Impact of fibre and red/processed meat intake on treatment outcomes among patients with chronic inflammatory diseases initiating biological therapy: A prospective cohort study

Abstract

Background: Biologic disease-modifying drugs have revolutionised the treatment of a number of chronic inflammatory diseases (CID). However, up to 60% of the patients do not have a sufficient response to treatment and there is a need for optimization of treatment strategies.

Objective: To investigate if the treatment outcome of biological therapy is associated with the habitual dietary intake of fibre and red/processed meat in patients with a CID.

Methods: In this multicentre prospective cohort study, we consecutively enrolled 233 adult patients with a diagnosis of Crohn's Disease, Ulcerative Colitis, Rheumatoid Arthritis (RA), Axial Spondyloarthritis, Psoriatic Arthritis and Psoriasis, for whom biologic therapy was planned, over a 3 year period. Patients with completed baseline food frequency questionnaires were stratified into a high fibre/low red and processed meat exposed group (HFLM) and an unexposed group (low fibre/high red and processed meat intake = LFHM). The primary outcome was the proportion of patients with a clinical response to biologic therapy after 14-16 weeks of treatment.

Results: Of the 193 patients included in our primary analysis, 114 (59%) had a clinical response to biologic therapy. In the HFLM group (N = 64), 41 (64%) patients responded to treatment compared to 73 (56%) in the LFHM group (N = 129), but the difference was not statistically significant (OR: 1.48, 0.72-3.05). For RA patients however, HFLM diet was associated with a more likely clinical response (82% vs. 35%; OR: 9.84, 1.35-71.56).

Conclusion: Habitual HFLM intake did not affect the clinical response to biological treatment across CIDs. HFLM diet in RA patients might be associated with better odds for responding to biological treatment, but this would need confirmation in a randomised trial.

Trial registration: (clinicaltrials.gov), identifier [NCT03173144].

Keywords: biologic therapy; chronic inflammatory disease; diet; fibre; inflammatory bowel disease; processed meat; red meat; rheumatoid arthritis.

Conflict of interest statement

Author CH has received speaker fee from Takeda Pharma and Tillotts Pharma (unrelated to the present work). The remaining authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

Copyright © 2022 Overgaard, Sørensen, Munk, Nexøe, Glerup, Henriksen, Guldmann, Pedersen, Saboori, Hvid, Dahlerup, Hvas, Jawhara, Andersen, Pedersen, Nielsen, Bergenheim, Brodersen, Heitmann, Halldorsson, Holmskov, Bygum, Christensen, Kjeldsen, Ellingsen and Andersen.

Figures

Figure 1

Flow chart of the enrolment of participants. Number of Chronic Inflammatory Disease patients who were screened, included in the study and included in the analysis. Patients screened for eligibility were not explicitly recorded in the study. For CD, UC, and PsO we estimated a number based on the mean inclusion rate from two clinics that kept a pre-screening log. For RA, axSpA, and PsA, the number is not an estimate but the total number of patients that initiated biologic treatment in the clinic during enrolment. IBD, Inflammatory bowel disease (Crohn's disease and Ulcerative colitis); CD, Crohn's disease; UC, Ulcerative colitis; RA, Rheumatoid arthritis; axSpA, Axial spondyloarthritis; PsA, Psoriatic arthritis; PsO, Psoriasis; FFQ, Food Frequency Questionnaire; HFLM, high fibre/low meat; LFHM, low fibre/high meat; ITT, intention-to-treat; SF-12 PCS + MCS, short form health survey the physical and mental component summary, The short health scale includes four health dimensions (symptom burden, functional status, disease-related burden and general wellbeing); CRP, C-reactive protein.

Figure 2

Meta-analysis (random effects model) of the included Chronic Inflammatory Diseases (CIDs) on the “As Observed” population comparing clinical response to biologics in patients with a high intake of fibre and low intake of red/processed meat (HFLM) vs. patients with a low intake of fibre and high intake of red/processed meat (LFHM). The horizontal lines represent the odds ratio (OR) ± 95% confidence interval. Event = clinical response according to the specified criteria for each CID, i.e., the number shows how many out of the total number of participants in the group, that have had a clinical response. The “As Observed” populations means patients with complete data for clinical response (i.e., 17 patients are excluded).

Figure 3

Receiver operating characteristics curve analysis for the predictive value of the ratio of fibre and red/processed meat intake (A), fibre intake (B) and red/processed meat intake (C) on clinical response. The ROC curves were constructed by calculating the sensitivity and specificity for prediction of clinical response for (A) the ratio of fibre to red/processed meat intake, (B) fibre intake, and (C) red/processed meat intake. Thereafter the sensitivity was plotted against 1-specificity. ROC, receiver operating characteristics.