Projectdetails

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Efficacy of dietary intervention on gastro-intestinal symptoms in patients with Mastocytosis.

Keywords:
mastocytosis mast cells Diet

Researchers:
J.N.G. Oude Elberink
B. Vlieg-Boerstra

Nature of the research:
• Analysis ( Interpretation and processing ) of previously collected data on food intake, symptoms scores and quality of life scores in 15 patients with Mastocytosis • Data entrance from food diaries in Compleat (Wageningen University) and extraction of data • Assessment of food diaries according to the NOVA classification (1) • Statistical analyses in SPSS • Writing a draft manuscript on this case series of patients.

Fields of study:
immunology allergology Patient Related Research

Background / introduction
Mastocytosis is a disease characterized by an abnormal increase in tissue mast cells. Current classification defines cutaneous mastocytosis (CM) as a mast cell hyperplasia limited to the skin and systemic mastocytosis (SM) as multiple distinct entities in which mast cells infiltrate the
skin and/or other organs [1]. Patients with CM and SM may present symptoms related to the local mast cell burden as well as a result of the release of mediators from mast cells.
(Episodic) signs and symptoms of mast cell activation may affect one or more organ systems (such as flushing, tachycardia, diarrhea, fatigue, musculoskeletal pain and anaphylactic shock). Symptoms can be present on a daily basis or can be relatively infrequent. Patients with mastocytosis and GI symptoms may suffer from nausea, bloating, chronic diarrhea, hyperacidity, gastroduodenal ulcer disease, chronic abdominal pain, vomiting and food intolerance.
Little is known about the efficacy of dietary intervention on GI symptoms in mastocytosis. Data on the efficacy of histamine poor diets are scarce and evidence is lacking (2). Yet frequently histamine-poor diets are frequently followed by patients, often leading to extensive elimination and poor diet quality.
However, practice based results suggest good results from dietary interventions by allergy specialist dietitians (Vlieg & Melse Dietitians), focusing on 1. Targeted elimination, based on a thorough diet history, 2. Avoidance of physiological triggers of mast cells by food, 3. counseling the patient towards an immune-empowering diet in order to regulate mast cell function and intestinal microbiome, for example by administration of dietary fiber (3), 4 Avoidance of (ultra) processed foods.
The aim of the study is to a. describe the nature of the dietary intervention, b. analyze the efficacy of the dietary intervention, c. analyze diet quality before and after dietary intervention.
Research question / problem definition
In adult patients with mastocytosis and GI symptoms:
1. What are frequently mentioned triggers for GI symptoms?
2. What is the nature of the dietary intervention in terms of a. targeted elimination, b. avoidance of physiological triggering of mast cells, c. an immune-empowering diet.
3. What is the effect of dietary intervention on GI symptoms
4. What is the effect of dietary intervention on quality of life and overall wellbeing?
5. How is the quality of the diet a. before and b. after dietary intervention, as expressed by intake of nutrients as compared to the Recommended Daily Allowances for age/sexe?
6. How can the diet be classified according to the NOVA classification for food processing, a. before and b. after dietary intervention?
7. Which recommendations for dietary advice can be compiled?
Workplan
Preliminary work has been performed by students in Nutrition and Dietetics.
• Interpretation and processing of previously collected data on food intake and symptoms scores
• Data entrance from food diaries in Compleat (Wageningen University)
• Extract data from Compleat, import into SPSS and performing statistical analyses (comparison dietary intakes before-after dietary intervention regarding nutrients and food groups as compared to Recommended Daily Allowances, symptoms scoring)
• Allocate foods from food diaries into food groups according to the NOVA classification (1) and statistically compare classification results before and after dietary intervention
• Write a draft manuscript on this case series of patients.
References
1. Monteiro CA, Cannon G, Moubarac JC, Levy RB, Louzada MLC, Jaime PC. The UN Decade of Nutrition, the NOVA food classification and the trouble with ultra-processing. Public Health Nutr. 2018 ;21:5-17.
2. Vlieg-Boerstra BJ, van der Heide S, Oude Elberink JN, Kluin-Nelemans JC, Dubois AE. Mastocytosis and adverse reactions to biogenic amines and histamine-releasing foods: what is the evidence? Neth J Med. 2005;63:244-9.
3. Folkerts J, Stadhouders R, Redegeld FA, Tam SY, Hendriks RW, Galli SJ et al. Effect of Dietary Fiber and Metabolites on Mast Cell Activation and Mast Cell-Associated Diseases. Front Immunol 2018;9:1067
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