A novel Monash Pouch diet in patients with an ileoanal pouch is tolerable and has favorable metabolic luminal effects
Aims To evaluate a whole‐food diet strategy (the Monash Pouch diet [MPD]) designed based on the interacting roles dietary factors play with pouch health. Specifically, its tolerability and acceptability, whether it achieved its dietary and metabolic goals, and the effects on symptoms and inflammatio...
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| Published in | JGH open Vol. 7; no. 12; pp. 942 - 952 |
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| Main Authors | , , , , , , , , |
| Format | Journal Article |
| Language | English |
| Published |
Melbourne
Wiley Publishing Asia Pty Ltd
01.12.2023
John Wiley & Sons, Inc Wiley |
| Subjects | |
| Online Access | Get full text |
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| Summary: | Aims
To evaluate a whole‐food diet strategy (the Monash Pouch diet [MPD]) designed based on the interacting roles dietary factors play with pouch health. Specifically, its tolerability and acceptability, whether it achieved its dietary and metabolic goals, and the effects on symptoms and inflammation were examined.
Methods
In a 6‐week open‐label trial, patients with ileoanal pouches educated on the MPD were assessed regarding diet tolerability and acceptance, food intake (7‐day food diaries), pouch‐related symptoms (clinical pouchitis disease activity index), and, in 24‐h fecal samples, calprotectin, fermentative biomarkers, and volatile organic compounds (VOC).
Results
Of 12 patients, 6 male, mean (SD) age 55 (5) and pouch age 13 (2) years, one withdrew with partial small bowel obstruction. Tolerability was excellent in 9 (75%) and acceptance was high (81%). Targeted changes in dietary intake were achieved. Fecal branched‐ to short‐chain fatty acid ratio increased by median 60 [IQR: 11–80]% (P = 0.02). Fecal VOCs for 3 compounds were also increased, 2‐methyl‐5‐propan‐2‐ylcyclohexa‐1,3‐diene (Fold‐change [FC] 2.08), 1,3,3‐trimethyl‐2‐oxabicyclo[2.2.2]octane (FC 3.86), propan‐2‐ol (FC 2.10). All six symptomatic patients achieved symptomatic remission (P = 0.03). Fecal calprotectin at baseline was 292 [176–527] μg/g and at week 5 was 205 [148–310] μg/g (P = 0.72).
Conclusion
Well tolerated and accepted, the MPD achieved targeted changes in intakes and fermentation of carbohydrates relative to that of protein. There were signals of improvement in symptoms. These results indicate the need for a randomized‐controlled trial. (Trial registration: ACTRN12621000374864; https://www.anzctr.org.au/ACTRN12621000374864.aspx).
A 5‐week novel Monash Pouch diet was well tolerated and had high patient acceptability. The diet achieved a reduction in protein versus carbohydrate fermentative activity and deserves further investigation in a well‐powered larger randomized‐controlled trial. |
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| Bibliography: | Author contribution Zaid S Ardalan, Chu K Yao, Peter R Gibson and Miles P Sparrow conceived the concepts and designed the study. Zaid S Ardalan recruited participants, collected and analyzed data for the study and wrote the manuscript. Chu K Yao designed and administered the diet, was involved in data collection and analysis, and wrote the manuscript. Kraig Green and Chris Probert performed analysis of volatile organic compounds, interpreted the data and contributed to manuscript writing. Paul A Gill conducted analysis of fecal short‐chain fatty acids. Sam Rosella helped analyze fecal samples for calprotectin. Jane G Muir was involved in the design of the diet and critically revised the manuscript for important intellectual content. Miles P Sparrow designed the study, critically revised the manuscript for important intellectual content. Peter R Gibson designed the study, critically revised the manuscript for important intellectual content. All authors approved of the final manuscript. Declaration of conflict of interest Zaid S Ardalan, Sam Rosella, Paul A Gill, and Kraig Green have no disclosures to declare. Chu K Yao has received research support for investigator‐driven studies for Atmo Biosciences, Ferring Pharmaceuticals, Danone, and Yakult Australia. Sam Rosella and Peter R Gibson have no disclosures to declare. Jane G Muir was supported by a Research Fellowship from the National Health and Medical Research Foundation of Australia. Chris Probert has received speaker's fees for Dr Falk Pharma. Miles P Sparrow (i) has received educational grants or research support–Ferring, Orphan, Gilead, (ii) has received speaker's fees—Janssen, Abbvie, Ferring, Takeda, Pfizer, Shire, and (iii) serves as a consultant and advisory board member for Janssen, Takeda, Pfizer, Celgene, Abbvie, MSD, and Emerge Health. Peter R Gibson has served as consultant or advisory board member for Anatara, Atmo Biosciences, Immunic Therapeutics, Novozymes, Intrinsic Medicine, Comvita, Novoviah and Topas. He has received research grants for investigator‐driven studies from Atmo Biosciences. He holds shares in Atmo Biosciences. He has published two educational/recipe books on the low FODMAP diet. Zaid S Ardalan, Chu K Yao, Peter R Gibson, and Jane G Muir also work in a department that financially benefits from the sales of a digital application and booklets on the low FODMAP diet. Funds raised contribute to research of the Department of Gastroenterology and to the University. No author receives personal remuneration. Zaid S Ardalan and Chu K Yao are joint first authors. ObjectType-Article-1 SourceType-Scholarly Journals-1 ObjectType-Feature-2 content type line 14 content type line 23 Author contribution: Zaid S Ardalan, Chu K Yao, Peter R Gibson and Miles P Sparrow conceived the concepts and designed the study. Zaid S Ardalan recruited participants, collected and analyzed data for the study and wrote the manuscript. Chu K Yao designed and administered the diet, was involved in data collection and analysis, and wrote the manuscript. Kraig Green and Chris Probert performed analysis of volatile organic compounds, interpreted the data and contributed to manuscript writing. Paul A Gill conducted analysis of fecal short‐chain fatty acids. Sam Rosella helped analyze fecal samples for calprotectin. Jane G Muir was involved in the design of the diet and critically revised the manuscript for important intellectual content. Miles P Sparrow designed the study, critically revised the manuscript for important intellectual content. Peter R Gibson designed the study, critically revised the manuscript for important intellectual content. All authors approved of the final manuscript. Declaration of conflict of interest: Zaid S Ardalan, Sam Rosella, Paul A Gill, and Kraig Green have no disclosures to declare. Chu K Yao has received research support for investigator‐driven studies for Atmo Biosciences, Ferring Pharmaceuticals, Danone, and Yakult Australia. Sam Rosella and Peter R Gibson have no disclosures to declare. Jane G Muir was supported by a Research Fellowship from the National Health and Medical Research Foundation of Australia. Chris Probert has received speaker's fees for Dr Falk Pharma. Miles P Sparrow (i) has received educational grants or research support–Ferring, Orphan, Gilead, (ii) has received speaker's fees—Janssen, Abbvie, Ferring, Takeda, Pfizer, Shire, and (iii) serves as a consultant and advisory board member for Janssen, Takeda, Pfizer, Celgene, Abbvie, MSD, and Emerge Health. Peter R Gibson has served as consultant or advisory board member for Anatara, Atmo Biosciences, Immunic Therapeutics, Novozymes, Intrinsic Medicine, Comvita, Novoviah and Topas. He has received research grants for investigator‐driven studies from Atmo Biosciences. He holds shares in Atmo Biosciences. He has published two educational/recipe books on the low FODMAP diet. Zaid S Ardalan, Chu K Yao, Peter R Gibson, and Jane G Muir also work in a department that financially benefits from the sales of a digital application and booklets on the low FODMAP diet. Funds raised contribute to research of the Department of Gastroenterology and to the University. No author receives personal remuneration. |
| ISSN: | 2397-9070 2397-9070 |
| DOI: | 10.1002/jgh3.13008 |