High Sugar Consumption in Recurrent Aphthous Stomatitis

Objectives: Recurrent aphthous stomatitis (RAS) is a common inflammatory condition of unknown etiology, characterized by painful ulcers of the oral mucosa affecting 40% of the population. In a previous study (R03DE016356), certain dietary factors, particularly sugar, appeared to be associated with RAS. Thus, we hypothesized that sugar consumption would be highest in RAS cases and lowest in controls.

Methods: Data were collected through standardized questionnaires, blood draw, and physical examinations, during an unmatched case-control study (June 2009-April 2011). Main eligibility criteria were: age >12, at least 2 idiopathic RAS episodes in the 6 months prior to screening, fasting for >5 hours, no smoking, alcohol, or certain medications in past 24 hrs. Questionnaire items included RAS history, stress, and diet in past 7 days. We compared the diet in active (RAS onset <72 hours) and inactive subjects (no RAS in the 5 days before or after a visit) vs. controls. Data were stored in REDCap and analyzed using SAS v9.2 and the Mantel-Haenszel test with 2-sided alpha=0.05.

Results: Data for 100 subjects (46 controls, 25 inactive, and 29 active, 56% female, 59% white, age 18-50) showed no difference in the intake of soda, (p=0.08), chocolate (p=0.94), canned foods (p=0.56), alcoholic beverages (p=0.95), mineral supplements (p=0.65), rice, bread and pasta (p=0.91), hot foods and drinks (p=0.19), sour/acidic foods (p=0.76), and fruits and vegetables (p=0.71) between the control, inactive, and active groups. There was a significant difference for sugar intake (p=0.01), which was lowest in controls (2.7) vs. both inactive (3.4; p=0.07) and active (3.2; p=0.04) cases. There was no sugar intake difference between inactive and active cases (p=0.26).

Conclusions: Daily sugar intake 7 days before a visit was significantly higher in RAS cases than in controls. These findings are consistent with our prior study.  Further investigations are needed to understand this association.