High-quality diet early in life may reduce later risk of inflammatory bowel disease

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A high-quality diet at one year of age may reduce the later risk of inflammatory bowel disease, suggests a large long-term study, published online in the journal Intestine.

According to the results, abundant consumption of fish and vegetables and minimal consumption of sugary drinks at this age could be essential for protection. A linked editorial suggests it may be time for doctors to recommend a “preventative” diet for infants, given growing evidence pointing to biological plausibility.

Cases of inflammatory bowel disease (IBD), which includes Crohn’s disease and ulcerative colitis, are increasing globally. Although there is no obvious explanation for this trend, changes in dietary habits are thought to have contributed, due to their impact on the gut microbiome.

While various studies have examined the influence of diet on IBD risk in adults, there is little research on the potential influence of early childhood diet on risk.

In an effort to fill this knowledge gap, the researchers drew on data from the All Babies in Southeast Sweden (ABIS) study and the Norwegian Mother, Father and Child (MoBa) cohort study. ABIS includes 21,700 children born between October 1997 and October 1999; MoBa includes 114,500 children, 95,200 mothers and 75,200 fathers recruited from across Norway between 1999 and 2008.

Parents were asked specific questions about their children’s diets when they were 12 to 18 months and 30 to 36 months. The final analysis included dietary information for 81,280 1-year-olds: 11,013 (48% girls) from ABIS and 70,267 (49% girls) from MoBa.

Diet quality, derived from measuring consumption of meat, fish, fruits, vegetables, dairy products, sweets, snacks and beverages, was assessed using a modified version of the Healthy Eating Index (HEI) rating system, adapted for children. The weekly frequency of specific food groups was also assessed.

A higher quality diet – higher consumption of vegetables, fruits and fish, and lower consumption of meat, sweets, snacks and drinks – resulted in a higher HEI score. The total score was divided into thirds to indicate low, medium, or high diet quality.

Data on age at weaning, antibiotic use and infant formula consumption were also reported at 12 years (ABIS) and 18 months (MoBa). Children’s health was monitored for an average of 21 (ABIS) and 15 (MoBa) years, from age one to December 31, 2020-2021.

During this period, 307 children were diagnosed with IBD (131 with Crohn’s disease, 97 with ulcerative colitis, and 79 with unclassified IBD). The mean age at diagnosis was 17 years (ABIS) and 12 years (MoB).

Moderate and high quality diets at 1 year of age were associated with a 25% lower overall risk of IBD compared with a low quality diet at that age, after adjusting for potentially influential factors , such as parental history of IBD, sex of the child. , ethnicity, education and coexisting conditions in the mother.

Specifically, high fish consumption at one year of age was associated with a lower overall risk than its opposite, and with a 54% lower risk of ulcerative colitis in particular. Higher vegetable consumption at age 1 was also associated with reduced risk of IBD. In contrast, consumption of sugary drinks was associated with a 42% increased risk.

There was no clear association between other food groups, including meat, dairy, fruit, grains, potatoes, and foods high in sugar and/or fat, and overall risks of IBD, Crohn’s disease or ulcerative colitis.

At age 3, only high fish intake was associated with a reduced risk of IBD, and particularly ulcerative colitis. The results remained unchanged after taking into account the child’s household income, formula consumption, and antibiotic use at age 1 year.

This is an observational study and as such cannot establish cause. And the researchers recognize that while the participation rate for ABIS was high (79%), it was only 41% for MoBa. And because Sweden and Norway are both high-income countries, the results may not be generalizable to low- or middle-income countries with other dietary habits, they add.

“Although non-causal explanations for our findings cannot be ruled out, these new findings are consistent with the hypothesis that early-life diet, possibly mediated by changes in the gut microbiome, may affect the risk of developing MII”, they conclude.

In a related editorial, Dr Ashwin Ananthakrishnan, a gastroenterologist at Massachusetts General Hospital, Boston, US, warns that the questionnaires did not capture items, such as additives and emulsifiers, that are common in foods for babies and which may contribute to the development of IBD. .

Accurate measurements of dietary intake in infants and young children are inherently difficult, he adds.

But he adds that it may nevertheless be time to recommend a “preventative” diet, especially since it is likely to have other health benefits.

“Despite the absence of reference interventional data demonstrating a benefit of dietary interventions in disease prevention, in my opinion, it may still be reasonable to suggest such interventions to motivated individuals who integrate several of the diets associated with risk lower IBD and other studies.

“This includes ensuring adequate dietary fiber, especially from fruits and vegetables, consuming fish, minimizing sugary drinks, and preferring fresh foods and snacks over processed and ultra-processed foods.”

More information:
Diet in early life and risk of inflammatory bowel disease: a pooled study in two Scandinavian birth cohorts, Intestine (2024). DOI: 10.1136/gutjnl-2023-330971

Provided by the British Medical Journal

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