BMJ

, volume 374 , pages n1554

Association of ultra-processed food intake with risk of inflammatory bowel disease: prospective cohort study

Neeraj Narula ^{1, 2}

Emily C.L. Wong ¹

Mahshid Dehghan ²

Andrew Mente ²

Sumathy Rangarajan ²

Fernando Lanas ³

Patricio Lopez-Jaramillo ⁴

Priyanka Rohatgi ⁵

P. V. M. Lakshmi ⁶

Ravi Prasad Varma ⁷

Andres Orlandini ⁸

Alvaro Avezum ⁹

Andreas Wielgosz ¹⁰

Paul Poirier ¹¹

Majid A Almadi ¹²

Yuksel Altuntas ¹³

Kien Keat Ng ¹⁴

Jephat Chifamba ¹⁵

Karen Yeates ¹⁶

Thandi Puoane ¹⁷

Rasha Khatib ¹⁸

Rita Yusuf ^{19, 20}

Kristina Bengtsson Boström ²¹

Katarzyna Zatonska ²²

Romaina Iqbal ²³

Weida Liu ²⁴

Yibing Zhu ²⁴

Sidong Li ²⁴

Antonio Dans ²⁵

Afzalhussein Yusufali ²⁶

Noushin Mohammadifard ²⁷

John K. Marshall ¹

Paul Moayyedi ^{1, 2}

Walter Reinisch ²⁸

Salim Yusuf ²

Hide authors affiliations Show authors affiliations: 28 affiliations

Department of Medicine (Division of Gastroenterology) and Farncombe Family Digestive Health Research Institute, McMaster University, Hamilton, ON, Canada |

Population Health Research Institute, McMaster University and Hamilton Health Sciences, Hamilton, ON, Canada

Hamilton Health Sciences

McMaster University

Department of Internal Medicine, Universidad de La Frontera, Temuco, Chile |

⁴

Masira Research Institute, Universidad de Santander (UDES) Fundación Oftalmológica de Santander-FOSCAL-Bucaramanga, Colombia |

⁵

Department of Nutrition and Dietetics, Apollo Hospitals, Bangalore, India |

⁶

School of Public health, Post Graduate Institute of Medical Education and Research, Chandigarh, India |

⁷

Achutha Menon Centre for Health Science Studies, SCTIMST and Health Action by People, Thiruvananthapuram, India |

⁸

Department of Cardiology, Estudios Clinicos Latinoamerica ECLA Rosario, Santa Fe, Argentina |

⁹

International Research Centre, Hospital Alemao Oswaldo Cruz, Sao Paulo, Brazil, Universidade Santo Amaro (UNISA), Sao Paulo, Brazil |

¹⁰

Department of Medicine, University of Ottawa, Ottawa, ON, Canada |

¹¹

Faculté de Pharmacie, Université Laval Institut Universitaire de Cardiologie et de Pneumologie de Québec, Québec, Canada |

¹²

Department of Medicine, Division of Gastroenterology, College of Medicine, King Saud University, Riyadh, Saudi Arabia |

¹³

University of Health Sciences, Faculty of Medicine, Istanbul Sisli Hamidiye Etfal Health Training and Research Hospital, Clinic of Endocrinology and Metabolism Sisli/Istanbul, Turkey |

¹⁴

Faculty of Medicine and Defence Health, National Defence University of Malaysia, Kuala Lumpur, Malaysia |

¹⁵

Department of Physiology, University of Zimbabwe College of Health Sciences, Harare, Zimbabwe |

¹⁶

Department of Medicine, Queen’s University, Kingston, ON, Canada |

¹⁷

School of Public Health, University of the Western Cape, Bellville. South Africa |

¹⁸

Institute for Community and Public Health, Birzeit University, Birzeit, Palestine |

¹⁹

Advocate Research Institute, Advocate Health Care, IL, USA |

²⁰

School of Life Sciences, Independent University, Bangladesh Bashundhara, Dhaka, Bangladesh |

²¹

School of Public Health and Community Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Göteborg, Sweden |

²²

Department of Social Medicine, Wroclaw Medical University, Wroclaw, Poland |

²³

Department of Community Health Sciences, the Aga Khan University, Karachi, Pakistan |

²⁴

Medical Research and Biometrics Center, National Center for Cardiovascular Diseases, Fuwai Hospital, Chinese Academy of Medical Sciences Mentougou District, Beijing, China |

²⁵

Section of Adult Medicine and Medical Research Unit, University of Philippines, Manila, Philippines |

²⁶

Hatta Hospital, Dubai Medical University, Dubai Health Authority, Dubai, United Arab Emirates |

²⁷

Isfahan Cardiovascular Research Center, Cardiovascular Research Institute, Isfahan University of medical Sciences, Isfahan, Iran |

²⁸

Department of Internal Medicine III, Division of Gastroenterology and Hepatology, Medical University of Vienna, Vienna, Austria |

Publication type: Journal Article

Publication date: 2021-07-14

BMJ

scimago Q1

wos Q1

SJR: 2.976

CiteScore: 20.4

Impact factor: 42.7

ISSN: 09598146, 17561833, 09598138, 14685833, 00071447

DOI: 10.1136/bmj.n1554

Copy DOI

PubMed ID: 34261638

General Engineering

Abstract

Objective

To evaluate the relation between intake of ultra-processed food and risk of inflammatory bowel disease (IBD).

Design

Prospective cohort study.

Setting

21 low, middle, and high income countries across seven geographical regions (Europe and North America, South America, Africa, Middle East, south Asia, South East Asia, and China).

Participants

116 087 adults aged 35-70 years 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 three years.

Main outcome measures

The main outcome was development of IBD, including Crohn’s disease or ulcerative colitis. Associations between ultra-processed food intake and risk of IBD were assessed using Cox proportional hazard multivariable models. Results are presented as hazard ratios with 95% confidence intervals.

Results

Participants were enrolled in the study between 2003 and 2016. During the median follow-up of 9.7 years (interquartile range 8.9-11.2 years), 467 participants developed incident IBD (90 with Crohn’s disease and 377 with ulcerative colitis). After adjustment for potential confounding factors, higher intake of ultra-processed food was associated with a higher risk of incident IBD (hazard ratio 1.82, 95% confidence interval 1.22 to 2.72 for ≥5 servings/day and 1.67, 1.18 to 2.37 for 1-4 servings/day compared with <1 serving/day, P=0.006 for trend). Different subgroups of ultra-processed food, including soft drinks, refined sweetened foods, salty snacks, and processed meat, each were associated with higher hazard ratios for IBD. Results were consistent for Crohn’s disease and ulcerative colitis with low heterogeneity. Intakes of white meat, red meat, dairy, starch, and fruit, vegetables, and legumes were not associated with incident IBD.

Conclusions

Higher intake of ultra-processed food was positively associated with risk of IBD. Further studies are needed to identify the contributory factors within ultra-processed foods.

Study registration

ClinicalTrials.gov NCT03225586 .

Found

1 citation

Aikawa Nadia Emi

151 publications, 2 746 citations, 1 review

h-index: 27

University of São Paulo

Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo

1 citation

Anturaniemi Johanna

21 publications, 266 citations

h-index: 11

University of Helsinki

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GOST |

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GOST Copy

Narula N. et al. Association of ultra-processed food intake with risk of inflammatory bowel disease: prospective cohort study // BMJ. 2021. Vol. 374. p. n1554.

GOST all authors (up to 50) Copy

Narula N., Wong E. C., Dehghan M., Mente A., Rangarajan S., Lanas F., Lopez-Jaramillo P., Rohatgi P., Lakshmi P. V. M., Varma R. P., Orlandini A., Avezum A., Wielgosz A., Poirier P., Almadi M. A., Altuntas Y., Ng K. K., Chifamba J., Yeates K., Puoane T., Khatib R., Yusuf R., Boström K. B., Zatonska K., Iqbal R., Liu W., Zhu Y., Li S., Dans A., Yusufali A., Mohammadifard N., Marshall J. K., Moayyedi P., Reinisch W., Yusuf S. Association of ultra-processed food intake with risk of inflammatory bowel disease: prospective cohort study // BMJ. 2021. Vol. 374. p. n1554.

RIS |

Cite this

RIS Copy

TY - JOUR

DO - 10.1136/bmj.n1554

UR - https://doi.org/10.1136/bmj.n1554

TI - Association of ultra-processed food intake with risk of inflammatory bowel disease: prospective cohort study

T2 - BMJ

AU - Narula, Neeraj

AU - Wong, Emily C.L.

AU - Dehghan, Mahshid

AU - Mente, Andrew

AU - Rangarajan, Sumathy

AU - Lanas, Fernando

AU - Lopez-Jaramillo, Patricio

AU - Rohatgi, Priyanka

AU - Lakshmi, P. V. M.

AU - Varma, Ravi Prasad

AU - Orlandini, Andres

AU - Avezum, Alvaro

AU - Wielgosz, Andreas

AU - Poirier, Paul

AU - Almadi, Majid A

AU - Altuntas, Yuksel

AU - Ng, Kien Keat

AU - Chifamba, Jephat

AU - Yeates, Karen

AU - Puoane, Thandi

AU - Khatib, Rasha

AU - Yusuf, Rita

AU - Boström, Kristina Bengtsson

AU - Zatonska, Katarzyna

AU - Iqbal, Romaina

AU - Liu, Weida

AU - Zhu, Yibing

AU - Li, Sidong

AU - Dans, Antonio

AU - Yusufali, Afzalhussein

AU - Mohammadifard, Noushin

AU - Marshall, John K.

AU - Moayyedi, Paul

AU - Reinisch, Walter

AU - Yusuf, Salim

PY - 2021

DA - 2021/07/14

PB - BMJ

SP - n1554

VL - 374

PMID - 34261638

SN - 0959-8146

SN - 1756-1833

SN - 0959-8138

SN - 1468-5833

SN - 0007-1447

ER -

BibTex

Cite this

BibTex (up to 50 authors) Copy

@article{2021_Narula,

author = {Neeraj Narula and Emily C.L. Wong and Mahshid Dehghan and Andrew Mente and Sumathy Rangarajan and Fernando Lanas and Patricio Lopez-Jaramillo and Priyanka Rohatgi and P. V. M. Lakshmi and Ravi Prasad Varma and Andres Orlandini and Alvaro Avezum and Andreas Wielgosz and Paul Poirier and Majid A Almadi and Yuksel Altuntas and Kien Keat Ng and Jephat Chifamba and Karen Yeates and Thandi Puoane and Rasha Khatib and Rita Yusuf and Kristina Bengtsson Boström and Katarzyna Zatonska and Romaina Iqbal and Weida Liu and Yibing Zhu and Sidong Li and Antonio Dans and Afzalhussein Yusufali and Noushin Mohammadifard and John K. Marshall and Paul Moayyedi and Walter Reinisch and Salim Yusuf},

title = {Association of ultra-processed food intake with risk of inflammatory bowel disease: prospective cohort study},

journal = {BMJ},

year = {2021},

volume = {374},

publisher = {BMJ},

month = {jul},

url = {https://doi.org/10.1136/bmj.n1554},

pages = {n1554},

doi = {10.1136/bmj.n1554}

}

Publisher

BMJ

Journal

BMJ

scimago Q1

wos Q1

SJR

2.976

CiteScore

20.4

Impact factor

42.7

ISSN

09598146 (Print)

17561833 (Electronic)

09598138 (Print)

14685833 (Electronic)

00071447 (Print)

Profiles

Neeraj Narula