Composition of plant-based diets and the incidence and prognosis of inflammatory bowel disease: a multinational retrospective cohort study

IF 13.6 Q1 HEALTH CARE SCIENCES & SERVICES Lancet Regional Health-Europe Pub Date : 2025-03-14 DOI:10.1016/j.lanepe.2025.101264
Jie Chen , Yuhao Sun , Lintao Dan , Judith Wellens , Shuai Yuan , Hong Yang , Tammy Y.N. Tong , Amanda J. Cross , Nikos Papadimitriou , Antoine Meyer , Christina C. Dahm , Susanna C. Larsson , Alicja Wolk , Jonas F. Ludvigsson , Kostas Tsilidis , Edward Giovannucci , Jack Satsangi , Xiaoyan Wang , Evropi Theodoratou , Simon S.M. Chan , Nick Wareham
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Abstract

Background

Many currently proposed diets for inflammatory bowel disease (IBD) focus on increasing plant-based foods, although a vegetarian diet can still contain products such as emulsifiers and refined grains that are believed to negatively impact IBD incidence and progression. To better inform dietary management in IBD, we investigated the association between plant-based diets and the incidence and complications of IBD.

Methods

We leveraged data from the UK Biobank (UKB, 2009–2022) including 187,888 participants free of IBD at baseline and the European Prospective Investigation into Cancer and Nutrition (EPIC, 1991–2010) cohort including 341,539 individuals free of IBD across centres among Denmark, France, Germany, Greece, Italy, the Netherlands, Sweden and UK. Healthy and unhealthy diets were characterised using plant-based diet indexes (PDIs); in individual participants, these were based on the 24-h dietary recalls for UKB and food frequency questionnaires for EPIC. The primary outcome was the incidence of IBD; secondary outcomes evaluated endpoints of disease prognosis (IBD-related surgery, diabetes, cardiovascular diease, and all-cause mortality). Cox regression was applied to estimate hazard ratios (HRs).

Findings

In the UKB (925 incident IBD, median follow-up 11.6 years, IQR 1.3 years), higher adherence to healthy PDI was associated with a lower IBD risk (HR 0.75, 95% CI 0.60–0.94), while higher alignment to an unhealthy PDI associated with an increased risk (HR 1.48, 95% CI 1.21–1.82) when comparing extreme quintiles of PDIs. Among individuals with established IBD, healthy PDI was inversely associated (HR 0.50, 95% CI 0.30–0.83) and unhealthy PDI was positively associated (HR 2.12, 95% CI 1.30–3.44) with need for IBD-related surgery. We did not observe significant associations between PDIs and risk of cardiovascular disease, diabetes mellitus or mortality. In the EPIC study (548 incident IBD, median follow-up 14.5 years, IQR 7.0 years), the HR of incident IBD for healthy PDI was 0.71 (95% CI 0.59–0.85) and for unhealthy PDI was 1.54 (95% CI 1.30–1.84).

Interpretation

We provide evidence that the composition of a plant-based diet may be an important determinant of the risk of developing IBD, and of disease course after diagnosis. Further research is needed to explore the mechanistic pathways linking plant-based diets and IBD incidence and prognosis.

Funding

National Natural Science Foundation of China, Natural Science Fund for Distinguished Young Scholars of Zhejiang Province, National Undergraduate Training Program for Innovation and Entrepreneurship, CRUK Career Development Fellowship, The “Co-PI” project, Natural Science Fund for Excellent Young Scholars of Hunan Province.
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背景目前许多针对炎症性肠病(IBD)的饮食建议都侧重于增加植物性食物,但素食中仍可能含有乳化剂和精制谷物等产品,而这些产品被认为会对 IBD 的发病率和病情发展产生负面影响。为了更好地指导 IBD 患者的饮食管理,我们研究了植物性饮食与 IBD 发病率和并发症之间的关系。方法我们利用了英国生物库(UKB,2009-2022 年)的数据,其中包括 187,888 名基线时未患 IBD 的参与者,以及欧洲癌症和营养前瞻性调查(EPIC,1991-2010 年)队列的数据,其中包括 341,539 名未患 IBD 的个体,这些数据来自丹麦、法国、德国、希腊、意大利、荷兰、瑞典和英国的多个中心。健康和不健康饮食采用植物性膳食指数(PDI)来表征;对于个体参与者,UKB 采用的是 24 小时膳食回顾,EPIC 采用的是食物频率问卷。主要结果是 IBD 发病率;次要结果评估疾病预后终点(IBD 相关手术、糖尿病、心血管疾病和全因死亡率)。研究结果在UKB(925例IBD患者,中位随访时间为11.6年,IQR为1.3年)中,较高的健康PDI坚持率与较低的IBD风险相关(HR为0.75,95% CI为0.60-0.94),而较高的不健康PDI坚持率与较高的风险相关(HR为1.48,95% CI为1.21-1.82)。在已确诊的 IBD 患者中,健康的 PDI 与 IBD 相关手术的需求成反比(HR 0.50,95% CI 0.30-0.83),而不健康的 PDI 与 IBD 相关手术的需求成正比(HR 2.12,95% CI 1.30-3.44)。我们没有观察到 PDI 与心血管疾病、糖尿病或死亡风险之间存在明显关联。在 EPIC 研究(548 例 IBD 患者,中位随访 14.5 年,IQR 7.0 年)中,健康 PDI 的 IBD 发病 HR 为 0.71(95% CI 0.59-0.85),不健康 PDI 的发病 HR 为 1.54(95% CI 1.30-1.84)。基金项目:国家自然科学基金、浙江省杰出青年科学基金、国家大学生创新创业训练计划、CRUK职业发展奖学金、"Co-PI "项目、湖南省优秀青年科学基金。
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来源期刊
CiteScore
19.90
自引率
1.40%
发文量
260
审稿时长
9 weeks
期刊介绍: The Lancet Regional Health – Europe, a gold open access journal, is part of The Lancet's global effort to promote healthcare quality and accessibility worldwide. It focuses on advancing clinical practice and health policy in the European region to enhance health outcomes. The journal publishes high-quality original research advocating changes in clinical practice and health policy. It also includes reviews, commentaries, and opinion pieces on regional health topics, such as infection and disease prevention, healthy aging, and reducing health disparities.
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