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. 2025 Sep 1;31(9):2458-2466.
doi: 10.1093/ibd/izaf032.

Dietary Nut and Legume Intake and Risk of Crohn's Disease and Ulcerative Colitis

Emily W Lopes  1   2 , Zeling Yu  1 , Shawna E Walsh  3 , Kevin Casey  2 , Ashwin N Ananthakrishnan  1   2 , James M Richter  1 , Kristin E Burke  1   2 , Andrew T Chan  1   2   4 , Hamed Khalili  1   2   4   5
Affiliations

Dietary Nut and Legume Intake and Risk of Crohn's Disease and Ulcerative Colitis

Emily W Lopes et al. Inflamm Bowel Dis. .

Abstract

Background: We investigated the relationship between nut and legume intake and risk of Crohn's disease (CD) and ulcerative colitis (UC).

Methods: We conducted a prospective cohort study of 223 283 adults from the Nurses' Health Study (NHS), NHSII, and Health Professionals Follow-Up Study (1986-2017), excluding those with inflammatory bowel disease (IBD) at baseline. Food frequency questionnaires were used to calculate nut and legume intake. Inflammatory bowel disease was self-reported on questionnaires and confirmed via blinded record review. Using Cox proportional hazards models, we calculated adjusted hazard ratios (aHRs) and 95% confidence intervals (CIs) for CD and UC according to categories of nut and legume intake.

Results: In over 5 460 315 person-years of follow-up (CD = 371, UC = 481), neither nut nor legume intake was associated with CD or UC risk. Compared to those who never consumed nuts, those who consumed nuts ≥2 times/week had an aHR = 0.96 (95% CI, 0.63-1.47; Ptrend = 0.57) for CD and 1.30 (95% CI, 0.92-1.84; Ptrend = 0.36) for UC. Compared to those who consumed legumes 0-3 times/month, those who consumed legumes ≥4 times/week had an aHR of 1.26 (95% CI, 0.78-2.04; Ptrend = 0.59) for CD and 0.72 (95% CI, 0.44-1.18; Ptrend = 0.20) for UC. Baseline BMI modified the relationship between nut intake and CD risk (Pint = 0.03). In those with BMI ≥25, the aHR for CD was 0.14 (95% CI, 0.03-0.56; P = .006) per additional serving/day of nuts compared with 0.88 (95% CI, 0.45-1.74; P = .72) for those with BMI <25.

Conclusions: Nut and legume intake were not associated with CD or UC risk. However, higher nut intake decreased CD risk in overweight or obese individuals. Thus, personalized-risk stratification, rather than generalized dietary recommendations, may be important for IBD prevention strategies.

Keywords: Crohn’s disease; body mass index; inflammatory bowel disease; nutrition; ulcerative colitis.

Plain language summary

Here, we show that overall nut and legume intake was not associated with risk for development of IBD; however, higher nut intake decreased Crohn’s disease risk in those with elevated body mass index.

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Conflict of interest statement

H.K. is supported by the American College of Gastroenterology Senior Research Award and the Beker Foundation; H.K. has received consulting fees from Abbvie and Takeda; H.K. has also received grant funding from Pfizer and Takeda; A.T.C. is the Stuart and Suzanne MGH Research Scholar; A.T.C. has received consulting fees from Bayer Pharma AG, Pfizer Inc., and Boehringer Ingelheim for work unrelated to this manuscript. There are no other relationships or activities that could appear to have influenced the submitted work.

Comment in

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