A high-quality diet at age 1 may reduce the risk of inflammatory bowel disease later in life, according to a large long-term study published online in the journal. the courage.
Plenty of fish and vegetables and minimal consumption of sugar-sweetened beverages at this age may be key to protection, the findings suggest.
A linked editorial suggests that it may be time for doctors to recommend a ‘preventive’ diet for babies, given the growing evidence of biological plausibility indices.
Inflammatory bowel disease (IBD), including Crohn’s disease and ulcerative colitis, is increasing worldwide. Although there is no clear explanation for this trend, changes in dietary patterns are thought to have a contributing role due to effects on the gut microbiome.
Although several studies have looked at the effect of diet on IBD risk in adults, there is little in the way of research on the potential impact of childhood diet on risk.
To plug this knowledge gap, the researchers drew on survey data from the All Babies in Southeast Sweden Study (ABIS) and the Norwegian Mother, Father and Child Cohort Study (MOBA).
ABIS includes 21,700 children born between October 1997 and October 1999; MoBA recruited 114,500 children, 95,200 mothers and 75,200 fathers from Norway between 1999 and 2008.
Parents were asked specific questions about their children’s diet at ages 12–18 months and 30–36 months. The final analysis included dietary data for 81,280 1-year-olds: 11,013 (48% girls) from ABIS and 70,267 (49% girls) from MoBa.
Diet quality was assessed using a modified version of the Healthy Eating Index (HEI) scoring system adapted for children, collected from measuring consumption of meat, fish, fruit, vegetables, dairy, sweets, snacks and beverages. Weekly frequency of specific food groups was also assessed.
Superior food quality; higher intake of vegetables, fruit and fish, and lower intake of meat, sweets, snacks and drinks; was reflected in higher HEI scores. Total scores were divided into thirds to indicate low, moderate, or high quality diets.
Data on weaning age, antibiotic use and formula feed intake at 12 (ABIS) and 18 months (MoBa) were also reported.
Children’s health was monitored for an average of 21 (ABIS) and 15 (MoBa) years from the age of 1 year to 31 December 2020-21.
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 of diagnosis was 17 (ABIS) and 12 (MoB).
Moderate- and high-quality diets at 1 year of age were associated with an overall 25% lower risk of IBD than low-quality diets at this age, after adjustment for potentially influential factors, such as parental history of IBD, child sex, ethnic origin, education, and maternal co-occurrence. condition
Specifically, high fish intake at age 1 was associated with a lower overall risk than its opposite, and a 54% lower risk of ulcerative colitis in particular.
Higher vegetable intake at age 1 was also associated with a reduced risk of IBD. On the other hand, consumption of sugar-sweetened beverages was associated with a 42% higher risk.
There was no clear association between meat, dairy, fruit, grains, potatoes, and foods high in sugar and/or fat and overall IBD or other food groups with risk of Crohn’s disease or ulcerative colitis.
By age 3 years, only high fish intake was associated with a reduced risk of IBD and especially ulcerative colitis.
Results were unchanged after accounting for family income and infant formula intake and antibiotic use by age 1 year.
This is an observational study, and as such, cannot establish causation. And the researchers acknowledged that while the ABIS participation rate was high (79%), it was only 41% for MoBa. And because Sweden and Norway are 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 results cannot be ruled out, these novel findings are consistent with the hypothesis that early-life diet, possibly mediated by changes in the gut microbiome, may influence the risk of developing IBD,” they concluded.
In an accompanying editorial, Dr. Ashwin Ananthakrishnan, a gastroenterologist at Massachusetts General Hospital, Boston, USA, cautioned that the questionnaire did not capture ingredients, such as additives and emulsifiers that are common in baby food, and that may contribute to the development of IBD.
Accurate measurement of food intake in infants and young children is inherently difficult, he adds.
But he says it may still be time to recommend a ‘preventive’ diet, especially as it may have other health benefits.
“Despite the absence of gold standard interventional data demonstrating the benefit of dietary interventions in disease prevention, in my opinion, it may be reasonable to recommend such interventions to motivated individuals who incorporate several dietary patterns associated with a reduced risk of IBD from this and other studies.
“These include ensuring adequate dietary fiber, particularly from fruits and vegetables, eating fish, reducing sugar-sweetened beverages and choosing fresh over processed and ultra-processed foods and snacks.”
Guo, A., etc (2024). Early life diet and risk of inflammatory bowel disease: a study in two Scandinavian birth cohorts. the courage. doi.org/10.1136/gutjnl-2023-330971.