Western and Carnivorous Dietary Patterns are Associated with Greater Likelihood of IBD Development in a Large Prospective Population-based Cohort

Abstract

Objective: Nutrition plays a role in the development of Crohn's disease [CD] and ulcerative colitis [UC]. However, prospective data on nutrition and disease onset are limited. Here, we analysed dietary patterns and scores in relation to inflammatory bowel disease [IBD] development in a prospective population-based cohort.

Methods: We analysed 125 445 participants of whom 224 individuals developed de novo UC and 97 CD over a maximum 14-year follow-up period. Participants answered health-related [also prospectively] and dietary questionnaires [FFQ] at baseline. Principal component analysis [PCA] was conducted deriving a-posteriori dietary patterns. Hypotheses-based a-priori dietary scores were also calculated, including the protein score, Healthy Eating Index, LifeLines Diet Score [LLDS], and alternative Mediterranean Diet Score. Logistic regression models were performed between dietary patterns, scores, and IBD development.

Results: PCA identified five dietary patterns. A pattern characterised by high intake of snacks, prepared meals, non-alcoholic beverages, and sauces along with low vegetables and fruit consumption was associated with higher likelihood of CD development (odds ratio [OR]: 1.16, 95% confidence interval [CI]: 1.03-1.30, p = 0.013). A pattern comprising red meat, poultry, and processed meat, was associated with increased likelihood of UC development [OR: 1.11, 95% CI: 1.01-1.20, p = 0.023]. A high diet quality score [LLDS] was associated with decreased risk of CD [OR: 0.95, 95% CI: 0.92-0.99, p = 0.009].

Conclusions: A Western dietary pattern was associated with a greater likelihood of CD development and a carnivorous pattern with UC development, whereas a relatively high diet quality [LLDS] was protective for CD development. Our study strengthens the importance of evaluating dietary patterns to aid prevention of IBD in the general population.

Keywords: Alternate Mediterranean Diet Score [aMED]; Healthy Eating Index [HEI]; Inflammatory bowel disease [IBD]; LifeLines Diet Score [LLDS]; Protein Score; dietary patterns; dietary scores; principal component analysis [PCA].

Figure 1.

Flowchart of LifeLines participant inclusion. Description: *Only 129 364 LLDS available. **Implausible intake = overall intake for males <800 or >97.5% kcal/day and for females <500 or >97.5% kcal/day. ***Filtering is done sequentially [1 to 4], categories are not mutually exclusive. ****Only excluded when analysing LLDS. n, number; HEI, Healthy Eating Index; LLDS, LifeLines Diet Score; aMED, alternative Mediterranean score; PCA, principal component analysis; UC, ulcerative colitis; CD, Crohn’s disease.