Plasma fatty acid composition and incidence of coronary heart disease in middle aged adults: the Atherosclerosis Risk in Communities (ARIC) Study

BACKGROUND AND AIM: To prospectively investigate the relation of plasma cholesterol ester (CE) and phospholipid (PL) fatty acid (FA) composition with incidence of coronary heart disease (CHD). METHODS AND RESULTS: 3,591 white participants in the Minneapolis field center of the Atherosclerosis Risk in Communities Study, aged 45-64 years, were studied. Plasma FA composition of CEs and PLs was quantified using gas-liquid chromatography and expressed as percentage of total FAs. Incident CHD was identified during 10.7 years of follow-up. In both CE and PL fractions, the proportions of stearic (18:0) acid, dihomo-gamma-linolenic (20:3n6) acid and total saturated fatty acids (SFAs) were significantly higher while arachidonic (20:4n6) acid and total polyunsaturated fatty acids (PUFAs) were significantly lower among participants who developed incident CHD (n = 282). After adjusting for age, gender, smoking, alcohol drinking, sports activity, and non-FA dietary factors, the incidence of CHD was significantly and positively associated with the proportion of dihomo-gamma-linolenic acid but inversely associated with arachiadonic acid. The multiply-adjusted rate ratios (RRs) of CHD incidence for the highest versus the lowest quintile were 1.31 in CE and 1.44 in PL for dihomo-gamma-linolenic acid (p for trend: 0.05 and 0.017, respectively), 0.59 in CE and 0.65 in PL for arachidonic acid (p: 0.016 and 0.024, respectively). Also significantly and positively associated with incident CHD were PL stearic acid and CE linolenic (18:3n3) acid. Only a borderline significant positive association was observed for total SFAs in CE (multivariate RRs across quintiles: 1.00, 1.15, 1.40, 1.62, 1.32; p = 0.07). Total PUFAs or monounsaturated FA were not independently associated with CHD. CONCLUSIONS: Our study found a weak positive association of SFAs with incident CHD. Our findings also confirm that FA metabolism in the body, such as the activity of delta-5 desaturase, which converts dihomo-gamma-linolenic acid to arachidonic acid, may affect the development of CHD.     

Antineutrophil cytoplasmic antibodies in sera from colectomised ulcerative colitis patients and its relation to the presence of pouchitis.

BACKGROUND: Few studies have evaluated the influence of colectomy on antineutrophil cytoplasmic antibody (ANCA) positivity in ulcerative colitis (UC). In small series of patients it has been suggested that ANCA positivity in UC might be predictive for development of pouchitis after colectomy. AIMS: To assess the prevalence of ANCA in UC patients treated by colectomy and a Brooke's ileostomy (UC-BI) or ileal pouch anal anastomosis (UC-IPAA), and the relation between the presence of ANCA, the type of surgery, and the presence of pouchitis. SUBJECTS: 63 UC patients treated by colectomy (32 with UC-BI and 31 with UC-IPAA), 54 UC, and 24 controls. METHODS: Samples were obtained at least two years after colectomy. ANCA were detected by indirect immunofluorescent assay. RESULTS: There were no differences between patients with (36.3%) or without pouchitis (35.0%) and between patients with UC (55%), UC-BI (40.6%), and UC-IPAA (35.4%). However, ANCA prevalence significantly decreases in the whole group of operated patients (38.0%) compared with non-operated UC (p = 0.044). CONCLUSIONS: The prevalence of ANCA in operated patients was significantly lower than in non-operated UC, suggesting that it might be related either to the presence of inflamed or diseased tissue. ANCA persistence is not related to the surgical procedure and it should not be used as a marker for predicting the development of pouchitis.     

Diabetes Nutrition and Complications Trial: adherence to the ADA nutritional recommendations, targets of metabolic control, and onset of diabetes complications. A 7-year, prospective, population-based, observational multicenter study

ObjectiveTo know the adherence to the ADA nutritional recommendations and its relation to targets of metabolic control and onset of diabetic complications in a sample of diabetic people in Spain.Research Design and MethodsThe Diabetes Nutrition and Complications Trial (DNCT) is a prospective, population-based, observational multicenter study designed to know the nutritional pattern, based on the 7-day food diaries, of a population with long-standing diabetes mellitus (93/99 type 1/type 2 diabetic patients, 20/18 years of duration of diabetes, and 6.9%/6.4% HbA_1c values) and its relation with the onset of microvascular and macrovascular diabetes complications between 1993 and 2000.ResultsAfter a median follow-up period of 6.5 years, more than 55% of diabetic people complied with the recommendation of protein intake between 15% and 20%, but only 27% consumed less than 10% of saturated fatty acids (SFAs), the 13% achieved up 10% of polyunsaturated fatty acids (PUFAs) intake, the 39% consumed more than 60% from carbohydrate and monounsaturated fatty acids (MUFAs), and the 30% consumed <300 mg/day of cholesterol. In spite of these, more than 90% had an optimal HDL cholesterol and non-HDL cholesterol level, and triglycerides level, while less than 41% of diabetic people had an HbA_1c value >7.5%. Moreover, more than 69% consumed a MUFAs-to-SFAs ratio >1.5 and the 46% a PUFAs-to-SFAs ratio >0.4. Nonadherence to nutritional recommendation, but MUFAs/SFAs ratio >1.5 and PUFAs/SFAs ratio >0.4, was associated with a reduction between 3.4- and 8.2-fold in the risk of onset of diabetic complications.ConclusionsThe adherence to ADA nutritional recommendations for people with diabetes in Spain is rather poor except for the protein consumption. Only PUFAs/SFAs >0.4 and MUFAs/SFAs>1.5 were associated to near-optimal targets of metabolic control and a reduction in the risk of the onset of diabetic complications. These data suggest that other nutritional recommendations should be taken in mind.     

Association between serum fatty acids and lipoprotein subclass profile in healthy young adults: Exploring common genetic and environmental factors

Objective

Little is known about the associations of serum fatty acids with lipoprotein profile and the underlying genetic and environmental etiology of these relationships. We aimed to analyze the phenotypic association of serum n-6 and n-3 polyunsaturated (PUFAs), monounsaturated (MUFAs) and saturated (SFAs) fatty acids (relative proportion to total fatty acids) with lipids and lipoproteins, and to quantify common genetic and environmental factors determining their covariation.

Methods

Two cohorts of healthy Finnish twins were assessed in young adulthood. Data were available for 1269 individual twins including 561 complete pairs. Serum metabolites were measured by nuclear magnetic resonance spectroscopy. Bivariate quantitative genetic models were used to decompose the phenotypic covariance between the pairs of traits into genetic and environmental components.

Results

Among the strongest correlations observed, serum total n-6 PUFAs and linoleic acid were inversely (max. r = −0.65) and MUFAs positively (max. r = 0.63) correlated with triglycerides and very low-density lipoprotein (VLDL) particle concentration, particularly with large VLDL (for n-6 PUFAs) and medium VLDL (for MUFAs). Genetic factors significantly contributed to their covariance with bivariate heritability estimates ranging from 44% to 56% for n-6 PUFAs and 58% to 66% for MUFAs. Genetic correlations with lipid traits were moderate to high (max. r_A = −0.59 and 0.70 for n-6 PUFAs and MUFAs, respectively). Statistically significant, but substantially weaker phenotypic correlations of total n-3 PUFAs, docosahexaenoic acid (DHA) and SFAs with lipoprotein profile were not decomposed into their genetic and environmental components.

Conclusion

Shared genetic factors are important in explaining why higher concentrations of serum n-6 PUFAs and lower concentrations of serum MUFAs strongly associate with lower triglyceride and VLDL particle concentrations.     

Nutrition-related mobile applications - Should they be used for dietary prevention and treatment of cardiovascular diseases?

Background and aimsThere is no prior research on the usefulness that popular nutrition-related mobile applications would have in assessing fatty acids intake. In this study, we examine these applications through their utilization in the assessment of consumption of saturated (SFAs) and polyunsaturated (PUFAs) fatty acids against the Polish reference method (RM, Dieta 6.0). This report does also include the information about monounsaturated fatty acids and cholesterol intake.Methods and resultsSFAs and PUFAs intake was assessed using two-day dietary recalls obtained from 120 individuals by 3 selected mobile applications (App1 = Yazio, App2 = MyFitnessPal, App3 = Fitatu) and compared with RM.Despite strong (SFAs by App1 and App3) and moderate (SFAs by App2 and PUFAs by App1, App2, App3) correlations with RM, Bland-Altman analyses showed relevant biases and wide range between limits of agreement. Considering SFAs and MUFAs intake, App1 had the best agreement. App1 had high sensitivity (94.6%) in recognition of subjects with SFAs intake >10% with moderate specificity (67.9%), while App2 had poor sensitivity (27.2%) and high specificity (100%). App3 showed moderate sensitivity and specificity (77.2% and 75%, respectively).ConclusionsMobile applications are not accurate tools in SFAs and PUFAs assessment when compared to the RM. Nonetheless, their ability to recognize SFAs intake >10% energy intake may suggest that further development of mobile applications could potentially become an attractive tool in clinical practice.     

Abnormal plasma polyunsaturated fatty acid pattern in non-active inflammatory bowel disease.

An abnormal plasma polyunsaturated fatty acid pattern (PUFA) (increased n3 and decreased n6 PUFA) has been reported in active inflammatory bowel disease (IBD). The possibility of a primary defect in the PUFA metabolism in IBD was hypothesised. The aim of this study was to assess plasma PUFA pattern in inactive inflammatory bowel disease and to ascertain whether patients who had had a colectomy and who were suffering from ulcerative colitis have a similar PUFA pattern than those patients with non-active ulcerative colitis and who had not had a colectomy. Plasma fatty acids were analysed by semi-capillary column gas-liquid chromatography in three groups of patients with inactive IBD (24 patients with inactive ulcerative colitis who had not had a colectomy, 15 patients with ulcerative colitis who had had a colectomy, and 27 patients with Crohn's disease). Plasma concentration and percentage of C22:6n3 and unsaturation index were significantly higher in patients with inactive ulcerative colitis without a colectomy and the Crohn's disease group (p < 0.0001) than in controls. Plasma concentration and percentage of C22:6n3 and the unsaturation index remained significantly higher, in both the operated and non-operated ulcerative colitis patients when compared with controls (p < 0.0001). These results suggest that in inactive IBD, an increased PUFA biosynthesis might be the cause of the high values of n3 compounds. These findings although seen in active disease, are more noticeable in remission because of the lack of artefactual factors (malnutrition, steroids, inflammation). In addition, persistence of high values in both groups of ulcerative colitis patients--that is, those who had had a colectomy and those who had not suggests the existence of a primary abnormality in the PUFA metabolism in IBD.     

Polyunsaturated fatty acids effect on serum triglycerides concentration in the presence of metabolic syndrome components. The Alaska-Siberia Project

Serum fatty acids (FAs) have wide effects on metabolism: Serum saturated fatty acids (SFAs) increase triglyceride (TG) levels in plasma, whereas polyunsaturated fatty acids (PUFAs) reduce them. Traditionally, Eskimos have a high consumption of omega-3 fatty acids (ω3 FAs); but the Westernization of their food habits has increased their dietary SFAs, partly reflected in their serum concentrations. We studied the joint effect of serum SFAs and PUFAs on circulating levels of TGs in the presence of metabolic syndrome components. We included 212 men and 240 women (age, 47.9 ± 15.7 years; body mass index [BMI], 26.9 ± 5.3) from 4 villages located in Alaska for a cross-sectional study. Generalized linear models were used to build surface responses of TG as functions of SFAs and PUFAs measured in blood samples adjusting by sex, BMI, and village. The effects of individual FAs were assessed by multiple linear regression analysis, and partial correlations (r) were calculated. The most important predictors for TG levels were glucose tolerance (r = 0.116, P = .018) and BMI (r = 0.42, P < .001). Triglyceride concentration showed negative associations with 20:3ω6 (r = −0.16, P = .001), 20:4ω6 (r = −0.14, P = .005), 20:5ω3 (r = −0.17, P < .001), and 22:5ω3 (r = −0.26, P < .001), and positive associations with palmitic acid (r = 0.16, P < .001) and 18:3ω3 (r = 0.15, P < .001). The surface response analysis suggested that the effect of palmitic acid on TG is blunted in different degrees according to the PUFA chemical structure. The long-chain ω3, even in the presence of high levels of saturated fat, was associated with lower TG levels. Eicosapentaenoic acid (20:5ω3) had the strongest effect against palmitic acid on TG. The total FA showed moderate association with levels of TG, whereas SFA was positively associated and large-chain PUFA was negatively associated. The Westernized dietary habits among Eskimos are likely to change their metabolic profile and increase comorbidities related to metabolic disease.     

Fatty acids of erythrocyte membrane in acute pancreatitis patients

AIM:To evaluate changes in the fatty acid composition of erythrocyte membrane phospholipids during severe and mild acute pancreatitis(AP)of alcoholic and nonalcoholic etiology.METHODS:All consecutive patients with a diagnosis of AP and onset of the disease within the last 72 h admitted to the Hospital of Lithuanian University of Health Sciences between June and December 2007 were included.According to the Acute Physiology and ChronicHealth Evaluation(APACHEⅡ)scale,the patients were subdivided into the mild(APACHEⅡscore<7,n=22)and severe(APACHEⅡscore≥7,n=17)AP groups.Healthy individuals(n=26)were enrolled as controls.Blood samples were collected from patients on admission to the hospital.Fatty acids(FAs)were extracted from erythrocyte phospholipids and expressed as percentages of the total FAs present in the chromatogram.The concentrations of superoxide dismutase and glutathione peroxidase were measured in erythrocytes.RESULTS:We found an increase in the percentages of saturated and monounsaturated FAs,a decrease in the percentages of total polyunsaturated FAs(PUFAs)and n-3 PUFAs in erythrocyte membrane phospholipids of AP patients compared with healthy controls.Palmitic(C16:0),palmitoleic(C16:1n7cis),arachidonic(C20:4n6),docosahexaenoic(DHA,C22:6n3),and docosapentaenoic(DPA,C22:5n3)acids were the major contributing factors.A decrease in the peroxidation and unsaturation indexes in AP patients as well as the severe and mild AP groups as compared with controls was observed.The concentrations of antioxidant enzymes in the mild AP group were lower than in the control group.In severe AP of nonalcoholic etiology,the percentages of arachidic(C20:0)and arachidonic(C20:4n6)acids were decreased as compared with the control group.The patients with mild AP of nonalcoholic etiology had the increased percentages of total saturated FAs and gama linoleic acid(C18:3n6)and the decreased percentages of elaidic(C18:1n9t),eicosapentaenoic acid(EPA,C20:5n3),DPA(C22:5n3),DHA(C22:6n3)as well as total and n-3 PUFAs in erythro     

Changes of the mucosal n3 and n6 fatty acid status occur early in the colorectal adenoma-carcinoma sequence.

Despite data favouring a role of dietary fat in colonic carcinogenesis, no study has focused on tissue n3 and n6 fatty acid (FA) status in human colon adenoma-carcinoma sequence. Thus, FA profile was measured in plasma phospholipids of patients with colorectal cancer (n = 22), sporadic adenoma (n = 27), and normal colon (n = 12) (control group). Additionally, mucosal FAs were assessed in both diseased and normal mucosa of cancer (n = 15) and adenoma (n = 21) patients, and from normal mucosa of controls (n = 8). There were no differences in FA profile of both plasma phospholipids and normal mucosa, between adenoma and control patients. There were considerable differences, however, in FAs between diseased and paired normal mucosa of adenoma patients, with increases of linoleic (p = 0.02), dihomogammalinolenic (p = 0.014), and eicosapentaenoic (p = 0.012) acids, and decreases of alpha linolenic (p = 0.001) and arachidonic (p = 0.02) acids in diseased mucosa. A stepwise reduction of eicosapentaenoic acid concentrations in diseased mucosa from benign adenoma to the most advanced colon cancer was seen (p = 0.009). Cancer patients showed lower alpha linolenate (p = 0.002) and higher dihomogammalinolenate (p = 0.003) in diseased than in paired normal mucosa. In conclusion changes in tissue n3 and n6 FA status might participate in the early phases of the human colorectal carcinogenesis.     

The association of desaturase 9 and plasma fatty acid composition with insulin resistance-associated factors in female adolescents

Desaturase 9 (Δ9), which converts saturated fatty acids (SFAs) into monounsaturated fatty acids, is an important component in leptin-mediated energy homeostasis in rodent models. Few human studies, however, have been performed regarding the clinical relevance of Δ9, particularly whether Δ9 is involved in the relationship between blood fatty acid profiles and insulin resistance-associated factors. The aim of the present study was to examine fatty acid data from 178 apparently healthy female adolescents and determine whether (a) Δ9 has independent associations with adiposity, insulin resistance level, and fasting plasma polyunsaturated fatty acids (PUFAs); (b) Δ9 is a predictor of fasting blood lipid profile; and (c) the associations between fasting plasma fatty acid component and insulin resistance level are independent of abdominal obesity level. Desaturase 9-16 (surrogate of Δ9 as calculated by plasma ratio C16:1 n-7/C16:0) correlated with waist girth (r = .160, P < .05), homeostasis model assessment of insulin resistance (HOMA-IR) (r = .201, P < .01), plasma PUFAs (eg, C20:4 n-6 [r = −.269, P < .001], C22:6 n-3 [r = −.274, P < .001]). After adjustment for dietary SFAs, Δ9-16 had stronger correlation with waist (r = .227, P < .01) and significant correlation with PUFAs, whereas it had a nonsignificant correlation with HOMA-IR. The same pattern was observed with Δ9-18 (surrogate of Δ9 as calculated by plasma ratio C18:1 n-9/C18:0). After adjustment for dietary SFAs, waist, and HOMA-IR, Δ9-16 and Δ9-18 were still positive predictors of triglyceride (both P < .001) and apolipoprotein B (Δ9-18, P < .001; Δ9-16, P = .052). After adjustment for waist, HOMA-IR only remained a positive determinant of medium-chain SFAs (C14:0, P < .001; C16:0, P < .05); but it emerged to be inversely related to C20:4 n-6 (P < 0.1). The positive and independent associations of medium-chain SFAs with insulin resistance level suggest their vital roles in diabetes pathogenesis, whereas certain PUFAs such as C20:4 n-6 appear to be protective. The observed associations of Δ9 with adiposity and plasma lipid profile in these apparently healthy female adolescents support the concept derived from rodent models that Δ9 activity is independently reflective of higher body mass index and higher circulatory triglyceride levels.     

Association of plasma fatty acids pattern with omentin gene expression in human adipose tissues: A cross-sectional study

Background and aimsOmentin, as an adipokine, has been reported to improve insulin resistance and inflammation may be related to fatty acids (FAs). Plasma FAs can be used as biomarkers of dietary FAs and endogenous FA exposure. We aimed to evaluate the association between plasma FAs pattern and omentin gene expression in adipose tissue (AT).Methods and resultsVisceral and subcutaneous AT and fasting blood were gathered from 97 adults aged >18 years. Participants were already admitted to hospitals for elective abdominal surgery. Dietary intakes were assessed using a food frequency questionnaire. The relative omentin gene expression in visceral and subcutaneous AT was measured by Real-Time PCR and plasma FAs was determined by gas chromatography. The principal component analysis was performed to derive the FAs pattern from plasma individual FAs. Three patterns were derived from plasma FAs, 1) high de-novo lipogenesis (DNL), 2) high trans saturated fatty acids (SFA), and docosahexaenoic acid (trans-SFA/DHA), and 3) high long-chain SFA (LC-SFA). After adjustment for age, sex, and insulin concentration, only the LC-SFA pattern was associated with omentin gene expression in visceral AT (β = 2.25, P = 0.03). Other patterns were not associated with omentin gene expression in visceral and subcutaneous AT.ConclusionA pattern characterized by high levels of myristic acid (14:0), heptadecanoic acid (17:0), pentadecanoic acid (15:0), and Cis_heptadecanoic acid (17:1), which named LC-SFA was related to omentin gene expression in visceral AT.     

Ileal Pouch–Anal Anastomosis, Conventional Ileostomy and Ileorectal Anastomosis Modify Cholesterol Metabolism

Proctocolectomy modifies the enterohepatic circulation and activity of bacterial enzymes depending on the structure of the stoma and function of the terminal ileum. We evaluated in our comparative study effects of different colectomy constructions on cholesterol metabolism. Levels of lipoprotein cholesterol and triglycerides, noncholesterol sterols, and squalene in serum, fecal fat, and bile acids, cholesterol absorption efficiency, and cholesterol metabolism by sterol balance technique were analyzed in human subjects with ileal pouch-anal anastomosis (n = 34), conventional ileostomy (n = 8), ileorectostomy (n = 6), and controls (n = 29). Malabsorption of bile acids, but not of fat, and low serum levels of total and low-density lipoprotein cholesterol, but high levels of high-density lipoprotein cholesterol and increased cholesterol synthesis were evident in the colectomy groups. In contrast to the ileorectostomy group, expressing high absorption and biliary secretion of cholesterol, a low cholesterol absorption percentage accompanied by elevated serum proportions of cholesterol precursor sterols and phytosterols characterized the ileal pouch-anal anastomosis and conventional ileostomy groups. After colectomy, fecal excretion of secondary bile acids was low, whereas relative proportions of identifiable bile acids remained the same in each study group. Low serum levels of total and low-density lipoprotein cholesterol of colectomized subjects may decrease the risk of premature atherosclerosis. The favorable serum lipid profile was due to enhanced fecal loss of cholesterol as bile acids despite abnormally high cholesterol synthesis. Ileal dysfunction probably diminished cholesterol absorption in subjects with ileal pouch-anal anastomosis and conventional ileostomy, with no explanation for those with ileorectostomy with no clinical gastrointestinal dysfunction. Relative synthesis of identifiable primary bile acids remained unchanged postoperatively, but formation of secondary bile acids was weak due to scarce bacterial flora.     

Polyunsaturated fatty acids and peripheral artery disease

There is substantial evidence that polyunsaturated fatty acids (PUFAs) such as n-3 and n-6 fatty acids (FAs) play an important role in prevention of atherosclerosis. In vitro and in vivo studies focusing on the interactions between monocytes and endothelial cells have explored the molecular effects of FAs on these interactions. Epidemiological surveys, followed by large, randomized, control trials have demonstrated a reduction in major cardiovascular events with supplementation of n-3 FAs in secondary prevention settings. The evidence of beneficial effects specific to patients with peripheral artery disease (PAD) remains elusive, and is the focus of this review.     

Classification of Diet-Modulated Gene Signatures at the Colon Cancer Initiation and Progression Stages

Background  

The effects of dietary polyunsaturated (PUFAs) and monounsaturated fatty acids (MUFAs) on intestinal cytokinetics within the context of colon cancer initiation and progression have been extensively studied. n-3 PUFAs have received the most attention due to their potential protective role. However, further investigation of the epigenetic perturbations caused by fatty acids in the context of colon cancer development is needed.     

Fatty acid composition in chronic heart failure: low circulating levels of eicosatetraenoic acid and high levels of vaccenic acid are associated with disease severity and mortality

Abstract. Øie E, Ueland T, Dahl CP, Bohov P, Berge C, Yndestad A, Gullestad L, Aukrust P, Berge RK (Research Institute for Internal Medicine, Department of Cardiology, Oslo University Hospital, Rikshospitalet, Oslo, Center for Heart Failure Research, University of Oslo, Oslo, Section of Endocrinology, Oslo University Hospital, Rikshospitalet, Oslo, Faculty of Medicine, University of Oslo, Oslo, Section of Medical Biochemistry, Institute of Medicine, University of Bergen, Bergen, Department of Heart Disease, Haukeland University Hospital, University of Bergen, Bergen; and Section of Clinical Immunology and Infectious Diseases, Oslo University Hospital, Rikshospitalet, Oslo; Norway). Fatty acid composition in chronic heart failure: low circulating levels of eicosatetraenoic acid and high levels of vaccenic acid are associated with disease severity and mortality. J Intern Med 2011; 270 : 263–272. Objectives. Free fatty acids (FFAs) are the major energy sources of the heart, and fatty acids (FAs) are active components of biological membranes. Data indicate that levels of FAs and their composition may influence myocardial function and inflammation. The aim of this study was to investigate whether total levels and composition of FAs and FFAs in plasma are altered in clinical heart failure (HF) and whether any alterations in these parameters are correlated with the severity of HF. Subjects. Plasma from 183 patients with stable HF was compared with plasma from 44 healthy control subjects. Results. Our main findings are as follows: (i) patients with HF had decreased levels of several lipid parameters and increased levels of FFAs in plasma, compared with controls, which were significantly correlated with clinical disease severity. (ii) Patients with HF also had a decreased proportion in the plasma of several n‐3 polyunsaturated FAs, an increased proportion of several monounsaturated FAs, and a decreased proportion of some readily oxidized long‐chain saturated FAs. (iii) These changes in FA composition were significantly associated with functional class, impaired cardiac function (i.e., decreased cardiac index and increased plasma N‐terminal pro‐B‐type natriuretic peptide levels) and enhanced systemic inflammation (i.e., increased high‐sensitivity C‐reactive protein levels). (iv) Low levels of C20:4n‐3 (eicosatetraenoic acid) and in particular high levels of C18:1n‐7 (vaccenic acid) were significantly associated with total mortality in this HF population. Conclusions. Our data demonstrate that patients with HF are characterized by a certain FA phenotype and may support a link between disturbed FA composition and the progression of HF.     

New serological markers in pediatric patients with inflammatory bowel disease

The spectrum of serological markers associated with inflammatory bowel disease(IBD)is rapidly growing.Due to frequently delayed or missed diagnoses,the application of non-invasive diagnostic tests for IBD,as well as differentiation between ulcerative colitis(UC)and Crohn’s disease(CD),would be useful in the pediatric population.In addition,the combination of pancreatic autoantibodies and antibodies against Saccharomyces cerevisiae antibodies/perinuclear cytoplasmic antibody(pANCA)improved the sensitivity of serological markers in pediatric patients with CD and UC.Some studies suggested that age-associated differences in the patterns of antibodies may be present,particularly in the youngest children.In CD,most patients develop stricturing or perforating complications,and a significant numberof patients undergo surgery during the disease course.Based on recent knowledge,serum antibodies are qualitatively and quantitatively associated with complicated CD behavior and CD-related surgery.Pediatric UC is characterized by extensive colitis and a high rate of colectomy.In patients with UC,high levels of antiCBir1 and pANCA are associated with the development of pouchitis after ileal pouch-anal anastomosis.Thus,serologic markers for IBD can be applied to stratify IBD patients into more homogeneous subgroups with respect to disease progression.In conclusion,identification of patients at an increased risk of rapid disease progression is of great interest,as the application of early and more aggressive pharmaceutical intervention could have the potential to alter the natural history of IBD,and reduce complications and hospitalizations.     

Relationship between pouch microbiota and pouchitis following restorative proctocolectomy for ulcerative colitis

Restorative proctocolectomy with ileal pouch-anal anastomosis(IPAA)has become the surgical treatment of choice for many patients with medically refractory ulcerative colitis(UC)and familial adenomatous polyposis(FAP).UC patients with IPAA(UC-IPAA)are,nevertheless,susceptible to inflammatory and noninflammatory sequelae such as pouchitis,which is only rarely noted in FAP patients with IPAA.Pouchitis is the most frequent long-term complication of UC-IPAA patients,with a cumulative prevalence of up to 50%.Although the aetiology of pouchitis remains unclear,accumulating evidence suggests that a dysbiosis of the pouch microbiota and an abnormal mucosal immune response are implicated in its pathogenesis.Studies using culture and molecular techniques have detected a dysbiosis of the pouch microbiota in patients with pouchitis.Risk factors,genetic associations,and serological markers suggest that interactions between the host immune response and the pouch microbiota underlie the aetiology of this idiopathic inflammatory condition.This systematic review focuses on the dysbiosis of the microbiota that inhabit the pouch in UC and FAP patients and its interaction with the mucosal immune system.A metaanalysis was not attempted due to the highly heterogeneous microbiota composition and the different detection methods used by the various studies.Although no specific bacterial species,genus,or family has as yet been identified as pathogenic,there is evidence that a dysbiosis characterized by decreased gut microbiota diversity in UC-IPAA patients may,in genetically predisposed subjects,lead to aberrant mucosal immune regulation triggering an inflammatory process.     

Primary sclerosing cholangitis, inflammatory bowel disease, and colon cancer

The prevalence of inflammatory bowel disease (IBD) in patients with PSC differs in various part of the world. Ulcerative colitis (UC) is most common, but 1 to 14% of all primary sclerosing cholangitis (PSC) patients have Crohn disease with colonic involvement. Many PSC patients without clinical symptoms of IBD have colonoscopic and histological findings compatible with IBD, and the subclinical phase may last several years before onset of symptoms of active colitis. The characteristics of UC in patients with PSC are different from those in UC patients without PSC. The colitis is usually substantial, the clinical course of the colitis is quiescent, and rectal sparing is common. Moreover, PSC patients with UC have a higher risk of developing colorectal dysplasia/carcinoma than UC patients without PSC. In patients having an ileal pelvic pouch with ileal anal anastomosis, PSC is a risk factor for development of pouchitis. It is important that all PSC patients with UC are included in colonoscopic surveillance programs.     

Plasma thrombin-activatable fibrinolysis inhibitor and plasminogen activator inhibitor-1 levels in inflammatory bowel disease

BACKGROUND: Patients with inflammatory bowel disease (IBD) have an increased risk of thromboembolic events. Imbalance of fibrinolysis has been suggested as one of the possible pathogenetic mechanisms. As plasminogen activator inhibitor-1 (PAI-1) and thrombin-activatable fibrinolysis inhibitor (TAFI) are inhibitors of fibrinolysis, we studied TAFI as well as PAI-1 plasma levels in IBD patients compared with healthy controls. METHODS: A total of 132 IBD patients [68 ulcerative colitis (UC) and 64 Crohn's disease (CD)] and 50 healthy controls were enrolled. PAI-1 and TAFI plasma levels were assessed by commercially available enzyme-linked immunosorbent assay kits. Their relationship with clinical parameters of UC and CD was assessed. RESULTS: Mean plasma PAI-1 levels were significantly higher in both UC patients (3.9+/-1.3 IU/ml) and CD patients (4.0+/-1.5 IU/ml) compared with healthy controls (3.1+/-1.1 IU/ml) (P=0.01). On the other hand, mean plasma TAFI levels were significantly lower in both UC patients (14.7+/-3.1 microg/ml) and CD patients (13.3+/-3.4 microg/ml) compared with healthy controls (17.4+/-3.0 microg/ml) (P<0.0001). Patients with active disease had significantly higher PAI-1 levels compared with patients with inactive disease for both diseases (P=0.03 and P=0.01, respectively). No significant association between plasma TAFI levels and disease activity was also found. Plasma TAFI levels were significantly lower in patients with ileal CD compared with patients with colonic CD. CONCLUSION: PAI-1 plasma levels are increased whereas TAFI levels are decreased in IBD patients. These results suggest an imbalance of fibrinolysis in IBD.