. 2026 Jan 19:gutjnl-2025-337846.

doi: 10.1136/gutjnl-2025-337846. Online ahead of print.

Associations between demographic, clinical and dietary factors and flares in inflammatory bowel disease: the PRognostic effect of Environmental factors in Crohn's and Colitis (PREdiCCt) prospective cohort study

Nathan Constantine-Cooke¹, Beatriz Gros^{2

3}, Nikolas Plevris³, Linda J Williams⁴, Gareth-Rhys Jones⁵, Janet Kyle⁶, Nicholas A Kennedy^{7

8}, Victor Velasco-Pardo¹, Alexander Rudge¹, Debbie Alexander¹, Carl A Anderson⁹, Maiara Brusco de Freitas¹⁰, Lisa M Derr^{4

11}, Lauranne Aap Derikx¹², Sian Gilchrist¹³, Paul Henderson^{14

15}, Graham W Horgan¹⁶, Peter Irving^{17

18}, Christopher A Lamb^{19

20}, Luke Jostins-Dean²¹, James O Lindsay^{22

23}, Jonathan MacDonald²⁴, Craig Mowat²⁵, Charles Murray²⁶, Miles Parkes²⁷, Spyros I Siakavellas²⁸, Catalina A Vallejos^{1

29}, Daniel R Gaya²⁴, Jonathan M Rhodes³⁰, Alexandra M Johnstone³¹, Christopher J Weir³², Charlie W Lees^{33

3}; PREdiCCt study group

Collaborators, Affiliations

Collaborators

Affiliations

¹ Institute of Genetics and Cancer, University of Edinburgh Western General Hospital, Edinburgh, UK.
² Gastroenterology Department, Reina Sofía University Hospital, IMIBIC, CIBERehd, Córdoba, Spain.
³ Edinburgh IBD Unit, Western General Hospital, Edinburgh, UK.
⁴ Usher Institute, The University of Edinburgh Usher Institute of Population Health Sciences and Informatics, Edinburgh, UK.
⁵ School for Infection and Immunity, University of Glasgow, Glasgow, UK.
⁶ Institute of Applied Health Sciences, University of Aberdeen, Aberdeen, UK.
⁷ Gastroenterology, Royal Devon and Exeter NHS Foundation Trust, Exeter, UK.
⁸ University of Exeter, Exeter, UK.
⁹ Wellcome Trust Genome Campus, Wellcome Trust Sanger Institute, Cambridge, UK.
¹⁰ Clinical Medicine, Aalborg Universitet, Copenhagen, Denmark.
¹¹ The University of Edinburgh Usher Institute of Population Health Sciences and Informatics, Edinburgh, UK.
¹² Department of Gastroenterology, Erasmus MC, Rotterdam, The Netherlands.
¹³ Department of Gastroenterology, NHS Fife, Kirkcaldy, UK.
¹⁴ Paediatric Gastroenterology and Nutrition, Royal Hospital for Children and Young People, Edinburgh, UK.
¹⁵ Child Life and Health, The University of Edinburgh Department of Child Life and Health, Edinburgh, UK.
¹⁶ Biomathematics and Statistics Scotland, Edinburgh, UK.
¹⁷ St Thomas' Hospital, London, UK.
¹⁸ King's College London, London, UK.
¹⁹ Translational & Clinical Research Institute, Newcastle University, Newcastle upon Tyne, UK.
²⁰ Gastroenterology, Newcastle Upon Tyne Hospitals NHS Trust, Newcastle upon Tyne, UK.
²¹ Kennedy Institute of Rheumatology, Oxford University, Oxford, UK.
²² Barts and The London School of Medicine, Queen Mary University of London, London, UK.
²³ Barts Health NHS Trust, London, UK.
²⁴ NHS Glasgow and Greater Clyde, Glasgow, UK.
²⁵ University of Dundee, Dundee, UK.
²⁶ Gastroenterology, Royal Free Hospital, London, UK.
²⁷ Department of Gastroenterology, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK.
²⁸ Gastroenterology Department, University of Edinburgh Western General Hospital, Edinburgh, UK.
²⁹ HDR UK, London, UK.
³⁰ University of Liverpool Department of Molecular and Clinical Cancer Medicine, Liverpool, UK.
³¹ University of Aberdeen, The Rowett Institute, Aberdeen, UK.
³² The University of Edinburgh Usher Institute, Edinburgh, UK.
³³ Institute of Genetics and Cancer, University of Edinburgh Western General Hospital, Edinburgh, UK charlie.lees@ed.ac.uk.

PMID: 41554630
DOI: 10.1136/gutjnl-2025-337846

Free article

Associations between demographic, clinical and dietary factors and flares in inflammatory bowel disease: the PRognostic effect of Environmental factors in Crohn's and Colitis (PREdiCCt) prospective cohort study

Nathan Constantine-Cooke et al. Gut. 2026.

Free article

. 2026 Jan 19:gutjnl-2025-337846.

doi: 10.1136/gutjnl-2025-337846. Online ahead of print.

Authors

Collaborators

Affiliations

¹ Institute of Genetics and Cancer, University of Edinburgh Western General Hospital, Edinburgh, UK.
² Gastroenterology Department, Reina Sofía University Hospital, IMIBIC, CIBERehd, Córdoba, Spain.
³ Edinburgh IBD Unit, Western General Hospital, Edinburgh, UK.
⁴ Usher Institute, The University of Edinburgh Usher Institute of Population Health Sciences and Informatics, Edinburgh, UK.
⁵ School for Infection and Immunity, University of Glasgow, Glasgow, UK.
⁶ Institute of Applied Health Sciences, University of Aberdeen, Aberdeen, UK.
⁷ Gastroenterology, Royal Devon and Exeter NHS Foundation Trust, Exeter, UK.
⁸ University of Exeter, Exeter, UK.
⁹ Wellcome Trust Genome Campus, Wellcome Trust Sanger Institute, Cambridge, UK.
¹⁰ Clinical Medicine, Aalborg Universitet, Copenhagen, Denmark.
¹¹ The University of Edinburgh Usher Institute of Population Health Sciences and Informatics, Edinburgh, UK.
¹² Department of Gastroenterology, Erasmus MC, Rotterdam, The Netherlands.
¹³ Department of Gastroenterology, NHS Fife, Kirkcaldy, UK.
¹⁴ Paediatric Gastroenterology and Nutrition, Royal Hospital for Children and Young People, Edinburgh, UK.
¹⁵ Child Life and Health, The University of Edinburgh Department of Child Life and Health, Edinburgh, UK.
¹⁶ Biomathematics and Statistics Scotland, Edinburgh, UK.
¹⁷ St Thomas' Hospital, London, UK.
¹⁸ King's College London, London, UK.
¹⁹ Translational & Clinical Research Institute, Newcastle University, Newcastle upon Tyne, UK.
²⁰ Gastroenterology, Newcastle Upon Tyne Hospitals NHS Trust, Newcastle upon Tyne, UK.
²¹ Kennedy Institute of Rheumatology, Oxford University, Oxford, UK.
²² Barts and The London School of Medicine, Queen Mary University of London, London, UK.
²³ Barts Health NHS Trust, London, UK.
²⁴ NHS Glasgow and Greater Clyde, Glasgow, UK.
²⁵ University of Dundee, Dundee, UK.
²⁶ Gastroenterology, Royal Free Hospital, London, UK.
²⁷ Department of Gastroenterology, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK.
²⁸ Gastroenterology Department, University of Edinburgh Western General Hospital, Edinburgh, UK.
²⁹ HDR UK, London, UK.
³⁰ University of Liverpool Department of Molecular and Clinical Cancer Medicine, Liverpool, UK.
³¹ University of Aberdeen, The Rowett Institute, Aberdeen, UK.
³² The University of Edinburgh Usher Institute, Edinburgh, UK.
³³ Institute of Genetics and Cancer, University of Edinburgh Western General Hospital, Edinburgh, UK charlie.lees@ed.ac.uk.

PMID: 41554630
DOI: 10.1136/gutjnl-2025-337846

Abstract

Background: IBD is characterised by recurrent flares, but evidence on whether modifiable dietary factors influence flare risk is limited.

Objective: The PREdiCCt study was designed to examine demographic, clinical and dietary factors associated with disease flare among patients with IBD in self-reported remission.

Design: Multicentre, prospective cohort study conducted across 47 UK centres. Patients with Crohn's disease (CD), ulcerative colitis (UC) or IBD unclassified (IBDU) in self-reported remission were prospectively followed up. The baseline diet was assessed using a validated food frequency questionnaire. The primary outcome was time to patient-reported flare (captured by monthly IBD-Control) and objective flare (clinical flare plus C-reactive protein >5 mg/L and/or faecal calprotectin (FC) >250 µg/g with treatment escalation). Associations were evaluated using Cox frailty models adjusted for demographic, clinical and biochemical variables, including baseline FC.

Results: Between November 2016 and March 2020, 2629 participants (1370 CD; 1259 UC/IBDU) were enrolled and followed up for a median of 4.1 years (IQR 3.0-5.0). Baseline FC was strongly associated with patient-reported flares (FC ≥250 µg/g: adjusted HR (aHR) 2.22; FC 50-250 µg/g: aHR 1.52 (reference <50 µg/g)) and objective flares (FC ≥250 µg/g: aHR 3.25; FC 50-250 µg/g: aHR 1.98). In UC, higher total meat intake was associated with increased risk of objective flares (highest versus lowest quartile: aHR 1.95, 95% CI 1.07 to 3.56). No consistent associations were observed for ultraprocessed foods, fibre or polyunsaturated fatty acids and flare.

Conclusion: Higher habitual meat intake was associated with increased risk of objective flare in UC, suggesting diet may contribute to flare susceptibility in specific patient groups.

Trial registration number: NCT03282903.

Keywords: CROHN'S DISEASE; DIET; INFLAMMATORY BOWEL DISEASE; ULCERATIVE COLITIS.

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Conflict of interest statement

Competing interests: BG has served as a consultant to AbbVie, Pfizer, Roche and Galapagos and has served as a speaker for AbbVie, Janssen, Takeda, Pfizer, Gilead, Roche and Galapagos. NP has served as a speaker for AbbVie, Janssen, Pfizer, Takeda, Ferring and Fresenius Kabi and received travel support from AbbVie, Janssen and Takeda. G-RJ has received speaking fees for Janssen, Ferring, Fresenius, Takeda and AbbVie. NAK has served as an advisory board member and/or speaker for AbbVie, Bristol Myers Squibb, Celltrion, Falk, Galapagos, Johnson & Johnson, Pfizer, Pharmacosmos, Takeda and Tillotts. CM has received speaking and advisory board fees for AbbVie, Galapagos, Janssen and Tillotts. SIS has served as an advisory board member and/or speaker for AbbVie, Demo SA, Johnson & Johnson, Lilly, Pfizer and Takeda. DG has received speaker honouraria and advisory board fees from Pfizer, AbbVie, Janssen, Takeda and Dr Falk. AJ holds voluntary committee roles within the Nutrition Society, British Nutrition Foundation and Association for the Study of Obesity. CW has undertaken consultancy work for AB Science for which his department has received a fee and holds committee roles within the Medicines and Healthcare products Regulatory Agency (MHRA). CWL has acted as a consultant to AbbVie, Janssen, Takeda, Pfizer, Galapagos, Eli Lilly, Bristol Myers Squibb, Boehringer Ingelheim, Sandoz, Novartis, GSK, Gilead, Vifor Pharma and Dr. Falk; he has received speaking fees and travel support from Pfizer, Janssen, AbbVie, Eli Lilly, Galapagos, MSD, Takeda, Shire, Ferring and Dr. Falk. All other authors have no conflicts of interest to disclose.

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Associations between demographic, clinical and dietary factors and flares in inflammatory bowel disease: the PRognostic effect of Environmental factors in Crohn's and Colitis (PREdiCCt) prospective cohort study

Collaborators

Affiliations

Associations between demographic, clinical and dietary factors and flares in inflammatory bowel disease: the PRognostic effect of Environmental factors in Crohn's and Colitis (PREdiCCt) prospective cohort study

Authors

Collaborators

Affiliations

Abstract

Conflict of interest statement

Associated data

LinkOut - more resources

Full Text Sources

Medical

Research Materials