Multicenter Study

. 2021 Jul 14:374:n1554.

doi: 10.1136/bmj.n1554.

Association of ultra-processed food intake with risk of inflammatory bowel disease: prospective cohort study

Neeraj Narula^{1

2}, Emily C L Wong³, Mahshid Dehghan², Andrew Mente², Sumathy Rangarajan², Fernando Lanas⁴, Patricio Lopez-Jaramillo⁵, Priyanka Rohatgi⁶, P V M Lakshmi⁷, Ravi Prasad Varma⁸, Andres Orlandini⁹, Alvaro Avezum¹⁰, Andreas Wielgosz¹¹, Paul Poirier¹², Majid A Almadi¹³, Yuksel Altuntas¹⁴, Kien Keat Ng¹⁵, Jephat Chifamba¹⁶, Karen Yeates¹⁷, Thandi Puoane¹⁸, Rasha Khatib¹⁹, Rita Yusuf^{20

21}, Kristina Bengtsson Boström²², Katarzyna Zatonska²³, Romaina Iqbal²⁴, Liu Weida²⁵, Zhu Yibing²⁵, Li Sidong²⁵, Antonio Dans²⁶, Afzalhussein Yusufali²⁷, Noushin Mohammadifard²⁸, John K Marshall³, Paul Moayyedi^{3

2}, Walter Reinisch²⁹, Salim Yusuf²

Affiliations

¹ Department of Medicine (Division of Gastroenterology) and Farncombe Family Digestive Health Research Institute, McMaster University, Hamilton, ON, Canada neeraj.narula@medportal.ca.
² Population Health Research Institute, McMaster University and Hamilton Health Sciences, Hamilton, ON, Canada.
³ Department of Medicine (Division of Gastroenterology) and Farncombe Family Digestive Health Research Institute, McMaster University, Hamilton, ON, Canada.
⁴ Department of Internal Medicine, Universidad de La Frontera, Temuco, Chile.
⁵ Masira Research Institute, Universidad de Santander (UDES) Fundación Oftalmológica de Santander-FOSCAL-Bucaramanga, Colombia.
⁶ Department of Nutrition and Dietetics, Apollo Hospitals, Bangalore, India.
⁷ School of Public Health, Post Graduate Institute of Medical Education and Research, Chandigarh, India.
⁸ Achutha Menon Centre for Health Science Studies, SCTIMST and Health Action by People, Thiruvananthapuram, India.
⁹ Department of Cardiology, Estudios Clinicos Latinoamerica ECLA Rosario, Santa Fe, Argentina.
¹⁰ International Research Centre, Hospital Alemao Oswaldo Cruz, Sao Paulo, Brazil, Universidade Santo Amaro (UNISA), Sao Paulo, Brazil.
¹¹ Department of Medicine, University of Ottawa, Ottawa, ON, Canada.
¹² Faculté de pharmacie, Université Laval Institut universitaire de cardiologie et de pneumologie de Québec, Québec, Canada.
¹³ Department of Medicine, Division of Gastroenterology, College of Medicine, King Saud University, Riyadh, Saudi Arabia.
¹⁴ University of Health Sciences, Faculty of Medicine, Istanbul Sisli Hamidiye Etfal Health Training and Research Hospital, Clinic of Endocrinology and Metabolism Sisli/Istanbul, Turkey.
¹⁵ Faculty of Medicine and Defence Health, National Defence University of Malaysia, Kuala Lumpur, Malaysia.
¹⁶ Department of Physiology, University of Zimbabwe College of Health Sciences, Harare, Zimbabwe.
¹⁷ Department of Medicine, Queen's University, Kingston, ON, Canada.
¹⁸ School of Public Health, University of the Western Cape, Bellville. South Africa.
¹⁹ Institute for Community and Public Health, Birzeit University, Birzeit, Palestine.
²⁰ Advocate Research Institute, Advocate Health Care, IL, USA.
²¹ School of Life Sciences, Independent University, Bangladesh Bashundhara, Dhaka, Bangladesh.
²² School of Public Health and Community Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Göteborg, Sweden.
²³ Department of Social Medicine, Wroclaw Medical University, Wroclaw, Poland.
²⁴ Department of Community Health Sciences, The Aga Khan University, Karachi, Pakistan.
²⁵ Medical Research and Biometrics Center, National Center for Cardiovascular Diseases, Fuwai Hospital, Chinese Academy of Medical Sciences Mentougou District, Beijing, China.
²⁶ Section of Adult Medicine and Medical Research Unit, University of Philippines, Manila, Philippines.
²⁷ Hatta Hospital, Dubai Medical University, Dubai Health Authority, Dubai, United Arab Emirates.
²⁸ Isfahan Cardiovascular Research Center, Cardiovascular Research Institute, Isfahan University of Medical Sciences, Isfahan, Iran.
²⁹ Department of Internal Medicine III, Division of Gastroenterology and Hepatology, Medical University of Vienna, Vienna, Austria.

PMID: 34261638
PMCID: PMC8279036
DOI: 10.1136/bmj.n1554

Multicenter Study

Association of ultra-processed food intake with risk of inflammatory bowel disease: prospective cohort study

Neeraj Narula et al. BMJ. 2021.

. 2021 Jul 14:374:n1554.

doi: 10.1136/bmj.n1554.

Authors

Affiliations

¹ Department of Medicine (Division of Gastroenterology) and Farncombe Family Digestive Health Research Institute, McMaster University, Hamilton, ON, Canada neeraj.narula@medportal.ca.
² Population Health Research Institute, McMaster University and Hamilton Health Sciences, Hamilton, ON, Canada.
³ Department of Medicine (Division of Gastroenterology) and Farncombe Family Digestive Health Research Institute, McMaster University, Hamilton, ON, Canada.
⁴ Department of Internal Medicine, Universidad de La Frontera, Temuco, Chile.
⁵ Masira Research Institute, Universidad de Santander (UDES) Fundación Oftalmológica de Santander-FOSCAL-Bucaramanga, Colombia.
⁶ Department of Nutrition and Dietetics, Apollo Hospitals, Bangalore, India.
⁷ School of Public Health, Post Graduate Institute of Medical Education and Research, Chandigarh, India.
⁸ Achutha Menon Centre for Health Science Studies, SCTIMST and Health Action by People, Thiruvananthapuram, India.
⁹ Department of Cardiology, Estudios Clinicos Latinoamerica ECLA Rosario, Santa Fe, Argentina.
¹⁰ International Research Centre, Hospital Alemao Oswaldo Cruz, Sao Paulo, Brazil, Universidade Santo Amaro (UNISA), Sao Paulo, Brazil.
¹¹ Department of Medicine, University of Ottawa, Ottawa, ON, Canada.
¹² Faculté de pharmacie, Université Laval Institut universitaire de cardiologie et de pneumologie de Québec, Québec, Canada.
¹³ Department of Medicine, Division of Gastroenterology, College of Medicine, King Saud University, Riyadh, Saudi Arabia.
¹⁴ University of Health Sciences, Faculty of Medicine, Istanbul Sisli Hamidiye Etfal Health Training and Research Hospital, Clinic of Endocrinology and Metabolism Sisli/Istanbul, Turkey.
¹⁵ Faculty of Medicine and Defence Health, National Defence University of Malaysia, Kuala Lumpur, Malaysia.
¹⁶ Department of Physiology, University of Zimbabwe College of Health Sciences, Harare, Zimbabwe.
¹⁷ Department of Medicine, Queen's University, Kingston, ON, Canada.
¹⁸ School of Public Health, University of the Western Cape, Bellville. South Africa.
¹⁹ Institute for Community and Public Health, Birzeit University, Birzeit, Palestine.
²⁰ Advocate Research Institute, Advocate Health Care, IL, USA.
²¹ School of Life Sciences, Independent University, Bangladesh Bashundhara, Dhaka, Bangladesh.
²² School of Public Health and Community Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Göteborg, Sweden.
²³ Department of Social Medicine, Wroclaw Medical University, Wroclaw, Poland.
²⁴ Department of Community Health Sciences, The Aga Khan University, Karachi, Pakistan.
²⁵ Medical Research and Biometrics Center, National Center for Cardiovascular Diseases, Fuwai Hospital, Chinese Academy of Medical Sciences Mentougou District, Beijing, China.
²⁶ Section of Adult Medicine and Medical Research Unit, University of Philippines, Manila, Philippines.
²⁷ Hatta Hospital, Dubai Medical University, Dubai Health Authority, Dubai, United Arab Emirates.
²⁸ Isfahan Cardiovascular Research Center, Cardiovascular Research Institute, Isfahan University of Medical Sciences, Isfahan, Iran.
²⁹ Department of Internal Medicine III, Division of Gastroenterology and Hepatology, Medical University of Vienna, Vienna, Austria.

PMID: 34261638
PMCID: PMC8279036
DOI: 10.1136/bmj.n1554

Abstract

Objective: To evaluate the relation between intake of ultra-processed food and risk of inflammatory bowel disease (IBD).

Design: Prospective cohort study.

Setting: 21 low, middle, and high income countries across seven geographical regions (Europe and North America, South America, Africa, Middle East, south Asia, South East Asia, and China).

Participants: 116 087 adults aged 35-70 years with at least one cycle of follow-up and complete baseline food frequency questionnaire (FFQ) data (country specific validated FFQs were used to document baseline dietary intake). Participants were followed prospectively at least every three years.

Main outcome measures: The main outcome was development of IBD, including Crohn's disease or ulcerative colitis. Associations between ultra-processed food intake and risk of IBD were assessed using Cox proportional hazard multivariable models. Results are presented as hazard ratios with 95% confidence intervals.

Results: Participants were enrolled in the study between 2003 and 2016. During the median follow-up of 9.7 years (interquartile range 8.9-11.2 years), 467 participants developed incident IBD (90 with Crohn's disease and 377 with ulcerative colitis). After adjustment for potential confounding factors, higher intake of ultra-processed food was associated with a higher risk of incident IBD (hazard ratio 1.82, 95% confidence interval 1.22 to 2.72 for ≥5 servings/day and 1.67, 1.18 to 2.37 for 1-4 servings/day compared with <1 serving/day, P=0.006 for trend). Different subgroups of ultra-processed food, including soft drinks, refined sweetened foods, salty snacks, and processed meat, each were associated with higher hazard ratios for IBD. Results were consistent for Crohn's disease and ulcerative colitis with low heterogeneity. Intakes of white meat, red meat, dairy, starch, and fruit, vegetables, and legumes were not associated with incident IBD.

Conclusions: Higher intake of ultra-processed food was positively associated with risk of IBD. Further studies are needed to identify the contributory factors within ultra-processed foods.

Study registration: ClinicalTrials.gov NCT03225586.

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Conflict of interest statement

Competing interests: All authors have completed the ICMJE uniform disclosure form at www.icmje.org/coi_disclosure.pdf and declare: no support from the organisation listed in the funding statement for the submitted work; no financial relationships with any organisations that might have an interest in the submitted work in the previous three years, no other relationships or activities that could appear to have influenced the submitted work.

References

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Association of ultra-processed food intake with risk of inflammatory bowel disease: prospective cohort study

Affiliations

Association of ultra-processed food intake with risk of inflammatory bowel disease: prospective cohort study

Authors

Affiliations

Abstract

Conflict of interest statement

References

Publication types

MeSH terms

Associated data

LinkOut - more resources

Full Text Sources

Medical