A high intake of fish and vegetables at 1 year of age was associated with a lower risk of IBD, while consuming sugar-sweetened beverages was linked to a greater risk of developing IBD.
Karl Mårild, MD, PhD
Credit: University of Gothenburg
Findings from a pooled study of 2 Scandinavian birth cohorts are providing clinicians with an overview of the potential impact of early childhood diet quality on the risk of developing inflammatory bowel disease (IBD).1
Results underscore the role of diet in the disease’s pathogenesis, highlighting the protective effect of a high intake of fish and vegetables at 1 year of age while calling attention to an increased risk of IBD associated with consuming sugar-sweetened beverages.1
Although the exact cause of IBD is not known, it is thought to arise from a convergence of genetic risk, environmental factors, and gut microbiota. Gut microbiome and host-microbe interactions are at the forefront of recent IBD research, focusing primarily on the impact of diet and its ability to alter the gut microbiome in ways that either promote or prevent IBD. However, research about the impact of diet in pediatric patients is scarce compared to what is available for adults, highlighting a significant gap in research.2
“Although diet in early life is critical for the development of the gut microbiome and gut immune tolerance, diet has primarily been assessed in adulthood and few studies have assessed childhood diet in IBD risk,” wrote Karl Mårild, MD, PhD, associate professor of pediatrics in the Institute of Clinical Sciences at Sahlgrenska Academy at the University of Gothenburg in Sweden, and colleagues.1
To assess the impact of early-life diet quality and food intake frequencies on the subsequent risk of IBD, investigators examined data from the All Babies in Southeast Sweden (ABIS) and the Norwegian Mother, Father and Child Cohort (MoBa) studies. They leveraged information from study questionnaires about participants’ upbringing and lifestyle habits.1
Investigators restricted participation in the present study to 81,280 children with food data available at 1 year of age and 65,692 with food data at 3 years of age. The main predictors of interest were overall diet quality, assessed using the modified Healthy Eating Index, and intake of individual food groups.1
The modified Healthy Eating Index included the intake of 7 food groups: ‘fruits and vegetables’, ‘dairy foods,’ ‘meat,’ ‘fish and eggs,’ ‘soft drinks,’ ‘salty snacks,’ and ‘sweet snacks.’ A higher Healthy Eating Index score was indicative of better diet quality, including an increased intake of vegetables, fruit, and fish, and a lower intake of meat, sweets, snacks, and drinks.1
Investigators also monitored participants’ intake frequency of meat, fish, dairy, fruits, vegetables, grains, potatoes, sugar-dense and fat-dense food, and sugar-sweetened beverages. Scores for both the Health Eating Index and intake frequency were divided into groups representing low, medium, and high diet quality and food intake.1
During 1,304,433 person-years of follow-up, 307 children were diagnosed with IBD, defined as ≥ 2 ICD-10 codes for IBD in the Swedish National Patient Register and the Norwegian Patient Registry. This corresponded to an incidence rate of 32 per 100,000 person-years in ABIS and 22 per 100,000 person-years in MoBa.1
Compared with low diet quality, medium (pooled adjusted hazard ratio [aHR], 0.75; 95% Confidence interval [CI], 0.58-0.98) and high (pooled aHR, 0.75; 95% CI, 0.56-1.00) diet quality at 1 year of age were associated with a reduced risk of IBD. Of note, high versus low diet quality at age 3 years was not associated with later IBD in cohort-specific nor pooled analyses.1
When assessing participants’ intake frequency of specific foods, investigators pointed out those with high fish intake at 1 year of age had a reduced risk of IBD (pooled aHR, 0.70; 95% CI, 0.49-1.00). A similar trend was observed for medium (pooled HR, 0.66; 95% CI, 0.49-0.89) and high (pooled HR, 0.72; 95% CI, 0.55-0.95) vegetable intake at 1 year of age.1
Whereas fish and vegetables appeared to demonstrate a protective effect against IBD, investigators noted intake of sugar-sweetened beverages at 1 year of age was associated with an increased risk of later IBD (pooled aHR, 1.42; 95% CI, 1.05-1.90).1
Pooled analyses and cohort-specific analyses showed no association between the other examined food groups, including meat, dairy, fruits, grains, potatoes, and sugar-dense and fat-dense food with risk of IBD, Crohn disease, or ulcerative colitis.1
Of note, diet quality at 3 years of age was not associated with IBD, suggesting the impact of diet on disease development is greatest at a young age. Associations observed at 1 year of age remained consistent after adjustment for formula intake, household income, and antibiotic use.1
Investigators noted the study’s main limitations arise from the data’s origin in 2 high-income countries, which may limit the generalizability of these findings due to varying dietary habits in low- or middle-income countries. Additionally, the diet questionnaire has not been qualitatively or quantitatively validated against other more conventional methods, and it focused on early-life diet that may not relate to dietary patterns later in life.1
“These novel findings suggest that early-life diet, particularly at 1 year of age, is important for later IBD development and support further research in this field to understand the role of diet in the prevention of IBD,” investigators concluded.1
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