Background/Aims: Epidemiological associations have implicated factors associated with Westernization, including the Western diet, in the development of inflammatory bowel disease (IBD). The role of diet in IBD etiopathogenesis, disease control and symptom management remains incompletely understood. Few studies have collected data on the dietary habits of immigrant populations living with IBD. Our aim was to describe the dietary practices and beliefs of British South Asians with IBD.Methods: A 30-item questionnaire was developed and consecutively administered to 255 British South Asians with IBD attending gastroenterology clinics in the United Kingdom.Results: Fifty-one percent of participants believed diet was the initiating factor for their IBD and 63% felt diet had previously triggered disease relapse. Eighty-nine percent avoided certain dietary items in the belief that this would prevent relapse. The most commonly avoided foods and drinks were spicy and fatty foods, carbonated drinks, milk products, alcohol, coffee, and red meat. A third of patients had tried a whole food exclusion diet, most commonly lactose- or gluten-free, and this was most frequently reported amongst those with clinically active IBD (P= 0.02). Almost 60% of participants avoided eating the same menu as their family, or eating out, at least sometimes, to prevent IBD relapse.Conclusions: British South Asians with IBD demonstrate significant dietary beliefs and food avoidance behaviors with increased frequency compared to those reported in Caucasian IBD populations. Studies in immigrant populations may offer valuable insights into the interaction between diet, Westernization and cultural drift in IBD pathogenesis and symptomatology.

Introduction. Previous epidemiological studies suggest a higher rate of pancolonic disease in South Asians (SA) compared with White Europeans (WE). The aim of the study was to compare colectomy rates for ulcerative colitis (UC) in SA to those of WE.Methods. Patients with UC were identified from a national administrative dataset (Hospital Episode Statistics, HES) between 1997 and 2012 according to ICD-10 diagnosis code K51 for UC. The colectomy rate for each ethnic group was calculated as the proportion of patients who underwent colectomy from the total UC cases for that group.Results. Of 212,430 UC cases, 73,318 (35.3%) were coded for ethnicity. There was no significant difference in the colectomy rate between SA and WE (6.93% versus 6.90%). Indians had a significantly higher colectomy rate than WE (9.8% versus 6.9%,p<0.001). Indian patients were 21% more likely to require colectomy for UC compared with WE group (OR: 1.21, 95% CI: 1.04–1.42, andp=0.001).Conclusions. Given the limitations in coding, the colectomy rate in this cohort was higher in Indians compared to WE. A prospectively recruited ethnic cohort study will decipher whether this reflects a more aggressive phenotype or is due to other confounding factors.

We read with great interest the original article by Brant et al.¹ x 1 Brant, S.R. et al. Gastroenterology. 2017; 152: 206–217 Abstract | Full Text | Full Text PDF | PubMed | Scopus (23) | Google Scholar See all References The discovery of African American (AA)-specific loci and loci that are shared between ethnic groups highlight the importance of studying inflammatory bowel disease in other populations apart from Europeans for a unique insight into the pathogenesis of inflammatory bowel disease. The challenges with studying populations of non-European ancestry remains one of terminology. The main drawback is that the difference between race and ethnicity is not clearly defined in most studies. Further discrepancies arise when considering the genetic background. For instance the African American race, is collectively grouped as one, irrespective of the country of origin reflecting different genetic backgrounds. It is not surprising that phenotype studies in Hispanic² x 2 Damas, O.M. et al. Am J Gastroenterol. 2013; 108: 231–239 Crossref | PubMed | Scopus (32) | Google Scholar See all References and South Asians populations³ x 3 Jayanthi, V. et al. Digestion. 1992; 52: 34–42 Crossref | PubMed | Scopus (19) | Google Scholar See all References have previously shown discordant results as the groups consist of a heterogenous population. “Hispanics” refers to people from Mexico, Cuba, and Puerto Rico and reflects a social construct rather than common genetic background. Similarly, South Asians encompass a broad population from different genetic backgrounds to include India, Pakistan, Bangladesh, and Sri Lanka. Clearer descriptors are needed to incorporate genetic as well as ethnic aspects of these groups as both influence disease expression. So although the authors describe the potential for identifying risk prediction for AA, this may not be applicable to all patients as the term reflects a broad racial group and ignores genetic origin and ethnic factors.

Background and Objectives: The role of diet in inflammatory bowel disease (IBD) remains incompletely understood. Studies have previously examined dietary practices in IBD, but none have specifically focused on older-onset disease. IBD may put vulnerable groups at risk of nutritional deficiency and associated complications, potentially heightened by comorbidities, frailty and polypharmacy. Our objective was to describe dietary practices and beliefs in older-onset IBD. Methods: A questionnaire exploring dietary practices and beliefs was prospectively administered to 137 people with older-onset IBD attending gastroenterology clinics. Results: Thirty-two percent believed diet was the initiating factor for their IBD. This was significantly more likely in people with Crohn’s disease than ulcerative colitis (P = 0.05) and in those who felt limited in their dietary choices due to cost (P = 0.008). Forty-three percent believed diet could trigger IBD relapse and 68% avoided dietary components to avoid relapse. Most frequently avoided were spicy and fatty foods, carbonated drinks, red meat, alcohol and raw fruit and vegetables. Twenty-two percent of participants had tried a whole food exclusion diet, most frequently gluten- or lactose-free. Almost a third avoided eating out (29%) or eating the same meal as their family (32%) to prevent relapse. Respondents rarely relied upon healthcare professionals or patient support organisations for their dietary information. Conclusion: Individuals with older-onset IBD report dietary practices with a high degree of consistency. Dietary avoidance may impact upon both nutritional and psychosocial wellbeing in this more vulnerable group and, as such, early dietetic assessment could help improve outcomes.

Introduction: Ulcerative colitis (UC) differs across geography and ethnic groups. Gut microbial diversity plays a pivotal role in disease pathogenesis and differs across ethnic groups. The functional diversity in microbial-driven metabolites may have a pathophysiologic role and offer new therapeutic avenues. Methods: Demographics and clinical data were recorded from newly diagnosed UC patients. Blood, urine and faecal samples were collected at three time points over one year. Bacterial content was analysed by 16S rRNA sequencing. Bile acid profiles and polar molecules in three biofluids were measured using liquid-chromatography mass spectrometry (HILIC) and nuclear magnetic resonance spectroscopy. Results: We studied 42 patients with a new diagnosis of UC (27 South Asians; 15 Caucasians) with 261 biosamples. There were significant differences in relative abundance of bacteria at the phylum, genus and species level. Relative concentrations of urinary metabolites in South Asians were significantly lower for hippurate (positive correlation for Ruminococcus) and 4-cresol sulfate (Clostridia) (p< 0.001) with higher concentrations of lactate (negative correlation for Bifidobacteriaceae). Faecal conjugated and primary conjugated bile acids concentrations were significantly higher in South Asians (p=0.02 and p=0.03 respectively). Results were unaffected by diet, phenotype, disease severity and ongoing therapy. Comparison of time points at diagnosis and at 1 year did not reveal changes in microbial and metabolic profile. Conclusion: Ethnic-related microbial metabolite associations were observed in South Asians with UC. This suggests a predisposition to UC may be influenced by environmental factors reflected in a distinct gene-environment interaction. The variations may serve as markers to identify risk factors for UC and modified to enhance therapeutic response.