High-quality early diet linked to lower IBD risk in children

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In a recently published study, Dr the courageResearchers are investigating the relationship between early-life diet and later risk of inflammatory bowel disease (IBD).

Study: early-onset diet and risk of inflammatory bowel disease: a study pooled in two Scandinavian birth cohorts.  Image credit: fizkes/Shutterstock.com Study: Early-onset feeding and risk of inflammatory bowel disease: a study in two Scandinavian birth cohorts. Image credit: fizkes/Shutterstock.com


IBD, which comprises both Crohn’s disease (CD) and ulcerative colitis (UC), is a growing global health problem characterized by chronic gastrointestinal (GI) tract inflammation. The increase in IBD cases may be due in part to dietary changes; However, the exact reason remains unclear.

Studies of adults indicate that a high sugar, fat, and red meat intake increases IBD risk, while eating more fruits, vegetables, and fish reflects good diet quality that may reduce IBD risk. Early-life diet, which is crucial for gut microbiome and immune development, has been understudied in relation to IBD risk.

Thus, more research is needed to elucidate the complex mechanisms by which early-life diet influences the development of IBD and inform effective dietary interventions for prevention.

About the study

The present study used data from two Scandinavian birth cohorts, the All Babies in Southeast Sweden (ABIS) Study and the Norwegian Mother, Father and Child Cohort (MOBA) Study.

ABIS, started in 1997, invited 21,700 children born over two years in southeastern Sweden and ultimately achieved a participation rate of 79%. MoBa, which started in 1999 and ended in 2008, is a Norwegian national pregnancy cohort involving 114,500 children, with a participation rate of 41%.

The cohorts presented detailed questionnaire data on children’s diet during critical stages of early life and were linked to national health registries in Sweden and Norway for comprehensive health tracking. Early life dietary information was collected from detailed questionnaires and included a wide range of food items such as meat, fish, fruit, vegetables and sugar-sweetened beverages. Food intake data were analyzed weekly.

Diet quality was assessed using a modified version of the Healthy Eating Index (HEI), in which intake of different food groups was categorized into quartiles. The researchers also examined the frequencies of foods such as meat, fish, dairy, fruits, and vegetables, which were categorized into low, moderate, and high intake levels.

IBD was identified using International Classification of Diseases (ICD) codes from national patient registries. Cox regression analysis was employed to estimate hazard ratios for IBD, including adjustment for factors such as gender, parental IBD history, and maternal comorbidity.

Study results

The study included 81,280 children, including 11,013 from ABIS and 70,267 from MoBa, whose dietary data were recorded at one year of age. During more than 1.3 million person-years of follow-up, 307 children were diagnosed with IBD, 131 with CD, 97 with UC, and 79 with unclassified IBD (IBD-U).

The incidence rate of IBD was 32 per 100,000 person-years in ABIS and 22 per 100,000 person-years in MoBA. Most babies were weaned from breastfeeding between four and six months of age.

The median follow-up time from age one was 21.3 years in ABIS and 15.2 years in MoBA. At age three, 65,692 children remained in the study.

Higher diet quality at one year of age was associated with a reduced risk of later IBD. This was consistent across ABIS and MoBa, with adjusted hazard ratios (aHRs) suggesting a significant reduction in IBD risk for children with moderate or high diet quality compared to low diet quality. However, diet quality was not significantly associated with IBD risk at age three.

High fish intake at age 1 years reduces risk of IBD, especially UC, in children; However, this association was not observed at age three. In contrast, the risk of IBD increased with consumption of sugar-sweetened beverages (SSBs) at age one; However, this association was not observed at age three.

No significant associations were observed between fruit, grains, meat, dairy, potatoes, sugar-dense, and fat-dense foods and other food groups with risk of IBD, CD, or UC.

Subanalysis revealed that diet quality at age one was inversely associated with childhood-onset IBD diagnosis before age 18 but not diet quality at age three. These results were consistent, even when excluding children with incomplete dietary data or children diagnosed with IBD before age six.

Post-hoc analyses, which adjusted for formula intake, household income, and antibiotic use within one year of age, did not affect these observations. In addition, there was no significant association between IBD risk and diet quality across the variables examined.

Changing the definition of IBD-U to include only the last two years of follow-up also left estimates unchanged. Taken together, these findings emphasize the importance of diet quality in early life, particularly at one year of age, in influencing the risk of developing IBD later in childhood.

Journal Reference:

  • Guo, A., Ludwigson, J., Bruntsetter, A. L., etc (2024) Early-onset diet and risk of inflammatory bowel disease: a cohort study in two Scandinavian birth cohorts. the courage. doi:10.1136/gutjnl-2023-330971

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