Introduction

Diet has been suggested to impact the clinical course of Crohn’s disease (CD). However, the importance of food processing level is uncertain.

Aims & Methods

We aimed to evaluate whether ultra-processed foods (UPFs) are associated with increased risk of relapse amongst patients with CD.
​In this prospective cohort study, adult CD patients in clinical remission (Harvey Bradshaw index, HBI<5) were followed every three months, for one year or until clinical relapse (HBI>4). Dietary intake was assessed using a food frequency questionnaire (FFQ) and using a dedicated validated processed food questionnaire (PFQ) to evaluate UPFs consumption. Multivariable Cox proportional hazards were used to estimate the adjusted Hazard Ratio of disease relapse according to high or low UPFs consumption.

Results

A total of 111 CD patients in clinical remission with a mean age of 37.9±14.0 years entered the final analysis. Over a median follow-up duration of 12 months [interquartile range, 8-12], 24 patients (21.6%) experienced a clinical relapse. A higher intake of UPFs was found to be associated with an increased risk of relapse occurrence (HR = 3.86, 95% CI 1.30-11.47). Clinical relapse was associated with high FC levels at the relapse visit compared to baseline (193.0 μg/g [114.0-807.0], 79.0 μg/g [17.0-274.5], respectively, P=0.002, n=16 for paired analysis). Among different UPF subgroups, ultra-processed breads, pastries and starches, as well as processed oils and spreads showed the strongest positive associations with CD relapse (HR = 3.27, 95% CI 1.26-8.45; HR = 2.76, 95% CI 1.02-7.45, respectively).

Table 1. Multivariable analysis^ƚ of the association between ultra-processed food consumption and disease relapse in patients with Crohn’s disease

Ultra-processed food consumption	Low intake	High intake	HR (95% CI)	P-value
Entire cohort (N=111)
N cases/N total	7/57	17/54	3.86 (1.30-11.47)	0.015
No elimination diet sub-sample (N=103)*
N cases/N total	6/51	17/52	4.38 (1.41-13.63)	0.011

The cut-off for low and high ultra-processed food consumption was determined by the median number: 3.6 servings/day.
^ƚ Cox model with time-dependent covariates. HRs are adjusted for: sex, age (years), smoking status, energy intake (kcal/day), saturated fat (% of total kcal) and monounsaturated fatty acids (% of total kcal).
*Patients during elimination diet treatment were excluded from the analysis (N=8).
Abbreviations: CI: confidence interval; HR: hazard ratio; CD: Crohn’s disease.

Conclusion

Higher consumption of UPFs was associated with an increased risk of relapse in patients with CD in remission. This study, along with future prospective research, can contribute to establish nutritional guidelines aimed at reducing UPFs consumption for patients in clinical remission.

Introduction

Familial adenomatous polyposis (FAP) is a hereditary disorder that predisposes patients to colorectal cancer (CRC). Prophylactic colectomy has greatly reduced the risk of CRC. However, new associations between FAP and the risk of other cancers have subsequently emerged. In this study, we aimed to assess the risk of specific primary and secondary cancers among FAP patients in comparison with matched controls.

Aims & Methods

All known FAP patients up until April 2021 were identified in the nationwide Danish Polyposis Register and paired with four unique controls matched by birth year, sex, and zip code. Risk of overall cancers, specific cancer types, and risk of a second primary cancer were assessed and compared with controls.

Results

The analysis included 565 FAP patients and 1,890 controls. The overall risk of cancer was significantly higher for FAP patients than controls (hazard ratio (HR): 4.12, CI 95%, 3.28-5.17, p<0.001). The increased risk was mainly due to CRC (HR: 4.61, CI 95% 2.58-8.22, p<0.001), pancreatic cancer (HR: 6.45, CI 95% 2.02-20.64, p=0.002), and duodenal/small bowel cancer (HR: 14.49, CI 95% 1.76-119.47, p=0.013), while no significant difference was observed for gastric cancer (HR: 3.29, CI 95% 0.53-20.23, p=0.20). Furthermore, the risk of a second primary cancer was significantly higher for FAP patients (HR: 1.89, CI 95% 1.02-3.50, p=0.042). After 15 years, the point estimates for FAP patients and controls were 83.6 % vs. 94.8% being alive without cancer, 7.2% vs. 1.9% developing cancer, and 15.1% vs. 3.4% were deceased, respectively. When extending the period to 30 years, 60.7% vs. 81.1% were alive without cancer, 11.4% vs. 5.6% developed cancer, and 27.9% vs. 13.4% were deceased for FAP patients and controls, respectively. Between 1980 and 2020, the risk of cancer among FAP patients decreased by approximately 50%.

Conclusion

Analyzing national data for Danish polyposis patients and matched controls, we found that although the risk of developing cancer among FAP patients has been reduced by 50% over the last forty years, that risk is still significantly higher than for matched controls. Colorectal, pancreatic, and duodenal/small bowel cancer, as well as development of second primary cancers, are the main contributors to this increased risk. The risk of gastric cancer did not differ between FAP patients and controls. These findings should be included in future surveillance protocols and treatment guidelines for FAP patients.

References

Karstensen JG, Burisch J, Pommergaard HC, et al. Colorectal Cancer in Individuals With Familial Adenomatous Polyposis, Based on Analysis of the Danish Polyposis Registry. Clin Gastroenterol Hepatol 2019;17(11):2294-300 e1.
Monahan KJ, Bradshaw N, Dolwani S, et al. Guidelines for the management of hereditary colorectal cancer from the British Society of Gastroenterology (BSG)/Association of Coloproctology of Great Britain and Ireland (ACPGBI)/United Kingdom Cancer Genetics Group (UKCGG). Gut 2020;69(3):411-44.
Karstensen JG, Bulow S, Burisch J, et al. Validation of the Endoscopic Part of the Spigelman Classification for Evaluating Duodenal Adenomatosis in Familial Adenomatous Polyposis: A Prospective Study of Interrater and Intrarater Reliability. Am J Gastroenterol 2022;117(2):343-45.
Monahan KJ, Bradshaw N, Dolwani S, et al. Guidelines for the management of hereditary colorectal cancer from the British Society of Gastroenterology (BSG)/Association of Coloproctology of Great Britain and Ireland (ACPGBI)/United Kingdom Cancer Genetics Group (UKCGG). Gut 2020;69(3):411-44.

Disclosure

JGK is a consultant for SNIPR BIOME.