IBD Risk Not Linked to Empirical Dietary Inflammatory Pattern Score

inflammatory bowel disease
inflammatory bowel disease
Researchers evaluated whether higher empirical dietary inflammatory pattern scores were associated with increased risk of developing IBD.

No significant association was observed between empirical dietary inflammatory pattern (EDIP) score, and the risk for inflammatory bowel disease (IBD), according to a study in Gastroenterology.

The EDIP was developed with data from the Nurses’ Health Study and is the weighted sum of 18 food groups (9 proinflammatory and 9 anti-inflammatory), with higher scores indicative of proinflammatory diets and lower scores suggesting anti-inflammatory diets.

The analysis was conducted in participants from the Prospective Urban Rural Epidemiology study, a large, multinational, prospective study of 21 low-, middle-, and high-income countries. The researchers used standardized questionnaires to record data at the community, household, and individual level at baseline and at regular follow-up visits every 3 years, as well as country-specific validated food frequency questionnaires to document participants’ baseline habitual dietary intake.

The participants were grouped into quartiles of EDIP scores according to food intake at baseline in order to evaluate the association between proinflammatory diets and IBD risk. The first quartile was used as the reference group for all comparisons.

From January 1, 2003, to December 31, 2016, 28,106 participants in 7 countries completed the food frequency questionnaires and at least 1 cycle of follow-up for analysis. After a median follow-up of 10.1 years (interquartile range, 9.1-11.4 years), 183 incident cases of IBD were recorded: 134 cases of ulcerative colitis (UC) and 49 cases of Crohn disease (CD).

The study authors found no association between EDIP score and risk for IBD among participants stratified by EDIP quartile (quartile 4 vs 1: hazard ratio [HR], 0.95; 95% CI, 0.60-1.51; Ptrend =.647). No difference in risk was observed when CD and UC were examined separately. However, the HRs were numerically higher for CD compared with UC (HR for CD in quartile 4 vs 1, 1.86; 95% CI, 0.78-4.39; Ptrend =.203).

After the EDIP score was modeled as a continuous variable, no difference was found in IBD risk (HR, 1.02; 95% CI, 0.77-1.35; P =.991). The researchers found no significant differences for CD or UC separately, although the HR was numerically higher for CD (HR, 1.52; 95% CI, 0.96-2.40; P =.073), compared with UC (HR, 0.85; 95% CI, 0.60-1.20; P =.357).

The investigators noted the possibility of residual bias resulting from unknown or unmeasured confounders, such as early-life antibiotic use.

“A meta-analysis of all the large prospective studies could be valuable to clarify the association of high inflammatory diets and risk of IBD,” the study authors commented.

Disclosure: Some of the study authors declared affiliations with pharmaceutical companies. Please see the original reference for a full list of disclosures.


Narula N, Wong ECL, Dehghan M, et al. Brief communication: does high inflammatory diet increase risk of inflammatory bowel disease? results from the Prospective Urban Rural Epidemiology (PURE) study: a prospective cohort study. Gastroenterol. Published online June 9, 2021. doi:10.1053/j.gastro.2021.06.007