A prospective study of long-term intake of dietary fiber and risk of Crohn's disease and ulcerative colitis.

BACKGROUND & AIMS Increased intake of dietary fiber has been proposed to reduce the risk of inflammatory bowel disease (Crohn's disease [CD] and ulcerative colitis [UC]). However, few prospective studies have examined associations between long-term intake of dietary fiber and risk of incident CD or UC. METHODS We collected and analyzed data from 170,776 women, followed up over 26 years, who participated in the Nurses' Health Study, followed up for 3,317,425 person-years. Dietary information was prospectively ascertained via administration of a validated semiquantitative food frequency questionnaire every 4 years. Self-reported CD and UC were confirmed through review of medical records. Cox proportional hazards models, adjusting for potential confounders, were used to calculate hazard ratios (HRs). RESULTS We confirmed 269 incident cases of CD (incidence, 8/100,000 person-years) and 338 cases of UC (incidence, 10/100,000 person-years). Compared with the lowest quintile of energy-adjusted cumulative average intake of dietary fiber, intake of the highest quintile (median of 24.3 g/day) was associated with a 40% reduction in risk of CD (multivariate HR for CD, 0.59; 95% confidence interval, 0.39-0.90). This apparent reduction appeared to be greatest for fiber derived from fruits; fiber from cereals, whole grains, or legumes did not modify risk. In contrast, neither total intake of dietary fiber (multivariate HR, 0.82; 95% confidence interval, 0.58-1.17) nor intake of fiber from specific sources appeared to be significantly associated with risk of UC. CONCLUSIONS Based on data from the Nurses' Health Study, long-term intake of dietary fiber, particularly from fruit, is associated with lower risk of CD but not UC. Further studies are needed to determine the mechanisms that mediate this association.

[1]  S. Ng,et al.  Incidence and phenotype of inflammatory bowel disease based on results from the Asia-pacific Crohn's and colitis epidemiology study. , 2013, Gastroenterology.

[2]  A. Ananthakrishnan,et al.  Association between depressive symptoms and incidence of Crohn's disease and ulcerative colitis: results from the Nurses' Health Study. , 2013, Clinical gastroenterology and hepatology : the official clinical practice journal of the American Gastroenterological Association.

[3]  W. Sandborn,et al.  Crohn's disease , 2012, The Lancet.

[4]  J. Manson,et al.  Hormone therapy increases risk of ulcerative colitis but not Crohn's disease. , 2012, Gastroenterology.

[5]  David C. Wilson,et al.  Host-microbe interactions have shaped the genetic architecture of inflammatory bowel disease , 2012, Nature.

[6]  Timothy L. Tickle,et al.  Dysfunction of the intestinal microbiome in inflammatory bowel disease and treatment , 2012, Genome Biology.

[7]  K. Brown,et al.  Diet-Induced Dysbiosis of the Intestinal Microbiota and the Effects on Immunity and Disease , 2012, Nutrients.

[8]  A. Chan,et al.  A Prospective Study of Cigarette Smoking and the Risk of Inflammatory Bowel Disease in Women , 2012, The American Journal of Gastroenterology.

[9]  T. Macdonald,et al.  The aryl hydrocarbon receptor in inflammatory bowel disease: linking the environment to disease pathogenesis , 2012, Current opinion in gastroenterology.

[10]  A. Ananthakrishnan,et al.  Oral contraceptives, reproductive factors and risk of inflammatory bowel disease , 2012, Gut.

[11]  S. Lynch,et al.  Role of the microbiota in inflammatory bowel diseases. , 2012, Inflammatory bowel diseases.

[12]  L. Ferguson,et al.  Role of nutrition and microbiota in susceptibility to inflammatory bowel diseases. , 2012, Molecular nutrition & food research.

[13]  A. Ananthakrishnan,et al.  Aspirin, Nonsteroidal Anti-inflammatory Drug Use, and Risk for Crohn Disease and Ulcerative Colitis , 2012, Annals of Internal Medicine.

[14]  G. Rogler,et al.  Systematic evaluation of risk factors for diagnostic delay in inflammatory bowel disease , 2012, Inflammatory bowel diseases.

[15]  E. Giovannucci,et al.  Higher predicted vitamin D status is associated with reduced risk of Crohn's disease. , 2012, Gastroenterology.

[16]  A. Ananthakrishnan,et al.  Geographical variation and incidence of inflammatory bowel disease among US women , 2012, Gut.

[17]  E. Hobeika,et al.  Natural Aryl Hydrocarbon Receptor Ligands Control Organogenesis of Intestinal Lymphoid Follicles , 2011, Science.

[18]  Natalie A. Roberts,et al.  Exogenous Stimuli Maintain Intraepithelial Lymphocytes via Aryl Hydrocarbon Receptor Activation , 2011, Cell.

[19]  F. Bushman,et al.  Linking Long-Term Dietary Patterns with Gut Microbial Enterotypes , 2011, Science.

[20]  A. Rizzo,et al.  Aryl hydrocarbon receptor-induced signals up-regulate IL-22 production and inhibit inflammation in the gastrointestinal tract. , 2011, Gastroenterology.

[21]  R. Xavier,et al.  Genetics and pathogenesis of inflammatory bowel disease , 2011, Nature.

[22]  H. El‐Serag,et al.  Dietary Intake and Risk of Developing Inflammatory Bowel Disease: A Systematic Review of the Literature , 2011, The American Journal of Gastroenterology.

[23]  Ruth Ley,et al.  Unravelling the effects of the environment and host genotype on the gut microbiome , 2011, Nature Reviews Microbiology.

[24]  F. Clavel-Chapelon,et al.  Animal Protein Intake and Risk of Inflammatory Bowel Disease: The E3N Prospective Study , 2010, The American Journal of Gastroenterology.

[25]  S. Duncan,et al.  Translocation of Crohn's disease Escherichia coli across M-cells: contrasting effects of soluble plant fibres and emulsifiers , 2010, Gut.

[26]  S. Massart,et al.  Impact of diet in shaping gut microbiota revealed by a comparative study in children from Europe and rural Africa , 2010, Proceedings of the National Academy of Sciences.

[27]  G. Radford-Smith,et al.  Role of diet in the development of inflammatory bowel disease , 2010, Inflammatory bowel diseases.

[28]  C. Mackay,et al.  Diet, gut microbiota and immune responses , 2010, Nature Immunology.

[29]  P. Dagnelie,et al.  Inflammatory Bowel Disease in South Limburg (the Netherlands) 1991-2002: Incidence, diagnostic delay, and seasonal variations in onset of symptoms. , 2009, Journal of Crohn's & colitis.

[30]  W. Sandborn,et al.  An Update on the Epidemiology of Inflammatory Bowel Disease in Asia , 2008, The American Journal of Gastroenterology.

[31]  C. Williams.  Does the incidence of IBD increase when persons move from a low- to a high-risk area? , 2008, Inflammatory bowel diseases.

[32]  E. Levy,et al.  Imbalances in Dietary Consumption of Fatty Acids, Vegetables, and Fruits Are Associated With Risk for Crohn's Disease in Children , 2007, The American Journal of Gastroenterology.

[33]  S. Galandiuk,et al.  Smoking and inflammatory bowel disease: a meta-analysis. , 2006, Mayo Clinic proceedings.

[34]  Shadi Sepehri,et al.  High prevalence of Escherichia coli belonging to the B2+D phylogenetic group in inflammatory bowel disease , 2006, Gut.

[35]  R. Bibiloni,et al.  The bacteriology of biopsies differs between newly diagnosed, untreated, Crohn's disease and ulcerative colitis patients. , 2006, Journal of medical microbiology.

[36]  W. Willett,et al.  Fruit and vegetable consumption and colorectal adenomas in the Nurses' Health Study. , 2006, Cancer research.

[37]  W. Willett,et al.  Fiber Intake and Incidence of Colorectal Cancer among 76,947 Women and 47,279 Men , 2005, Cancer Epidemiology Biomarkers & Prevention.

[38]  K. Wakai,et al.  Dietary Risk Factors for Inflammatory Bowel Disease: A Multicenter Case‐Control Study in Japan , 2005, Inflammatory bowel diseases.

[39]  J. Olsen,et al.  Psychological Stress and Inflammatory Bowel Disease: A Follow-up Study in Parents Who Lost a Child in Denmark , 2004, American Journal of Gastroenterology.

[40]  A. Ekbom,et al.  Appendectomy and protection against ulcerative colitis. , 2001, The New England journal of medicine.

[41]  P. Dagnelie,et al.  Diet as a risk factor for the development of ulcerative colitis , 2000, American Journal of Gastroenterology.

[42]  J. Hogenesch,et al.  The PAS superfamily: sensors of environmental and developmental signals. , 2000, Annual review of pharmacology and toxicology.

[43]  D Spiegelman,et al.  Dietary fat and coronary heart disease: a comparison of approaches for adjusting for total energy intake and modeling repeated dietary measurements. , 1999, American journal of epidemiology.

[44]  W. Willett,et al.  Dietary fiber and the risk of colorectal cancer and adenoma in women. , 1999, The New England journal of medicine.

[45]  S. Reif,et al.  Pre-illness dietary factors in inflammatory bowel disease. , 1997, Gut.

[46]  G A Colditz,et al.  Food-based validation of a dietary questionnaire: the effects of week-to-week variation in food consumption. , 1989, International journal of epidemiology.

[47]  W. Willett,et al.  Reproducibility and validity of a semiquantitative food frequency questionnaire. , 1985, American journal of epidemiology.

[48]  C. FordAlexander,et al.  ULCERATIVE colitis. , 1997, Journal of the American Medical Association.