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UMass Medical School was awarded a $1.7 million grant from The Leona M. and Harry B. Helmsley Charitable Trust to address the increasing prevalence of Crohn’s disease in Puerto Rico in a cost-effective, culturally sensitive way. With the funding, Ana Maldonado-Contreras, PhD, assistant professor of microbiology & physiological systems, will tailor a novel diet created at UMass Medical School to patients on the island with different food availability and preferences.

“The prevalence of Crohn’s disease has increased in Puerto Rico by five-fold in less than one decade,” Dr. Maldonado-Contreras said. “It is now comparable to that of North America and Europe, regions with the highest prevalence of Crohn’s disease in the world.”

Crohn’s disease is a chronic, debilitating form of inflammatory bowel disease (IBD) for which no cure exists. Symptoms include abdominal pain and cramps, persistent diarrhea or constipation, weight loss, rectal bleeding, loss of appetite and severe inflammation of the gastrointestinal tract.

“Multiple studies have highlighted the impact of diets rich in processed foods on the gut microbiome and on enhancing the risk of developing IBD, providing a rationale for further investigating nutrition as a potential therapy to induce or maintain remission. Recent clinical trials using diet as therapy have shown promising results with some patients achieving remission shortly after diet treatment,” Maldonado-Contreras said.

�������� by Maldonado-Contreras and Barbara Olendzki, RD, MPH, associate professor of medicine in the Division of Preventive & Behavioral Medicine, has suggested that the inflammatory bowel disease anti-inflammatory diet or IBD-AID can rapidly reduce Crohn’s disease symptoms, decrease inflammation, and promote changes in microbes in the gut that may be beneficial, all while offering an affordable and nutritious diet that can be prepared at home. IBD-AID, however, was designed around foods that are available in the mainland United States.

“Our goal is to tailor this dietary program that is being implemented in the United States for the treatment of Crohn’s disease to serve the needs of patients in Puerto Rico,” said Maldonado-Contreras. “So, we’re trying to have the program consider the food availabilities on the island and also different culturally common culinary preferences.”

One example of a nutritious food that is common in the U.S. but not in Puerto Rico or Latinx culture is peanut butter, which is rich in healthy omega-three fatty acids and monounsaturated fatty acids. “It’s a very foreign food for us,” said Maldonado-Contreras, who grew up in Venezuela. “But we can substitute avocado toast with olive oil for the peanut butter sandwich.”

The UMass Medical School research team will partner with the Center for IBD at the University of Puerto Rico in San Juan, led by Esther Torres, MD, to create and test Dieta Anti-Inflamatoria, or DAIN, a nutritional program designed for Puerto Ricans, in more than 800 Crohn’s disease patients.

DAIN will be designed to include a variety of probiotics, such as yogurt and fermented foods, which contain live microorganisms that are thought to be beneficial for the gut, and prebiotics, such as high-fiber foods, which provide nutrients that may support beneficial bacteria. It will include balanced nutrients to meet dietary requirements for safe long-term use and exclude adverse foods such as processed foods known to trigger gastrointestinal symptoms in some people.

The program is built to overcome the challenges of nutritional therapy, such as dietary compliance, by including hands-on cooking classes and dietary counseling.

Maldonado-Contreras said that in the first year of the three-year project, researchers will develop a patient toolkit with input from clinicians, nutritionists and patients. The diet will be adapted from IBD-AID and a full-color cookbook, along with a website and social media content, will be developed in Spanish.

She expects to begin testing the efficacy of DAIN for improving clinical outcomes for Crohn’s disease patients in Puerto Rico in the summer of 2022. For this study, a chef at the teaching kitchen at the University of Puerto Rico will teach patients how to cook meals based on the principles of the newly created diet.

“We’re excited about this diet because the patient can take control of their own symptoms and perhaps prevent them, too,” Maldonado-Contreras said. “And you know, close to 20 percent of the population in the mainland U.S. is Latinx, so 20 percent of our population may also benefit from DAIN. It’s a pioneering study that could serve as a blueprint for nutritional interventions to treat Crohn’s disease in other underserved populations.”

“We are committed to helping people with Crohn’s disease manage their day-to-day lives as seamlessly as possible,” said Kerry Hernandez, PhD, associate program officer at The Helmsley Charitable Trust. “Eating a healthy diet is an important component of the overall management of Crohn’s disease, however, to be followed successfully such diets have to incorporate regional availability of foods as well as cultural preferences and tastes. This grant will help us get closer to validated dietary recommendations for the Puerto Rican community and potentially the greater Hispanic diaspora living with Crohn’s disease.”