THE ASSOCIATION BETWEEN PROCESSED AND ULTRA-PROCESSED FOOD CONSUMPTION AND ACTIVE SYMPTOMATIC DISEASE AMONG ADULTS WITH IBD: THE MANITOBA LIVING WITH IBD STUDY

Introduction: We aimed to investigate the relationship between consumption of ultra-processed foods (UPFs) and: 1) active symptomatic disease and 2) intestinal inflammation in a cohort of adults living with inflammatory bowel disease (IBD).

Methods: Participant data (n=141) was used from the prospective Manitoba Living with IBD study. Food intake was assessed using the Harvard Food Frequency Questionnaire (FFQ). UPF consumption was determined at 1-year follow-up using the NOVA Classification system. The percentage of total energy consumption from UPFs (NOVA4) was calculated and divided into 3 tertiles. We used linear regression analysis to assess the association between UPFs (using low [T1] vs. high [T3] consumption of UPFs) and active disease using the IBD Symptom Inventory (IBDSI) score of >14 for CD and >13 UC; and intestinal inflammation as measured by a fecal calprotectin level of >250 ug/g.

Results: The mean number of episodes of active symptomatic disease over one year was significantly higher among persons with UC, but not CD, in the higher consumption of UPFs group (T3) compared to the lower consumption of UPF (T1) group (13.9 vs 5.8, p=0.037). There were no significant differences in the mean number of episodes of inflammation over one year for lower vs. upper consumption of UPF in either UC or CD persons. When adjusting for age, gender, disease type and disease duration, the number of episodes of active symptomatic disease was 8 times less for the lower consumption of UPF (T1) compared to the higher consumption of UPF (T3) (Beta= -8.42, p=0.01) among UC.

Conclusion: UPF consumption appears to be a predictor of active symptomatic disease. While it was not significantly associated with increased inflammation, the study limitation of having fewer points of measurement in the year for FCAL may have underpowered this finding. Reducing UPF consumption is an additional dietary strategy that can be suggested as a means of minimizing symptomatic disease among people living with IBD.