Introduction

Many prospective studies conducted in healthy volunteers have shown that diet is associated with the risk of developing IBD. By contrast, data are scarce on the role of diet in disease activity in patients with IBD. The aim of the present study was to find dietary factors associated with the risk of IBD relapses.

Aims & Methods

The “Mikinautes” e-cohort is a nationwide French prospective study recruiting IBD patients older than 6 years at inclusion and followed in private practice and public hospitals. French Crohn and Colitis Patients’ association was also involved in the design, funding and recruitment. Patients filled in online questionnaires about their dietary habits and health status. Validated food frequency questionnaires (FFQ) recorded average intakes of 230 food items over the past 12 months. Patients were followed for at least one year and medical records were prospectively collected. Relapse was defined by i) an increased disease activity reported monthly by the patients and/or a clinical report mentioning a relapse, together with ii) a documented consultation with a doctor and iii) a change in IBD therapy, either drug, enteral nutrition and/or surgery).
A posteriori dietary patterns (DPs) were identified using principal component analysis (PCA) performed on 31 food groups. Primary analysis was a Cox model among patients in remission at inclusion to reduce potential reverse causality. Secondary analyses included: i) a Cox model conducted among all patients, which measured the time between the onset of the last relapse before inclusion (or the ongoing relapse at inclusion) and the first relapse during follow-up and ii) a logistic model comparing inactive versus active patients (defined as patients who had at least one relapse at inclusion or over the first year of follow-up). Models were adjusted for age, sex, smoking status and energy intake.

Results

After exclusion of 14 patients with implausible dietary intakes, 693 patients were retained for analyses, comprising 66% of females, 59% Crohn Disease (CD) patients, 34% ulcerative colitis (UC) patients and 7% indeterminate colitis (IC). Median follow-up [Q1-Q3] was 2.1 years [1.6;2.7]. 77% of patients were in remission at inclusion. Their cumulative probability (95% CI) of flare were 18% [15%; 21%] at 1 year and 25% [22%; 29%] at 2 years. In total, 36% of patients had an active disease after one year of follow-up (including active patients at inclusion).
Four DPs were identified through PCA. In CD, primary Cox analysis revealed an association between the second DP and disease activity (HR 95% CI: 0.42 [0.22;0.80] for 3^rdvs 1^st tertile of consumption, p-trend=0.050). This DP was characterized by high intakes of vegetables, fruit, nuts, legumes, cereals, eggs and unsweetened beverages and by a low consumption of dairy products and desserts, bread, sweet/fat or salty/fat products. Secondary analyses confirmed this association (HR: 0.37 [0.18;0.78] for 3^rdvs 1^st tertile, p-trend=0.010; OR: 0.42 [0.22;0.80] for 3^rdvs 1^st tertile, p-trend=0.010). In UC, fruit consumption was protective toward relapse in primary (HR: 0.46 [0.26;0.82] for 3^rdvs 1^st tertile, p-trend=0.009) together with secondary analyses; no dietary pattern was associated with relapse.

Conclusion

A diet characterized by a high consumption of fruit, vegetables, legumes and nuts is associated with a reduction in the risk of relapse by half in patients with CD. High fruit consumption is associated with the same decreased risk of relapse in patients with UC. These results inform dietary counseling in IBD.

References

Acknowledgements: This study was funded by the French association AFA Crohn-RCH France. It was supported by the networks of the Pediatric GETAID, the GETAID, the CREGG, the ANGH and EPIMAD. We thank Nutrinet-Santé, IBD patients and their doctors who contributed to this study.

Disclosure

FC reports receiving research grants from Alpha Wassermann, MaaT pharma, Mayoly Spindler, Medtronic, Nestlé; receiving payment for lectures from AbbVie, AlphaSigma, Ferring, Janssen, Eli Lilly,
Nestlé Health Sciences, Pierre Fabre, Pileje, Takeda, Tillots, Viatris ; receiving consulting fees from AbbVie, Janssen, MaaT pharma, Tillots. HS, SA, CGR, AB, LD and JPH have nothing to declare.

Introduction

Patients with irritable bowel syndrome (IBS) frequently seek dietary advice. However, few evidence-based options exist. Societal guidelines recommend traditional dietary advice (TDA) as first-line therapy, with the cumbersome and resource-intensive low FODMAP diet reserved as second-line therapy.
Recent pilot data suggests that the Mediterranean diet (MD), renowned for its general health benefits, improves the symptoms of IBS. Whether it can be considered another first-line dietary option is not known.

Aims & Methods

This randomized non-inferiority clinical trial assigned 139 individuals with IBS, from across the United Kingdom, to follow the MD (n=68) or TDA (n=71) for six weeks. The primary endpoint was the proportion of participants achieving clinical response, defined as a ≥50-point reduction in the IBS Symptom Severity Scale (IBS-SSS). Secondary outcomes included changes in IBS-SSS, psychological health, somatic symptom reporting, quality of life, diet satisfaction, and the Mediterranean Diet Adherence Screener (MEDAS).

Results

Baseline characteristics (mean age 40.4 [range 19-65] years, 80% female) and IBS-SSS (mean 309, SD 90) were similar between groups. On modified intention-to-treat analysis, the primary endpoint was met by 62% (95% CI 50%-73%) taking a MD versus 42% (95% CI 31%-55%) taking TDA. The difference in clinical response between the groups was in favor of the MD (20%, 95% CI 4%-36%), demonstrating it to be non-inferior based on the a priori defined requirement for the CI to exclude -5%. Rather, the MD was superior to TDA (odds ratio 2.3 [95% CI: 1.16-4.64], p = 0.017). There was a greater reduction in the mean IBS-SSS following a MD than TDA (-101.2 vs. -64.5, ∆-36.7 [95% C.I. -70.5 to -2.8], p=0.034). No significant differences were observed between the groups with regards to changes in mood, somatic symptoms, quality of life or diet satisfaction. The MEDAS significantly increased following a MD compared with TDA (p< 0.001).

Conclusion

The MD is non-inferior (rather, it demonstrated superiority) to TDA in managing the symptoms of IBS, and can be considered as another first-line dietary option.
Clinical trials registration: NCT05985018

Disclosure

Nil

Introduction

The rising incidence of inflammatory bowel disease (IBD) is suggested to be influenced by environmental factors including diet. However, studies investigating childhood diet and its influence on IBD development are scarce and mostly based on retrospective case-control studies.

Aims & Methods

To determine the association of early-life diet quality and food intake with the risk of later IBD, we took advantage of prospectively collected dietary data from the All Babies in Southeast Sweden (ABIS) and The Norwegian Mother, Father and Child Cohort Study (MoBa). In total, we followed 81,280 children from birth, 1997-2009, through 2021. Dietary information was assessed by parental questionnaires administered at the child’s ages 1 and 3 years. IBD was defined as >2 diagnoses retrieved from national registers. Diet quality was assessed using a Healthy Eating Index capturing the child’s intake of seven food groups including fruits, vegetables, dairy foods, meat, fish, soft drinks, salty snacks, and sweet snacks. The food groups were combined into a score ranging from 7-28 points and divided into tertiles reflecting low, medium, and high diet quality. Additionally, we assessed the child’s intake of individual food groups. A Cox regression model was used to estimate adjusted hazard ratios (aHR) and 95% confidence intervals (CI) accounting for the child’s sex, parental IBD, origin, education level, maternal comorbidities, full breastfeeding duration, and perinatal factors. Cohort-specific results were pooled using a random-effects model.

Results

In over 1,304,433 person-years (PYR) of follow-up, 307 participants developed IBD corresponding to an incidence rate of 32 per 100,000 PYR in ABIS and 22 per 100,000 PYR in MoBa. Our analyses revealed that compared to children with low diet quality, having medium and high diet quality by 1 year of age was associated with a reduced risk of IBD (medium, pooled HR=0.74; 95%CI=0.57, 0.97; high, pooled HR =0.73; 95%CI=0.55, 0.97; Table 1). The risk remained largely unchanged after adjusting for potential confounders (Table 1) and when additionally adjusting for full breastfeeding duration and perinatal factors (data not shown). Diet quality at 3 years was not significantly associated with later IBD (data not shown). Among individual food groups, the strongest association was observed in children with a high vs low fish intake by 1 and 3 years of age which was associated with a reduced risk of ulcerative colitis (1 year, pooled adjusted (a)HR=0.46; 95% CI=0.21, 0.99; 3 years, pooled aHR=0.46; 95% CI=0.24, 0.90), but not Crohn’s disease (1 year, pooled aHR=0.67; 95% CI=0.39, 1.17; 3 years, pooled aHR=1.01; 95% CI=0.51, 2.02).

Table 1. Pooled hazard ratios and 95% confidence interval of diet quality by 1 year of age and risk of later IBD

Conclusion

In this Scandinavian birth cohort study, early-life diet quality by 1 year, particularly a high intake of fish, was inversely associated with subsequent IBD.