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Dietary Patterns and Risk of Inflammatory Bowel Disease in Europe: Results from the EPIC Study

Racine, Antoine MD, PhD1,2; Carbonnel, Franck MD, PhD1,2; Chan, Simon S. M. MD BChir, PhD3,4; Hart, Andrew R. MB ChB, MD3,4; Bueno-de-Mesquita, H. Bas MD, PhD5,6,7,8; Oldenburg, Bas MD, PhD6; van Schaik, Fiona D. M. MD, PhD6; Tjønneland, Anne PhD, DMSc9; Olsen, Anja PhD, MSc9; Dahm, Christina C. PhD10; Key, Timothy DPhil11; Luben, Robert BSc12; Khaw, Kay-Tee MB BChir12; Riboli, Elio MD, PhD13; Grip, Olof MD, PhD14; Lindgren, Stefan MD, PhD14; Hallmans, Göran MD, PhD15; Karling, Pontus PhD16; Clavel-Chapelon, Françoise PhD1; Bergman, Manuela M. PhD17; Boeing, Heiner MD, PhD17; Kaaks, Rudolf PhD18; Katzke, Verena A. PhD18; Palli, Domenico MD, MPH19; Masala, G. MD, PH19; Jantchou, Prevost MD, PhD1,20; Boutron-Ruault, Marie-Christine MD, PhD1

doi: 10.1097/MIB.0000000000000638
Original Clinical Articles

Background: Specific nutrients or foods have been inconsistently associated with ulcerative colitis (UC) or Crohn's disease (CD) risks. Thus, we investigated associations between diet as a whole, as dietary patterns, and UC and CD risks.

Methods: Within the prospective EPIC (European Prospective Investigation into Cancer) study, we set up a nested matched case–control study among 366,351 participants with inflammatory bowel disease data, including 256 incident cases of UC and 117 of CD, and 4 matched controls per case. Dietary intake was recorded at baseline from validated food frequency questionnaires. Incidence rate ratios of developing UC and CD were calculated for quintiles of the Mediterranean diet score and a posteriori dietary patterns produced by factor analysis.

Results: No dietary pattern was associated with either UC or CD risks. However, when excluding cases occurring within the first 2 years after dietary assessment, there was a positive association between a “high sugar and soft drinks” pattern and UC risk (incidence rate ratios for the fifth versus first quintile, 1.68 [1.00–2.82]; P trend = 0.02). When considering the foods most associated with the pattern, high consumers of sugar and soft drinks were at higher UC risk only if they had low vegetables intakes.

Conclusions: A diet imbalance with high consumption of sugar and soft drinks and low consumption of vegetables was associated with UC risk. Further studies are needed to investigate whether microbiota alterations or other mechanisms mediate this association.

Article first published online 30 December 2015.Supplemental Digital Content is Available in the Text.

1INSERM, Centre for Research in Epidemiology and Population, Health, UMR1018, Institut Gustave Roussy, Université Paris Sud, Villejuif, France;

2Department of Gastroenterology, University Hospital of Bicêtre, Assistance Publique Hôpitaux de Paris, Université Paris-Sud, Le Kremlin Bicêtre, France;

3Department of Medicine, Norwich Medical School, University of East Anglia, Norwich, United Kingdom;

4Department of Gastroenterology, Norfolk and Norwich University Hospital NHS Trust, Norwich, United Kingdom;

5Department for Determinants of Chronic Diseases (DCD), National Institute for Public Health and the Environment (RIVM), Bilthoven, the Netherlands;

6Department of Gastroenterology and Hepatology, University Medical Centre, Utrecht, the Netherlands;

7Department of Epidemiology and Biostatistics, The School of Public Health, Imperial College London, London, United Kingdom;

8Department of Social and Preventive Medicine, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia;

9Institute of Cancer Epidemiology, Danish Cancer Society, Copenhagen, Denmark;

10Section for Epidemiology, Department of Public Health, Aarhus University, Aarhus, Denmark;

11Cancer Epidemiology Unit, Nuffield Department of Clinical Medicine, University of Oxford, Oxford, United Kingdom;

12Strangeways Research Laboratory, Institute of Public Health, University of Cambridge, Cambridge, United Kingdom;

13Division of Epidemiology, Imperial College London, London, United Kingdom;

14Department of Gastroenterology and Hepatology, University Hospital Malmö, Malmö, Sweden;

15Department of Public Health and Clinical Medicine, Nutritional Research, Umea University, Umea, Sweden;

16Department of Public Health and Clinical Medicine, GI unit, Umea University, Umea, Sweden;

17Department of Epidemiology, German Institute of Human Nutrition, Potsdam, Germany;

18Division of Clinical Epidemiology, DKFZ-German Cancer Research Centre Heidelberg, Heidelberg, Germany;

19Molecular and Nutritional Epidemiology Unit, Cancer Research and Prevention Institute—ISPO, Florence, Italy; and

20Sainte Justine University Hospital, Montréal, QC, Canada.

Reprints: Antoine Racine, INSERM, Espace Maurice Tubiana, Institut Gustave Roussy, 114 rue Édouard Vaillant, 94805 Villejuif, France (e-mail:

Supplemental digital content is available for this article. Direct URL citations appear in the printed text and are provided in the HTML and PDF versions of this article on the journal's Web site (

This study was funded by The Sir Halley Stewart Trust, Crohn's and Colitis UK, and The NHS Executive Eastern Region. SSMC is supported by an NIHR clinical lectureship. The coordination of EPIC is financially supported by the European Commission (DG-SANCO) and the International Agency for Research on Cancer. The national cohorts are supported by the Danish Cancer Society (Denmark); Ligue contre le Cancer, Institut Gustave Roussy, Mutuelle Générale de l'Education Nationale, and Institut National de la Santé et de la Recherche Médicale (INSERM; France); German Cancer Aid and Federal Ministry of Education and Research (Germany); Dutch Ministry of Health, Welfare and Sports, Dutch Prevention Funds, LK Research Funds, Dutch ZON (Zorg Onderzoek Nederland), World Cancer Research Fund (WCRF), and Statistics Netherlands (the Netherlands); Swedish Cancer Society and Swedish Scientific Council and Regional Government of Skane and Västerbotten (Sweden); Cancer Research UK, Medical Research Council (United Kingdom).

The authors have no conflict of interest to disclose.

Received June 02, 2015

Accepted September 17, 2015

© Crohn's & Colitis Foundation of America, Inc.
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