Su1223 Efficacy and Safety of Adalimumab 80mg Weekly in Crohn's Disease

INTRODUCTION: Dietary n-6 polyunsaturated fatty acids (n-6 PUFA) may have a proinflammatory and n-3 fatty acids (n-3 PUFA) a protective effect in the development of ulcerative colitis (UC) and Crohn's disease (CD).However, data is limited on the role of these fatty acids on disease activity and prognosis.The aim of this study was to assess whether serum levels of n-6:n-3 fatty acids in patients with clinically quiescent inflammatory bowel disease can predict a subsequent increase in disease activity and whether these levels are reflective of dietary intake.METHODS: 60 patients with radiologically and endoscopically confirmed UC or CD and quiescent disease activity (HBI ,4, SCCAI ,=3) were recruited into a prospective study.Serum free fatty acid profile at recruitment was determined by capillary liquid gas chromatography.Disease activity from time of initial serum sampling was monitored at regular 2 monthly intervals till 6 months, and if and when patients presented with a physician confirmed clinical flare.The association between serum n6, n3, n6: n3 ratios at recruitment, and subsequent clinical activity were then determined using conditional logistic regression and t-test.Dietary intake of PUFA (n=39) was determined from a detailed 24 hour recall food frequency questionnaire (FFQ) and correlated with serum PUFAs taken at a corresponding time.RESULTS: 36 antiTNF-Naïve patients with UC and 24 with CD were recruited.25 UC (58.1%) and 17 CD (37.2%) patients experienced a physician confirmed flare within 6 months (mean time to flare 108.5 days).Mean HBI at recruitment was 0.3 (0-3) and mean SCCAI was 0.5 (0-3).Mean duration of UC was 10.8 years (95% CI 7.0-14.6years) and CD 12.5 years (95%CI 9.0-16.0years).Mean percentage of total n-6 PUFA per total fat intake at recruitment in flared vs non flared patients was 33.2% to 29.7% in UC (p=0.02) and 33.2% to 29.9% in CD (p= 0.06) .Total n-6:n-3 ratios at onset in UC patients who flared was 17.7 vs 11.4 in non-flares (p=0.03) after adjustments for gender, smoking status, NSAID use, disease activity at recruitment, extent of UC and disease duration.There was no statistically significant difference in CD patients.Serum arachidonic acid to combined eicosopentanoic and docosahexanoic acid ratios were significant for UC (p=0.01).Similar results were also noted when assessing absolute concentrations of serum PUFA.Dietary PUFA intake from FFQ data correlated well with serum PUFA (correlation coefficient 0.47, p=0.003).CONCLUSION: Serum n-6:n-3 PUFA levels (which are reflective of dietary intake), can predict subsequent disease activity over a 6 month period in patients with quiescent UC.This supports a role for dietary PUFA modifications in UC.Further studies investigating the relationship between dietary PUFA and its mode of activity in mucosal inflammation are warranted.