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Background & Aims

The rising incidence of inflammatory bowel disease in regions undergoing Westernization has coincided with the increase in ultra-processed food (UPF) consumption over the past few decades. We aimed to examine the association between consumption of UPFs and the risk of Crohn's disease (CD) and ulcerative colitis (UC).

Methods

We performed a prospective cohort study of three nationwide cohorts of health professionals in the United States -- the Nurses' Health Study (1986-2014), the Nurses' Health Study II (1991-2017), and the Health Professionals Follow-up Study (1986-2012). We employed Cox proportional hazards models with adjustment for confounders to estimate the hazard ratios (HRs) and 95% confidence intervals (CIs) for CD and UC according to self-reported consumption of UPFs.

Results

The study included 245,112 participants. Over 5,468,444 person-years of follow-up, we documented 369 incident cases of CD and 488 incident cases of UC. The median age at diagnosis was 56 years (range 29-85). Compared to participants in the lowest quartile of simple updated UPF consumption, those in the highest quartile had a significantly increased risk of CD (HR 1.70, 95% CI 1.23-2.35, P_trend = 0.0008). Among different UPF subgroups, ultra-processed breads and breakfast foods; frozen or shelf-stable ready-to-eat/heat meals; and sauces, cheeses, spreads, and gravies showed the strongest positive associations with CD risk (HR per one standard deviation increase in intake 1.18, 95% CI 1.07-1.29; 1.11, 95% CI 1.01-1.22; and 1.14, 95% CI 1.02-1.27, respectively). There was no consistent association between UPF intake and UC risk.

Conclusions

Higher UPF intake was associated with an increased risk of incident CD. Further studies are needed to identify specific contributory dietary components.

You can read an interview with the senior study author here, and about the clinical implications of the study here.