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Nutrition in acute and chronic diseases

Food groups associated with immune-mediated inflammatory diseases: a Mendelian randomization and disease severity study



Immune-mediated inflammatory diseases (IMIDs) are prevalent diseases. There is, however, a lack of understanding of the link between diet and IMIDs, how much dietary patterns vary between them and if there are food groups associated with a worsening of the disease.


To answer these questions we analyzed a nation-wide cohort of n = 11,308 patients from six prevalent IMIDs and 2050 healthy controls. We compared their weekly intake of the major food categories, and used a Mendelian randomization approach to determine which dietary changes are caused by disease. Within each IMID, we analyzed the association between food frequency and disease severity.


After quality control, n = 11,230 recruited individuals were used in this study. We found that diet is profoundly altered in all IMIDs: at least three food categories are significantly altered in each disease (P < 0.05). Inflammatory bowel diseases showed the largest differences compared to controls (n ≥ 8 categories, P < 0.05). Mendelian randomization analysis supported that some of these dietary changes, like vegetable reduction in Crohn’s Disease (P = 2.5 × 10−10, OR(95% CI) = 0.73(0.65, 0.80)), are caused by the disease. Except for Psoriatic Arthritis and Systemic Lupus Erythematosus, we have found ≥2 food groups significantly associated with disease severity in the other IMIDs (P < 0.05).


This cross-disease study demonstrates that prevalent IMIDs are associated to a significant change in the normal dietary patterns. This variation is highly disease-specific and, in some cases, it is caused by the disease itself. Severity in IMIDs is also associated with specific food groups. The results of this study underscore the importance of studying diet in IMIDs.

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The IMID Consortium includes the following: Eduardo Fonseca, Jesús Rodríguez, Patricia Carreira, Valle García, José A. Pinto-Tasende, Lluís Puig, Elena Ricart, Francisco Blanco, Jordi Gratacós, Ricardo Blanco, Víctor Martínez Taboada, Emilia Fernández, Isidoro González, Fernando Gomollón García, Raimon Sanmartí, Ana Gutiérrez, Àlex Olivé, José Luís López Estebaranz, Esther García-Planella, Juan Carlos Torre-Alonso, José Luis Andreu, David Moreno Ramírez, Benjamín Fernández, Mª Ángeles Aguirre Zamorano, Pablo de la Cueva, Pilar Nos Mateu, Paloma Vela, Francisco Vanaclocha, Héctor Corominas, Santiago Muñoz, Joan Miquel Nolla, Enrique Herrera, Carlos González, José Luis Marenco de la Fuente, Maribel Vera, Alba Erra, Daniel Roig, Antonio Zea, María Esteve, Carlos Tomás, Pedro Zarco, José María Pego, Cristina Saro, Antonio González, Mercedes Freire, Alicia García, Elvira Díez, Georgina Salvador, César Díaz-Torne, Simón Sánchez, Alfredo Willisch Domínguez, José Antonio Mosquera, Julio Ramírez, Esther Rodríguez Almaraz, Núria Palau, Raül Tortosa, Mireia López, Andrea Pluma, Adrià Aterido. We would like to thank Dr Eduard Cabré for stimulating discussions.

IMID Consortium

Eduardo Fonseca17, Jesús Rodríguez18, Patricia Carreira19, Valle García20, José A. Pinto-Tasende21, Lluís Puig22, Elena Ricart23, Francisco Blanco24, Jordi Gratacós25, Ricardo Blanco26, Víctor Martínez Taboada26, Emilia Fernández27, Pablo Unamuno27, Isidoro González28, Fernando Gomollón García29, Raimon Sanmartí30, Ana Gutiérrez31, Àlex Olivé32, José Luís López Estebaranz33, Esther García-Planella34, Juan Carlos Torre-Alonso35, José Luis Andreu36, David Moreno Ramírez37, Benjamín Fernández38, Mª Ángeles Aguirre Zamorano39, Pablo de la Cueva40, Pilar Nos Mateu41, Paloma Vela42, Francisco Vanaclocha43, Héctor Coromines44, Santiago Muñoz45, Joan Miquel Nolla46, Enrique Herrera47, Carlos González48, José Luis Marenco de la Fuente49, Maribel Vera50, Alba Erra51, Daniel Roig52, Antonio Zea53, María Esteve Comas54, Carles Tomàs55, Pedro Zarco56, José María Pego57, Cristina Saro58, Antonio González59, Mercedes Freire60, Alicia García61, Elvira Díez62, Georgina Salvador63, César Díaz64, Simón Sánchez65, Alfredo Willisch Dominguez66, José Antonio Mosquera67, Julio Ramírez68, Esther Rodríguez Almaraz69, Núria Palau51, Raül Tortosa51, Mireia López51, Andrea Pluma51, Adrià Aterido51


This work was supported by the Spanish Ministry of Economy and Competitiveness grants (IPT-010000-2010-36, PSE-010000-2006-6, and PI12/01362).

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Authors and Affiliations




AJ designed the study, conceived, designed and analyzed data and wrote the manuscript; SH performed data curation and statistical analysis; ED, JDC, CF, JT, JPG, AFN, ED, MBA, CP, RQ, FJLL, JLSC, JLM, MA, CM, JJPV, FM, SC and MLL contributed to patient recruitment, clinical data collection and analysis and manuscript revision; AA contributed to genetic data analysis; SM designed the study, coordinated clinical data collection and analysis, and co-wrote the manuscript.

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Correspondence to Antonio Julià or Sara Marsal.

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Members of the IMID Consortium are listed below Acknowledgements.

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Julià, A., Martínez-Mateu, S.H., Domènech, E. et al. Food groups associated with immune-mediated inflammatory diseases: a Mendelian randomization and disease severity study. Eur J Clin Nutr 75, 1368–1382 (2021).

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