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An oral supplement enriched with fish oil, soluble fiber, and antioxidants for corticosteroid sparing in ulcerative colitis: A randomized, controlled trial

Published:February 03, 2005DOI:https://doi.org/10.1016/S1542-3565(04)00672-X
      Background & Aims: N-3 fatty acids from fish oil, antioxidants, and short-chain fatty acids (SCFAs) produced during the fermentation of soluble fiber may attenuate inflammation associated with ulcerative colitis (UC). We assessed the efficacy of a nutritionally balanced oral supplement enriched with fish oil, fructooligosaccharides, gum arabic, vitamin E, vitamin C, and selenium on disease activity and medication use in adults with mild to moderate UC. Methods: A total of 121 patients with UC and a disease activity index (DAI) from 3–9 on a 12-point scale were block randomized for extent of disease and smoking status. In addition to their usual diet, patients consumed 18 oz of the oral supplement or a carbohydrate-based placebo formula each day for 6 months. Clinical and histologic responses were assessed at 3 and 6 months or at the final visit. A change in average prednisone use between groups was tested by using a linear mixed-effects model. Results: Eighty-six patients completed the study. Baseline characteristics were not different between groups except for a higher total DAI score in the oral supplement group (7.3 ± 1.3; n = 36) compared with the placebo group (6.2 ± 2.0; n = 50) (P < .05). Both groups showed significant and similar degree of improvement at 6 months in DAI (−2.5 for oral supplement and −2.8 for placebo) and histologic index (−1.9 for oral supplement vs. −2.0 for placebo). Both intent-to-treat and completed patients given oral supplement had a significantly greater rate of decrease in the dose of prednisone required to control clinical symptoms over 6 months as compared with the placebo group (P < .001). Conclusions: The improvement in clinical response combined with a decreased requirement for corticosteroids suggest that this enriched oral supplement can be a useful adjuvant therapy in patients with UC.

      Abbreviations used in this paper:

      AA (arachidonic acid), DAI (disease activity index), DHA (docosahexaenoic acid), EPA (eicosapentaenoic acid), IBD (inflammatory bowel disease), SCFA (short-chain fatty acid), UC (ulcerative colitis), UCNS (ulcerative colitis nutritional supplement)
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      References

        • Fiocchi C.
        Inflammatory bowel disease.
        Gastroenterology. 1998; 115: 182-205
        • Truelove S.C.
        • Witts L.J.
        Cortisone in ulcerative colitis. Final report on a therapeutic trial.
        BMJ. 1955; 2: 1041-1048
        • Hanauer S.B.
        • Baert F.J.
        The management of ulcerative colitis.
        Ann Rev Med. 1995; 46: 497-505
        • Empey L.R.
        • Jewell L.D.
        • Garg M.L.
        • et al.
        Fish oil-enriched diet is mucosal protective against acetic acid-induced colitis in rats.
        Can J Physiol Pharmacol. 1991; 69: 480-487
        • Vilaseca J.
        • Salas A.
        • Guarner F.
        • et al.
        Dietary fish oil reduces progression of chronic inflammatory lesions in a rat model of granulomatous colitis.
        Gut. 1990; 31: 534-539
        • Lorenz R.
        • Weber P.C.
        • Szimnan P.
        • et al.
        Supplementation with n-3 fatty acids from fish oil in chronic inflammatory bowel disease.
        J Intern Med Suppl. 1989; 225: 225-232
        • Hillier K.
        • Jewell R.
        • Dorrell L.
        • et al.
        Incorporation of fatty acids from fish oil and olive oil into colonic mucosal lipids and effects upon eicosanoid synthesis in inflammatory bowel disease.
        Gut. 1991; 32: 1151-1155
        • Saloman P.
        • Kornbluth A.A.
        • Janowitz M.D.
        Treatment of ulcerative colitis with fish oil n-3-ω-fatty acid.
        J Clin Gastroenterol. 1990; 12: 157-161
        • Senagore A.J.
        • MacKeigan J.M.
        • Scheider M.
        • et al.
        Short-chain fatty acid enemas.
        Dis Colon Rectum. 1992; 35: 923-927
        • Scheppach W.
        • Sommer H.
        • Kirchner T.
        • et al.
        Effect of butyrate enemas on the colonic mucosa in distal ulcerative colitis.
        Gastroenterology. 1992; 103: 51-58
        • Scheppach W.
        • German-Austrian SCFA Study Group
        Treatment of distal ulcerative colitis with short-chain fatty acid enemas.
        Dig Dis Sci. 1996; 14: 2254-2259
        • Breuer I.
        • Soergel K.H.
        • Lashner B.A.
        • et al.
        Short chain fatty acid rectal irrigation for left-sided ulcerative colitis.
        Gut. 1997; 40: 485-491
        • Hidaka H.
        • Tashiro Y.
        • Elda T.
        Proliferation of bifidobacteria by oligosaccharides and their useful effect on human health.
        Bifidobact Microflora. 1991; 10: 65-79
        • Okazai M.
        • Fujikawa S.
        • Matsumoto N.
        Effect of xylooligosaccharide on the growth of bifidobacteria.
        Bifidobact Microflora. 1990; 9: 77-86
        • Gibson G.R.
        • Roberfroid M.B.
        Dietary modulation of the human colonic microbiota.
        J Nutr. 1995; 125: 1401-1412
        • Mitsuoka T.
        Bifidobacteria and their role in human health.
        J Indust Microbiol. 1990; 6: 263-268
        • Grisham M.B.
        Oxidants and free radicals in inflammatory bowel disease.
        Lancet. 1994; 344: 859-861
        • Buffinton G.
        • Doe W.
        Depleted mucosal antioxidant defenses in inflammatory bowel disease.
        Free Radic Biol Med. 1995; 19: 911-918
        • Keshavarzian A.
        • Sedghi S.
        • Kanofsky J.
        • et al.
        Excessive production or reactive oxygen metabolites by inflamed colon.
        Gastroenterology. 1992; 103: 177-185
        • Grisham M.B.
        • DeMichele S.J.
        • Garleb K.A.
        • et al.
        Sulfasalazine or enteral diets containing fish oil or oligosaccharides attenuate chronic colitis in rats.
        Inflamm Bowel Dis. 1996; 2: 178-188
        • Dudrick S.J.
        • Latifi R.
        • Schrager R.
        Nutritional management of inflammatory bowel disease.
        Surg Clin North Am. 1991; 71: 609-623
        • Burke A.
        • Lichtenstein G.R.
        • Rombeau J.L.
        Nutrition and ulcerative colitis.
        Baillieres Clin Gastroenterol. 1997; 11: 153-174
        • Sutherland L.R.
        • Martin F.
        • Greer S.
        • et al.
        5-aminosalicylic acid enema in the treatment of distal ulcerative colitis, proctosigmoiditis, and proctitis.
        Gastroenterology. 1987; 92: 1894-1898
        • Baron J.H.
        • Connell A.M.
        • Lennard-Jones J.E.
        Variation between observers in describing mucosal appearances in proctocolitis.
        BMJ. 1964; 1: 89-92
        • Huang Y.S.
        • Chaudhary S.
        • Thurmond J.M.
        • et al.
        Cloning of the delta 12- and delta 6-desaturases from Mortierella alpina and recombinant production of gamma-linolenic acid in Saccharomyces cerevisiae.
        Lipids. 1999; 34: 649-659
        • Craft N.E.
        High resolution HPLC method for the simultaneous analysis of carotenoids, retinoids, and tocopherols.
        FASEB Journal. 1996; 10: A527
        • Nostrant T.T.
        • Kumar N.B.
        • Appelman H.D.
        Histopathology differentiates acute self-limited colitis from ulcerative colitis.
        Gastroenterology. 1997; 92: 318-328
        • Surawicz C.M.
        • Haggitt R.C.
        • Husseman M.
        • et al.
        Mucosal biopsy diagnosis of colitis.
        Gastroenterology. 1994; 107: 755-763
        • Harris J.A.
        • Benedict F.G.
        A biometric study of basal metabolism in man.
        Carnegie Institute, Washington, DC1919 (Publication No. 179)
        • Malchow H.
        • Steinhardt H.J.
        • Lorenz-Meyer H.
        • et al.
        Feasibility and effectiveness of a defined-formula diet regimen in treating active Crohn’s disease.
        Scand J Gastroenterol. 1990; 25: 235-244
        • Yang V.W.
        Eicosanoids and inflammatory bowel disease.
        Gastroenterol Clin North Am. 1996; 25: 317-332
        • Boughton-Smith N.K.
        • Hawkey C.J.
        • Whittle B.J.R.
        Biosynthesis of lipoxygenase and cyclooxygenase products from [14 C]-arachidonic acid by human colonic mucosa.
        Gut. 1983; 24: 1176-1182
        • Sharon P.
        • Stenson W.F.
        Enhanced synthesis of leukotriene B4 by colonic mucosa inflammatory bowel disease.
        Gastroenterology. 1984; 86: 453-460
        • Lauritsen K.
        • Laursen L.S.
        • Bukhave K.
        • et al.
        Effects of topical 5-aminosalicylic acid and prednisolone on prostaglandin E2 and leukotriene B4 levels determined by equilibrium in vivo dialysis of rectum in relapsing ulcerative colitis.
        Gastroenterology. 1986; 91: 837-844
        • Lorenz R.
        • Weber P.C.
        • Szimnau P.
        • et al.
        Supplementation with n-3 fatty acids from fish oil in chronic inflammatory bowel disease.
        J Intern Med. 1989; 225: 225-232
        • Aslan A.
        • Triadafilopoulos G.
        Fish oil fatty acid supplementation in active ulcerative colitis.
        Am J Gastroenterol. 1992; 87: 432-437
        • Stenson W.F.
        • Cort D.
        • Rodgers J.
        • et al.
        Dietary supplementation with fish oil in ulcerative colitis.
        Ann Intern Med. 1992; 116: 609-614
        • Almallah Y.Z.
        • Richardson S.
        • O’Hanrahan T.
        • et al.
        Distal procto-colitis, natural cytotoxicity, and essential fatty acids.
        Am J Gastroenterol. 1998; 93: 804-809
        • Hawthorne A.B.
        • Daneshmend T.K.
        • Hawkey C.J.
        • et al.
        Treatment of ulcerative colitis with fish oil supplementation.
        Gut. 1992; 22: 922-928
        • Miller T.L.
        • Wolin M.J.
        Fermentations by saccharolytic intestinal bacteria.
        Am J Clin Nutr. 1979; 32: 164-172
        • Cummings J.H.
        Fermentation in the human large intestine.
        Lancet. 1983; 1: 1206-1209
        • Tigemeyer E.C.
        • Bourquin L.D.
        • Fahey Jr, G.C.
        • et al.
        Fermentability of various fiber sources by human fecal bacteria in vitro.
        Am J Clin Nutr. 1991; 53: 1418-1424
        • Roediger W.E.W.
        The starved colon-diminished mucosal nutrition, diminished absorption, and colitis.
        Dis Colon Rectum. 1990; 33: 858-862
        • Goodlad R.A.
        • Lenton W.
        • Ghatei M.A.
        • et al.
        Proliferative effects of ‘fibre’ on the intestinal epithelium.
        Gut. 1987; 28: 221-226
        • Kripke S.A.
        • Fox A.D.
        • Berman J.M.
        • et al.
        Stimulation of intestinal mucosal growth with intracolonic infusion of short-chain fatty acids.
        JPEN J Parenter Enteral Nutr. 1989; 13: 109-116
        • Sakata T.
        Stimulatory effect of short-chain fatty acids on epithelial cell rat intestine.
        Br J Nutr. 1987; 58: 95-103
        • Roediger W.E.W.
        The colonic epithelium in ulcerative colitis.
        Lancet. 1980; 2: 712-715
        • Chapman M.A.
        • Grahn M.F.
        • Boyle M.A.
        • et al.
        Butyrate oxidation is impaired in the colonic mucosa of sufferers of quiescent ulcerative colitis.
        Gut. 1994; 35: 73-76
        • Steinhart A.
        • Hiruki T.
        • Brzezinski A.
        • et al.
        Treatment of left-sided ulcerative colitis with butyrate enemas.
        Aliment Pharmacol Ther. 1996; 10: 729-736
        • Vernia P.
        • Monteleone G.
        • Grandinetti G.
        • et al.
        Combined oral sodium butyrate and mesalazine treatment compared to oral mesalazine alone in ulcerative colitis.
        Dig Dis Sci. 2000; 45: 976-981
        • Kanauchi O.
        • Iwanaga T.
        • Mitsuyama K.
        Germinated barley foodstuff feeding. A novel neutraceutical therapeutic strategy for ulcerative colitis.
        Digestion. 2001; 63: 160-170
        • Ramakrishna B.
        • Varghese R.
        • Jayakumar S.
        • et al.
        Circulating antioxidants in ulcerative colitis and their relationship to disease severity and activity.
        J Gastroenterol Hepatol. 1997; 12: 490-494
        • Sturniolo G.C.
        • Mestriner C.
        • Lecis P.E.
        • et al.
        Altered plasma and mucosal concentrations of trace elements and antioxidants in active ulcerative colitis.
        Scand J Gastroenterol. 1998; 33: 644-649