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

Narula N, Wong ECL, Dehghan M, Mente A, Rangarajan S, Lanas F, Lopez-Jaramillo P, Rohatgi P, Lakshmi PVM, Varma RP, Orlandini A, Avezum A, Wielgosz A, Poirier P, Almadi MA, Altuntas Y, Ng KK, Chifamba J, Yeates K, Puoane T, Khatib R, Yusuf R, Boström KB, Zatonska K, Iqbal R, Weida L, Yibing Z, Sidong L, Dans A, Yusufali A, Mohammadifard N, Marshall JK, Moayyedi P, Reinisch W, Yusuf S

BMJ (Clinical research ed.) · 273 citations

Review labels

Food frequency questionnaireIndustry fundedNo stated lifestyle adjustment

Neutral facts our review recorded about how this study was done. They describe method, never whether we like the result.

How it was studied

Design: Cohort study (indexed by PubMed)
Studied in: People
Main outcome: Clinical events such as disease or death
Intake measured by: Food frequency questionnaire

Who paid for it

Funding: Industry funded
Company: AstraZeneca
Company: GlaxoSmithKline
Company: Sanofi
Nonprofit: Heart and Stroke Foundation of Canada
Government: Departamento Administrativo de Ciencia, Tecnología e Innovación (COLCIENCIAS)
University or hospital: Hamilton Health Sciences
Government: Public Health Agency of Canada
Government: International Development Research Centre
Government: National Research Foundation
Government: South Africa Netherlands research Programme on Alternatives in Development
Government: Indian Council of Medical Research
Government: Public Health Agency
Government: Forskningsrådet för Arbetsliv och Socialvetenskap
Government: Svenska Forskningsrådet Formas
University or hospital: King Saud University
Company: AFA Försäkring
Government: Ministério da Ciência, Tecnologia e Inovação
Government: Vetenskapsrådet
University or hospital: Universiti Kebangsaan Malaysia
University or hospital: Universiti Teknologi MARA
University or hospital: North-West University
University or hospital: Universidad de La Frontera
University or hospital: Uniwersytet Medyczny im. Piastów Slaskich we Wroclawiu
Company: Servier
University or hospital: Independent University, Bangladesh
University or hospital: Serbian Academy of Sciences and Arts
Government: Canadian Institutes of Health Research
Government: Medical Research Council
Government: Philippine Council for Health Research and Development
University or hospital: Faculty of Community and Health Sciences, University of the Western Cape
Grants: Canadian Institutes of Health Research (6566-04-18062); Canadian Institutes of Health Research (290/W-PURE/2008/0); Universiti Teknologi MARA (UKM-Hejim-Komuniti-15-2010); Universiti Kebangsaan Malaysia (15-2010); Universiti Kebangsaan Malaysia (UKM-Hejim-Komuniti-15-2010); Departamento Administrativo de Ciencia, Tecnología e Innovación (COLCIENCIAS) (6566-04-18062)

Based on 30 listed funder(s).

Publication

Published: 2021-07-14 · BMJ · vol. 374 · p. n1554
Cited: 370 citations · more than 100% of similar papers · 44.1× the field average
Impact: Top 10% most cited in its field
References: 57 works
Access: Open access (hybrid journal) · CC-BY-NC
Research areas: Consumer Attitudes and Food Labeling · Nutritional Studies and Diet · Nutrition and Health in Aging
Keywords: Inflammatory bowel disease, Prospective cohort study, Medicine, Inflammatory Bowel Diseases, Cohort study, Cohort, Internal medicine, Disease, Environmental health
MeSH: humans, colitis, ulcerative, crohn disease, proportional hazards models, prospective studies, causality, energy intake, adult, aged, middle aged, female, male, diet, western

DOI ↗PubMed Central ↗OpenAlex ↗

35 authors

From CA, FR, CL, CO, IN, AR, BR, SA, TR, MY, ZW, ZA, PS, BD, US, SE, PL, PK, CN, PH, AE, IR, AT

Neeraj Narula · correspondingPopulation Health Research Institute; Institut de Recherche en Santé Digestive; Hamilton Health Sciences; McMaster University
Emily C L WongPopulation Health Research Institute; McMaster University
Mahshid DehghanPopulation Health Research Institute; Hamilton Health Sciences; McMaster University
Andrew MentePopulation Health Research Institute; Hamilton Health Sciences; McMaster University
Sumathy RangarajanPopulation Health Research Institute; Hamilton Health Sciences; McMaster University
Fernando Tomas LanasUniversidad de La Frontera

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.

Abstract via Europe PMC. Copyright remains with the authors or publisher (CC BY-NC).

Read the full text ↗View on PubMed ↗

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