XS, Maruthamuthu M, Solis N, Damas OM, Kerman DH, Deshpande AR, Lewis JE, Chen C, Abreu MT. Low-Fat, High-Fiber Diet Reduces Markers of Inflammation and Dysbiosis and Improves Quality of Life in Patients With Ulcerative Colitis. Clin Gastroenterol Hepatol. 2021 Jun;19(6):1189-1199.e30. doi: 10.1016/j.cgh.2020.05.026. Epub 2020 May 20.
Results Reference
derived

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Diet Study on Ulcerative Colitis

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