Association of ultra-processed food intake with risk of inflammatory bowel disease: prospective cohort study

Neeraj Narula, Emily C L Wong, Mahshid Dehghan, Andrew Mente, Sumathy Rangarajan, Fernando Lanas, Patricio Lopez-Jaramillo, Priyanka Rohatgi, P V M Lakshmi, Ravi Prasad Varma, Andres Orlandini, Alvaro Avezum, Andreas Wielgosz, Paul Poirier, Majid A Almadi, Yuksel Altuntas, Kien Keat Ng, Jephat Chifamba, Karen Yeates, Thandi Puoane, Rasha Khatib, Rita Yusuf, Kristina Bengtsson Boström, Katarzyna Zatonska, Romaina Iqbal, Liu Weida, Zhu Yibing, Li Sidong, Antonio Dans, Afzalhussein Yusufali, Noushin Mohammadifard, John K Marshall, Paul Moayyedi, Walter Reinisch, Salim Yusuf, Neeraj Narula, Emily C L Wong, Mahshid Dehghan, Andrew Mente, Sumathy Rangarajan, Fernando Lanas, Patricio Lopez-Jaramillo, Priyanka Rohatgi, P V M Lakshmi, Ravi Prasad Varma, Andres Orlandini, Alvaro Avezum, Andreas Wielgosz, Paul Poirier, Majid A Almadi, Yuksel Altuntas, Kien Keat Ng, Jephat Chifamba, Karen Yeates, Thandi Puoane, Rasha Khatib, Rita Yusuf, Kristina Bengtsson Boström, Katarzyna Zatonska, Romaina Iqbal, Liu Weida, Zhu Yibing, Li Sidong, Antonio Dans, Afzalhussein Yusufali, Noushin Mohammadifard, John K Marshall, Paul Moayyedi, Walter Reinisch, Salim Yusuf

Abstract

Objective: To evaluate the relation between intake of ultra-processed food and risk of inflammatory bowel disease (IBD).

Design: Prospective cohort study.

Setting: 21 low, middle, and high income countries across seven geographical regions (Europe and North America, South America, Africa, Middle East, south Asia, South East Asia, and China).

Participants: 116 087 adults aged 35-70 years with at least one cycle of follow-up and complete baseline food frequency questionnaire (FFQ) data (country specific validated FFQs were used to document baseline dietary intake). Participants were followed prospectively at least every three years.

Main outcome measures: The main outcome was development of IBD, including Crohn's disease or ulcerative colitis. Associations between ultra-processed food intake and risk of IBD were assessed using Cox proportional hazard multivariable models. Results are presented as hazard ratios with 95% confidence intervals.

Results: Participants were enrolled in the study between 2003 and 2016. During the median follow-up of 9.7 years (interquartile range 8.9-11.2 years), 467 participants developed incident IBD (90 with Crohn's disease and 377 with ulcerative colitis). After adjustment for potential confounding factors, higher intake of ultra-processed food was associated with a higher risk of incident IBD (hazard ratio 1.82, 95% confidence interval 1.22 to 2.72 for ≥5 servings/day and 1.67, 1.18 to 2.37 for 1-4 servings/day compared with <1 serving/day, P=0.006 for trend). Different subgroups of ultra-processed food, including soft drinks, refined sweetened foods, salty snacks, and processed meat, each were associated with higher hazard ratios for IBD. Results were consistent for Crohn's disease and ulcerative colitis with low heterogeneity. Intakes of white meat, red meat, dairy, starch, and fruit, vegetables, and legumes were not associated with incident IBD.

Conclusions: Higher intake of ultra-processed food was positively associated with risk of IBD. Further studies are needed to identify the contributory factors within ultra-processed foods.

Study registration: ClinicalTrials.gov NCT03225586.

Conflict of interest statement

Competing interests: All authors have completed the ICMJE uniform disclosure form at www.icmje.org/coi_disclosure.pdf and declare: no support from the organisation listed in the funding statement for the submitted work; no financial relationships with any organisations that might have an interest in the submitted work in the previous three years, no other relationships or activities that could appear to have influenced the submitted work.

© Author(s) (or their employer(s)) 2019. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.

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