Introduction
Ultra-processed foods (UPFs) have been linked to inflammatory bowel disease (IBD) incidence and progression(1)
Aims & Methods
We compared UPF and emulsifier intake in patients with IBD and healthy controls (HC) and examined their association with IBD-relevant outcomes.
Dietary intake was calculated from Food Frequency Questionnaires (FFQs) and food logs. Two 24-hour dietary recalls in patients with IBD were compared to two prospective logs from HC from an interventional study. Patients were recruited at the infusion unit and followed up for one year. For cross-sectional analysis, Kruskal Wallis with post-hoc Dunn test and Fisher exact test were used, as appropriate, to compare UPF and emulsifier intake, adjusted for multiple testing using Bonferroni. Kaplan–Meier survival analysis and log-rank tests were used to assess the association between tertiles of UPF and emulsifier intake and the incidence of IBD-related outcomes.
Results
We included 186 subjects (65 HC, 59 Crohn’s disease (CD) and 62 ulcerative colitis (UC)). Median (IQR) age was 26 (23 - 33) years for HCs, and 41 (32 - 51) and 46 (35 - 55) years for CD and UC resp. We included 52 healthy females, and 25 and 24 females in the CD and UC cohort resp.
Assessing food logs, UPF intake was similar in all groups, but emulsifier intakes were higher in IBD compared to HC (Table 1). In both UC and CD, higher intakes of potassium alginate, oat gum, mono- and di-glycerides of fatty acids, as well as carrageenan and xanthan gum were seen, compared to HC. Intake of polyglycerol polyricinoleate was higher in CD compared to HC, while intake of guar gum was higher in UC compared to HC. The proportion of non-consumers of potassium alginate was higher in HC compared to IBD.
Compared to HC, soft drinks, meat, and butter intake was higher in patients with IBD. However, intake of breakfast cereals, legumes, meat substitutes, whole grain pasta and rice, and fiber was lower in UC and CD. Coffee, potato, deli meat, and sodium intake was higher in CD patients than HC, while nut and seed intake was lower. There was no correlation between serum CRP and intake of UPFs, emulsifiers, macronutrients or total energy.
Longitudinal analysis showed a trend towards increased UPF intake and more frequent emergency department (ED) visits (p=0.059) and surgery (p=0.064), but not for IBD-related hospitalization (p>0.1). For increased emulsifier intake, we report a trend towards an increase in IBD-related hospitalisation (p=0.056), but not for ED visits or surgery (p>0.1).
| | CD
(N = 59) | UC
(N = 62) | HC
(N = 65) | CD vs. HC | UC vs. HC |
| Total emulsifiers | 9.02 ± 5.28 | 8.50 ± 6.13 | 5.64 ± 4.94 | p=0.0004 | p=0.03 |
| Carrageenan | 0.594 ±0.876 | 0.624 ±1.00 | 0.196 ± 0.433 | p=0.002 | p=0.001 |
| Gelatin | 0 ± 0 | 0 ± 0 | 0.0819 ±0.355 | p=0.01 | p=0.01 |
| Guar gum | 0.749 ± 0.932 | 0.903 ± 1.13 | 0.439 ± 0.789 | NS | p=0.02 |
| Mono- and diglycerides of fatty acids | 1.04 ± 1.18 | 1.03 ± 1.56 | 0.508 ± 0.935 | p=0.0009 | p=0.02 |
| Polyglycerol polyricinoleate | 0.308 ± 0.693 | 0.121 ±0.303 | 0.0846 ±0.349 | p=0.02 | NS |
| Potassium alginate | 0.118 ±0.320 | 0.138 ±0.564 | 0 ± 0 | p=0.002 | p=0.02 |
| Xanthan gum | 0.781 ±0.910 | 0.687 ±0.889 | 0.454 ± 0.939 | p=0.01 | p=0.03 |
Table 1: Dietary emulsifier intake with significant differences across groups. Mean intakes in daily servings and standard deviations.
Conclusion
We show higher intakes of emulsifiers in patients with IBD compared to HC, with similar UPF intake. Longitudinal analysis trends towards a link between UPF and emulsifier intake and poorer IBD-related outcomes, emphasizing the need for larger cohorts. The increased intake of specific emulsifiers such as carrageenan and guar gum warrant further investigation into their role in the propagation and maintenance of gut inflammation, as well as their impact on IBD-relevant patient outcomes.
References
(1) Chen J & Wellens J, Kalla R, et al. Intake of Ultra-processed Foods Is Associated with an Increased Risk of Crohn's Disease: A Cross-sectional and Prospective Analysis of 187 154 Participants in the UK Biobank. J Crohns Colitis. 2023 Apr 19;17(4):535-552.
Disclosure
JW reports no conflicts of interest.
MD reports no conflicts of interest.
SH received consultancy fees from Ferring, Takeda.
ML reports no conflicts of interest.
JV received speaker’s fees from Janssen; consultancy fees from Ferring.
EDM reports no conflicts of interest.
EV reports no conflicts of interest.
MF received research grants from AbbVie, EG Pharma, Janssen, Pfizer, Takeda and Viatris; con-sultancy fees from AbbVie, AgomAb Therapeutics, Boehringer Ingelheim, Celgene, Celltrion, Eli Lilly, Janssen-Cilag, Merck Sharp and Dohme, MRM Health, Pfizer, Takeda and ThermoFisher; and speakers’ fees from AbbVie, Biogen, Boehringer Ingelheim, Dr Falk Pharma, Ferring, Janssen-Cilag, Merck Sharp and Dohme, Pfizer, Takeda, Truvion Healthcare and Viatris.
BV reports research support from Sossei Heptares/Nxera and Takeda. In addition, BV reports speaker’s fees from Abbvie, Agomab, Alfasigma, Biogen, Bristol Myers Squibb, Celltrion, Eli Lily, Falk, Ferring, Galapagos, Johnson and Johnson, Pfizer, Sandoz, Takeda, Tillots Pharma, Truvion and Viatris, consultancy fees from Abbvie, Alfasigma, Alimentiv, Anaptys Bio, Applied Strategic, Astrazeneca, Atheneum, BenevolentAI, Biora Therapeutics, Boxer Capital, Bristol Myers Squibb, Domain Therapeutics, Eli Lily, Galapagos, Guidepont, Landos, Merck, Mirador Therapeutics, Mylan, Nxera, Inotrem, Ipsos, Johnson and Johnson, Pfizer, Sandoz, Sanofi, Santa Ana Bio, Sapphire Therapeutics, Sosei Heptares, Takeda, Tillots Pharma and Viatris, and stock options from Vagustim.
SV received financial support for research from AbbVie, J&J, Pfizer, Takeda and Galapagos; receives speakers’ and consultancy fees from AbbVie, Abivax, AbolerlsPharma, AgomAb, Alimentiv, Arena Pharmaceuticals, Astrazeneca, BioraTherapeutics, BMS, Boehringer Ingelheim, Celgene, Cytoki Pharma, Ferring, Galapagos, Genentech Roche, Gilead, GSK, lmidomics, Janssen, J&J, Lilly, Materia Prima, Mestag Therapeutics, Microbiotica, MiroBio, Morphic, MrMHealth, Pfizer, Progenity, Prometheus, Surrozen, Takeda, Theravance, Tillots Pharma AG, VectivBio, Ventyx, Zealand Pharma.
JS received financial support for research from Galapagos and Viatris; receives speakers’ fees from Pfizer, Abbvie, Ferring, Falk, Takeda, Janssen, Fresenius, and Galapagos; and receives consultancy fees from Pfizer, Janssen, Ferring, Fresenius, Abbvie, Galapagos, Celltrion, Pharmacosmos, and Pharmanovia.
