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High Quality Diet in Early Life May Curb Subsequent Inflammatory Bowel Disease Risk

A high-quality diet at the age of 1 may curb the subsequent risk of inflammatory bowel disease, suggests a large long-term study, published online in the journal Gut. Plenty of fish and vegetables and minimal consumption of sugar-sweetened drinks at this age may be key to protection, the findings indicate.

While various studies have looked at the influence of diet on IBD risk in adults, there is little in the way of research on the potential influence of early childhood diet on risk.

In a bid to plug this knowledge gap, the researchers drew on survey data from the All Babies in Southeast Sweden study (ABIS) and The Norwegian Mother, Father and Child Cohort Study (MoBa).

ABIS includes 21,700 children born between October 1997 and October 1999; MoBa includes 114, 500 children, 95,200 mothers, and 75,200 fathers recruited from across Norway between 1999 and 2008.
Parents were asked specific questions about their children’s diet when they were aged 12-18 months and 30-36 months. The final analysis included dietary information for 81,280 1 year olds: 11,013 (48% girls) from ABIS and 70, 267 (49% girls) from MoBa.

Diet quality, gleaned from measuring intake of meat, fish, fruit, vegetables, dairy, sweets, snacks and drinks, was assessed using a modified version of the Healthy Eating Index (HEI) scoring system, adapted for children. The weekly frequency of specific food groups was also assessed.

Higher diet quality was reflected in a higher HEI score. The total score was divided into thirds to indicate a low, medium, or high-quality diet. Data on age at weaning, antibiotic use, and formula feed intake were also reported at age 12 (ABIS) and 18 months (MoBa).

Medium and high-quality diets at the age of 1 were associated with an overall 25% lower risk of IBD compared with a low quality diet at this age, after adjusting for potentially influential factors, such as parental history of IBD, the child’s sex, ethnic origin and education and co-existing conditions in the mother.

Specifically, high fish intake at the age of 1 was associated with a lower overall risk compared with its opposite, and a 54% lower risk of ulcerative colitis in particular.

Higher vegetable intake at 1 year of age was also associated with a reduced risk of IBD. On the other hand, consumption of sugar-sweetened drinks was associated with a 42% heightened risk.

This is an observational study, and as such, can’t establish cause. And the researchers acknowledge that while the ABIS participation rate was high (79%), it was only 41% for MoBa. And because Sweden and Norway are two high-income countries, findings may not be generalisable to low- or middle-income countries with other dietary habits, they add.

“While non-causal explanations for our results cannot be ruled out, these novel findings are consistent with the hypothesis that early-life diet, possibly mediated through changes in the gut microbiome, may affect the risk of developing IBD,” they conclude.

In a linked editorial, gastroenterologist Dr Ashwin Ananthakrishnan of Massachusetts General Hospital, Boston, USA, cautions that the questionnaires didn’t capture elements, such as additives and emulsifiers which are common in baby food, and which may contribute to the development of IBD.

Accurate measures of food intake in infants and young children are inherently fraught with difficulty, he adds. But he goes on to say that it may nevertheless be time to recommend a ‘preventive’ diet, particularly as this is likely to have other health benefits.


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