The complex relationship between diet, symptoms, and intestinal inflammation in persons with inflammatory bowel disease: The Manitoba Living With IBD Study

• Published in: JPEN. Journal of parenteral and enteral nutrition 2022-05, Vol.46 (4), p.867-877
• Main Authors: Dolovich, Casandra, Shafer, Leigh Anne, Vagianos, Kathy, Witges, Kelcie, Targownik, Laura E., Bernstein, Charles N.
• Format: Article
• Language: English
• Subjects: Chronic Disease; Diet; FCAL; healthy diet score; Humans; inflammation; Inflammation - epidemiology; inflammatory bowel disease; Inflammatory Bowel Diseases - complications; Leukocyte L1 Antigen Complex; Manitoba - epidemiology; Prospective Studies; PURE
• ISSN: 0148-6071; 1941-2444
• DOI: 10.1002/jpen.2257

Background We aimed to examine whether an association exists between diet quality, based on the Prospective Urban Rural Epidemiology (PURE) Healthy Diet Score (HDS), and active inflammatory bowel disease (IBD). Methods Participants were drawn from the Manitoba Living With IBD Study cohort. The Harvard Food Frequency Questionnaire (FFQ) was used to calculate the HDS at two time points: baseline and 1‐year follow‐up. Using generalized estimating equations (GEE) logistic regression, we assessed the association between the HDS and (1) the IBD Symptom Inventory (IBDSI); (2) intestinal inflammation, measured by fecal calprotectin (FCAL); and (3) self‐reported IBD flares. Results There were 294 completed FFQs among 153 people. Of these, 100% had completed data about an IBD flare, 98% had FCAL measurements, and 96% had completed IBDSI scores. On a HDS scoring method of 0–8, the odds of FCAL >250 mcg/g were lower for participants with a HDS of 4 vs 0–3 (adjusted odds ratio [OR], 0.38; 95% CI, 0.19–0.77). When applying a second HDS scoring method (8–40), the odds of having an IBD flare were 3.6 times greater with a HDS between 21 and 24 compared with an HDS ≤20 (adjusted OR, 3.63; 95% CI, 1.03–12.78). Conclusions We found that active inflammation was less likely among those with a moderate HDS , whereas symptomatic IBD flares were more likely. People may choose to consume a moderate amount of healthy foods such as fruits and vegetables, even knowing that those foods may cause a symptomatic flare.