OP05 Association of ultra-processed food intake with risk of Inflammatory Bowel Disease from the prospective urban rural epidemiology (PURE) study: A prospective cohort study

Narula, N.(1);Wong, E.(1);Dehghan, M.(2);Mente, A.(2);Rangarajan, S.(2);Marshall, J.(1);Moayyedi, P.(1);Reinisch, W.(3);Yusuf, S.(2)

(1)McMaster University, Department of Medicine- Division of Gastroenterology, Hamilton, Canada;(2)McMaster University and Hamilton Health Sciences, Population Health Research Institute, Hamilton, Canada;(3)Medical University of Vienna, Department of Internal Medicine III- Division of Gastroenterology and Hepatology, Vienna, Austria


Dietary factors may influence the risk of developing inflammatory bowel disease (IBD), but evidence from large, prospective studies is scarce.  This study aimed to evaluate the relationship between ultra-processed food intake and the risk of developing IBD in the Prospective Urban Rural Epidemiology (PURE) cohort study.


This was a prospective cohort study among 21 low, middle, and high income countries across seven geographic regions of 116,087 individuals between the ages of 35-70 with at least one cycle of follow-up and complete baseline food frequency questionnaire (FFQ) data. Country-specific validated FFQs were used to document baseline dietary intake. Participants were followed prospectively at least every 3 years. The main clinical outcome for this study was development of IBD, including Crohn’s disease (CD) or ulcerative colitis (UC). Cox proportional hazard multivariable models were used to assess associations between ultra-processed food intake and risk of IBD.  Results are presented as hazard ratios (HR) with 95% confidence intervals (CI).


Participants were enrolled in the study between 2003 and 2016. During the median follow-up of 9.7 years (IQR 8.9–11.2), we recorded 467 incident cases of IBD (90 with CD and 377 with UC).  Higher ultra-processed food intake was associated with a higher risk of incident IBD (HR 1.82, 95% CI 1.22 to 2.72 for ≥5 servings/day and HR 1.67, 95% CI 1.18 to 2.37, for 1-4 servings/day as compared to <1 serving/day, ptrend=0.006), after adjustment for potential confounding factors.  Different subgroups of ultra-processed food including soft drinks, sweets, salty snacks, and processed meat each were associated with higher HR for IBD.  Results were consistent in UC and CD with low heterogeneity.  White meat, red meat, dairy, starch, fruits, vegetables, and legumes intake were not associated with incident IBD.


Higher ultra-processed food consumption was positively associated with development of IBD.  Further studies are needed to identify the potential culprits within ultra-processed foods.