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Dietary Intake and Risk of Developing Inflammatory Bowel Disease: A Systematic Review of the Literature

The American Journal of Gastroenterology volume 106, pages 563573 (2011) | Download Citation

Abstract

OBJECTIVES:

The incidence of inflammatory bowel disease (IBD) is increasing. Dietary factors such as the spread of the “Western” diet, high in fat and protein but low in fruits and vegetables, may be associated with the increase. Although many studies have evaluated the association between diet and IBD risk, there has been no systematic review.

METHODS:

We performed a systematic review using guideline-recommended methodology to evaluate the association between pre-illness intake of nutrients (fats, carbohydrates, protein) and food groups (fruits, vegetables, meats) and the risk of subsequent IBD diagnosis. Eligible studies were identified via structured keyword searches in PubMed and Google Scholar and manual searches.

RESULTS:

Nineteen studies were included, encompassing 2,609 IBD patients (1,269 Crohn’s disease (CD) and 1,340 ulcerative colitis (UC) patients) and over 4,000 controls. Studies reported a positive association between high intake of saturated fats, monounsaturated fatty acids, total polyunsaturated fatty acids (PUFAs), total omega-3 fatty acids, omega-6 fatty acids, mono- and disaccharides, and meat and increased subsequent CD risk. Studies reported a negative association between dietary fiber and fruits and subsequent CD risk. High intakes of total fats, total PUFAs, omega-6 fatty acids, and meat were associated with an increased risk of UC. High vegetable intake was associated with a decreased risk of UC.

CONCLUSIONS:

High dietary intakes of total fats, PUFAs, omega-6 fatty acids, and meat were associated with an increased risk of CD and UC. High fiber and fruit intakes were associated with decreased CD risk, and high vegetable intake was associated with decreased UC risk.

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References

  1. 1.

    , , . Basic epidemiology of inflammatory bowel disease in Puerto Rico. Inflamm Bowel Dis 2004;10:106–11.

  2. 2.

    , , et al. Epidemiology of inflammatory bowel disease in the Songpa-Kangdong district, Seoul, Korea, 1986–2005: A KASID study. Inflamm Bowel Dis 2008;14:542–9.

  3. 3.

    , , . Distribution and manifestations of inflammatory bowel disease in Asians, Hispanics, and African Americans: a systematic review. Am J Gastroenterol 2009;104:2100–9.

  4. 4.

    , , et al. Imbalances in dietary consumption of fatty acids, vegetables, and fruits are associated with risk for Crohn’s disease in children. Am J Gastroenterol 2007;102:2016–25.

  5. 5.

    , , et al. Impact of diet in shaping gut microbiota revealed by a comparative study in children from Europe and rural Africa. Proc Natl Acad Sci USA 2010;107:14691–6.

  6. 6.

    , , et al. Role of prostaglandins in ulcerative colitis. Enhanced production during active disease and inhibition by sulfasalazine. Gastroenterology 1978;75:638–40.

  7. 7.

    , , et al. [Sugar consumption in patients with Crohn’s disease] (article in German). Verh Dtsch Ges Inn Med 1976;82:922–4.

  8. 8.

    . Breakfast and Crohn’s disease. Br Med J 1978;2:1715–6.

  9. 9.

    . Breakfast and Crohn’s disease. Br Med J 1977;1:943–5.

  10. 10.

    , , . Increased sugar consumption in Crohn’s disease. Digestion 1980;20:323–6.

  11. 11.

    . Geographic and temporal variations of sugar and margarine consumption in relation to Crohn’s disease. Digestion 1988;41:161–71.

  12. 12.

    , , et al. Epidemiologic analysis of Crohn disease in Japan: increased dietary intake of n-6 polyunsaturated fatty acids and animal protein relates to the increased incidence of Crohn disease in Japan. Am J Clin Nutr 1996;63:741–5.

  13. 13.

    , , et al. Dietary patterns and risk for Crohn’s disease in children. Inflamm Bowel Dis 2008;14:367–73.

  14. 14.

    , , et al. Dietary risk factors for inflammatory bowel disease: a multicenter case-control study in Japan. Inflamm Bowel Dis 2005;11:154–63.

  15. 15.

    , , et al. Animal protein intake and risk of inflammatory bowel disease: the E3N Prospective Study. Am J Gastroenterol 2010;105:2195–201.

  16. 16.

    , . Dietary Fiber and nutrient intake in Crohn’s disease. Am J Clin Nutr 1979;32:1898–901.

  17. 17.

    , , . Diet and Crohn’s disease: characteristics of the pre-illness diet. Br Med J 1979;2:762–4.

  18. 18.

    , , et al. Dietary habits as risk factors for inflammatory bowel disease. Eur J Gastroenterol Hepatol 1995;7:47–51.

  19. 19.

    , , et al. Diet in the aetiology of ulcerative colitis: a European prospective cohort study. Digestion 2008;77:57–64.

  20. 20.

    , , et al. Dietary n-3 polyunsaturated fatty acids and the aetiology of ulcerative colitis: a UK prospective cohort study. Eur J Gastroenterol Hepatol 2010;22:602–6.

  21. 21.

    , , et al. Pre-illness dietary factors in inflammatory bowel disease. Gut 1997;40:754–60.

  22. 22.

    , , et al. Diet as a risk factor for the development of ulcerative colitis. Am J Gastroenterol 2000;95:1008–13.

  23. 23.

    IBD in EPIC Study Investigators, Tjonneland A, Overvad K, Bergmann MM et al. Linoleic acid, a dietary n-6 polyunsaturated fatty acid, and the aetiology of ulcerative colitis: a nested case-control study within a European prospective cohort study. Gut 2009;58:1606–11.

  24. 24.

    , , . Consumption of refined sugar by patients with Crohn’s disease, ulcerative colitis, or irritable bowel syndrome. Scand J Gastroenterol 1983;18:999–1002.

  25. 25.

    , , et al. Childhood factors in ulcerative colitis and Crohn’s disease. An international cooperative study. Scand J Gastroenterol 1987;22:1009–24.

  26. 26.

    , , et al. Environmental factors in inflammatory bowel disease: a co-twin control study of a Swedish-Danish twin population. Inflamm Bowel Dis 2006;12:925–33.

  27. 27.

    , , et al. [A case-control study of ulcerative colitis] (article in Japanese). Nippon Eiseigaku Zasshi 1991;45:1035–43.

  28. 28.

    Epidemiology Group of the Research Committee of Inflammatory Bowel Disease in Japan. Dietary and other risk factors of ulcerative colitis. A case-control study in Japan. J Clin Gastroenterol 1994;19:166–71.

  29. 29.

    , , et al. A population-based case control study of potential risk factors for IBD. Am J Gastroenterol 2006;101:993–1002.

  30. 30.

    Dietary Reference Intakes for Energy, Carbohydrate, Fiber, Fat, Fatty Acids, Cholesterol, Protein, and Amino Acids. Panel on Macronutrients, Panel on the Definition of Dietary Fiber, Subcommittee on Upper Reference Levels of Nutrients, Subcommittee on Interpretation and Uses of Dietary Reference Intakes, and Standing Committee on the Scientific Evaluation of Dietary Reference Intakes. Food and Nutrition Board, Institute of Medicine of the National Academies. National Academies Press: Washington, DC, 2005.

  31. 31.

    , , . Diet and ulcerative colitis. Br Med J 1980;280:293–4.

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Author information

Affiliations

  1. Section of Gastroenterology, Baylor College of Medicine, Houston, Texas, USA

    • Jason K Hou
    • , Bincy Abraham
    •  & Hashem El-Serag
  2. Section of Health Services Research, Baylor College of Medicine, Houston, Texas, USA

    • Jason K Hou
    •  & Hashem El-Serag
  3. Michael E. DeBakey Veterans Affairs Medical Center, Houston Texas, USA

    • Jason K Hou
    •  & Hashem El-Serag

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Competing interests

Guarantor of the article: Hashem El-Serag, MD, MPH.

Specific author contributions: Jason K. Hou: study design, literature search, data abstraction, and primary authorship; Bincy Abraham: study design, literature search and review, and editorial input; Hashem El-Serag: study design, data interpretation, and editorial input. All authors approved the final draft submitted.

Financial support: This work was supported by Houston Veterans Affairs Health Services Research and Development Center of Excellence grant HFP90-020 and National Institutes of Health/National Institute of Diabetes and Digestive and Kidney Diseases Center Grant P30 DK56338.

Potential competing interests: None.

Corresponding author

Correspondence to Jason K Hou.

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DOI

https://doi.org/10.1038/ajg.2011.44

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