P0457A healthy diet is associated with sustained remission and low relapse rates in Inflammatory bowel disease: a prospective e-cohort study

Abstract Background While diet influences the risk of Inflammatory Bowel Disease (IBD) its role in disease activity is less clear. This study aims to identify dietary factors associated with sustained remission and relapse risk in IBD. Methods The “Mikinautes” e-cohort is a nationwide French prospective study recruiting IBD patients older than 6 years at inclusion and followed in private practice and public hospitals. French association of patients with Crohn’s disease and Ulcerative Colitis was involved in the design, funding and recruitment. Patients filled in online questionnaires about their dietary habits and health status. Validated food frequency questionnaires (FFQ) recorded average intakes of 230 food items over the past 12 months. Patients were followed for at least one year and medical records were prospectively collected. Food items, nutrients, FSAmNPS DI food quality score and dietary patterns (DP) derived from principal component analysis (PCA) were tested. Relapse was defined by i) an increased disease activity reported monthly by the patients and/or a clinical report mentioning a relapse, together with ii) a documented consultation with a doctor and iii) a change in IBD therapy, either drug, enteral nutrition and/or surgery). Sustained remission was defined by the absence of relapse over a 1-year follow-up. A logistic regression model compared patients with or without sustained remission at 1 year and a Cox model looked for associations with relapses during a median 2-years of follow-up. Results 693 patients were retained for analyses, comprising 66% of females, 59% Crohn Disease (CD) patients, 34% ulcerative colitis (UC) patients and 7% indeterminate colitis (IC). 77% of patients were in remission at inclusion. Their cumulative probability (95% CI) of flare were 18% 15%; 21% at 1 year and 25% 22%; 29% at 2 years. 64% were in sustained remission during the first year of follow-up. In CD, a “healthy” DP characterized by high intakes of vegetables, fruits, nuts, legumes, cereals, eggs and unsweetened beverages and by a low consumption of bread, sweet/fatty/salty products was associated with inactive disease and low relapse rate (aOR: 0.42 0.22 - 0.80; p trend=0.010 for the logistic model and aHR 0.47 0.22 - 0.99; ptrend=0.050 for the Cox model). In UC, a low food quality was associated with disease activity and flares using the logistic (aOR: 1.99 CI 1.06-3.75]; p-trend=0.036) and the Cox (aHR: 1.95 CI 1.11-3.43; p-trend=0.020) models. Detailed analyses of food items and micronutrients confirmed these findings, particularly the benefit of vegetables in CD and fruits in UC. Conclusion A healthy diet is associated with a halved risk of disease activity in IBD patients, supporting dietary counselling in clinical practice. Conflict of interest: Ms. Sarter, Hélène: No conflict of interest Alirol, Servane: No conflict of interest Gower Rousseau, Corinne: None Buisson, Anne: No conflict of interest Dauchet, Luc: No conflict of interest Kesse, Emmanuelle: No conflict of interest Arnault, Nathalie: No conflict of interest Beaugerie, Laurent: Grant: Biogen, Takeda, Ferring, Celltrion, Viatris, Personal Fees: Takeda, Janssen, Nordic Pharma, Gilead, BMS, Viatris Dupont, Claire: No conflict of interest Savoye, Guillaume: Other: MSD, Ferring, Pfizer, Takeda, Vifor Nachury, Maria: Abbvie, Alfa Sigma, Biosynex, Celltrion, Galapagos, Janssen, Lilly, MSD, Pfizer, Takeda Coopman, Stephanie: No conflict of interest Bourreille, Arnaud: Grant: Takeda, MaunaKea technologies Personal Fees: AbbVie, Celltrion, Ferring, Galapagos, Gilead, MSD, Medtronic, OSE Immunotherapeutics, Janssen, Pfizer, Roche, Takeda, Tillotts, Vifor pharma Bouguen, Guillaume: Grant: Abbvie, Ferisinus Personal Fees: Abbvie, Takeda, Fresinus, Amgen, Biogène, Arena, Ferring, Gilead, Janssen, MSD, Pfizer, Sandoz, Takeda, Tillots, Vifor pharma Amiot, Aurelien: Personal Fees: Abbvie, Fresenius-Kabi, Adacyte, Tillotts pharma, Janssen, Pfizer, Biogen, AMgen, Sandoz, Takeda, Galapagos, Eli Lilly Ruemmele, Frank: Grant: Abbvie, Centocor, Nestle Health Science Other: Pfizer, Takeda, Shire, Therakos, Celgene, Nestle Nutrition Institute, Arkopharma Martinez Vinson, Christine: No conflict of interest Carbonnel, Franck: Grant: Alpha Wassermann, Nestlé, Mayoly Spindler Personal Fees: Abbvie, Arena, Biogen, Celltrion, Enterome, Ferring, Janssen, MaaT Pharma, Nestlé, Nordic Pharma, Pierre Fabre, Pharmacosmos, Roche, Takeda, Tillotts, Viatris Hugot, Jean-Pierre: Non-financial Support: Expert for Abbvie and Nestle companies.