Investigating The Relationship Between Breakfast Frequency, Dietary Content and Disease Activity in Inflammatory Bowel Disease

Abstract Background & Aims: Inflammatory bowel diseases (IBD), including ulcerative colitis (UC) and Crohn’s disease (CD), are chronic conditions influenced by genetic, environmental, and dietary factors. While the role of diet in IBD pathogenesis is increasingly recognized, the impact of meal-specific habits— particularly breakfast—remains underexplored. This study investigated the association between breakfast habits (frequency and composition) and disease activity in Turkish IBD patients, where breakfast holds cultural significance. Methods: A total of 191 patients (83 female, 108 male; aged 20–79 years) with confirmed UC or CD in remission were consecutively enrolled. Participants were excluded if they followed elimination diets (e.g., gluten-free, low-FODMAP). Breakfast habits were assessed via questionnaires, focusing on frequency ("daily," "3–5 days/week," "<2 days/week or never") and content (animal products [eggs, dairy] vs. carbohydrates [bread, pastries]). Disease activity was evaluated through hospital admissions or flare-ups (defined as bloody diarrhea, weight loss, or elevated biomarkers) in the past year. Statistical analyses included Mann-Whitney U and chi-square tests. Results: Patients with hospital admissions (n=72) had significantly lower breakfast frequency p<0.05) and consumed fewer animal products (p<0.05) but more carbohydrates (p<0.05) compared to those without admissions. The hospitalized group was younger (p<0.05) and had a higher proportion of CD (p<0.05). Notably, 57.6% of patients ate breakfast daily, while 6.3% skipped it entirely. Regular consumers of animal-based breakfasts (e.g., eggs, cheese, kefir) had fewer flare-ups (p<0.05) and hospitalizations (p<0.05). Carbohydrate-heavy breakfasts correlated with increased disease severity (p<0.05). Conclusion: Regular breakfast consumption, particularly with animal-derived proteins and fermented foods, might be associated with reduced IBD activity in populations with strong breakfast traditions. These observations provide preliminary evidence supporting further research of personalized nutritional strategies that incorporate meal-specific dietary modifications as part of comprehensive IBD management protocols.