P0757 Emulsifier restriction does not impair nutrient intake and improves food-related quality of life in active Crohn’s disease: dietary analysis of the ADDapt randomised controlled trial
Authors: Buckley A , Xu Y , Burke S , Bancil A , Sandall A , Cox S , Rucco V , Kelaiditis C , Gibson R , Chassaing B , Rossi M , Lindsay J , Whelan K 
Published: January 2025

Abstract

Background
Food additive emulsifiers are prevalent in the food supply1 and have been implicated in the development of intestinal inflammation2. A novel low-emulsifier diet (LED) has been tested for its effect in managing active Crohn’s disease (CD), however, it is crucial to consider the impact of dietary restrictions on nutrient intake and food-related quality of life (FRQoL). The aim of this study was to investigate whether dietary counselling can reduce emulsifier intake and whether this impacts dietary intake or FRQoL.

Methods
The ADDapt trial (NCT04046913) is a randomised, double-blind, placebo-controlled, re-supplementation trial in 154 patients with active CD, the clinical results of which are presented separately. Participants followed either a LED (LED group) or a LED with emulsifier re-supplementation (control). Both groups were provided dietary counselling from a dietitian as well as 25% of their foods from grocery deliveries and 3 daily trial snacks, which either did (control) or did not (LED) contain emulsifiers. Outcomes were measured at baseline and at week-8. Intake was measured using gold-standard 7-day food records which were coded using Nutritics software combined with an in-house emulsifier database1. FRQoL was measured using the validated FR-QoL-293. Outcomes at week-8 were compared between groups using unpaired tests and between baseline and week-8 in the LED group using paired tests.

Results
113 participants completed the trial with 102 submitting both baseline and week-8 food records. Patients in the LED group reduced emulsifier intake from median 30.0 (IQR 33.0) to 2.5 (6.0) emulsifiers per week (p&lt;0.001) (Figure 1). Patients in the control group consumed on average 2.5 g/d (±1.1) carrageenan, 3.6 g/d (±1.6) carboxymethyl cellulose and 0.8 g/d (±0.3) polysorbate-80 from re-supplemented trial snacks (all zero in the LED group). At week-8, energy and nutrient intakes were similar between groups, with only protein and calcium intake from trial snacks being different (Table 1). In the LED group, there were no major reductions in nutrient intake except for a small reduction in protein (Figure 1). FR-QoL-29 score significantly increased in the LED group (66.0 (IQR 20.0) to 76.0 (19.0), p=0.001) but not in the control group (67.0 (22.0) to 69.0 (15.3), p=0.09).

Conclusion
Dietary counselling significantly reduced emulsifier intake but did not result in major impairments in energy or nutrient intake. While the LED group had a reduction in protein, intake remained above the reference nutrient intake, indicating overall little negative impact of a LED on dietary intake. FRQoL improved on the LED. A LED is feasible and nutritionally safe in patients with active CD.

Funding
The Leona M. and Harry B. Helmsley Charitable Trust

References
1.Sandall A, Smith L, Svensen E, Whelan K. Emulsifiers in ultra-processed foods in the UK food supply. Public Health Nutr. 2023; 26(11):2256-2270.
2.Chassaing B, Koren O, Goodrich JK, Poole AC, Srinivasan S, Ley RE, Gewirtz AT. Dietary emulsifiers impact the mouse gut microbiota promoting colitis and metabolic syndrome. Nature. 2015;519(7541):92-6.
3.Hughes LD, King L, Morgan M, Ayis S, Direkze N, Lomer MC, Lindsay JO, Whelan K. Food-related Quality of Life in Inflammatory Bowel Disease: Development and Validation of a Questionnaire. J Crohns Colitis. 2016;10(2):194-201.