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Adherence to a Mediterranean Diet Is Associated With a Lower Risk of Later-Onset Crohn's Disease: Results From Two Large Prospective Cohort Studies


Adherence to a Mediterranean Diet Is Associated With a Lower Risk of Later-Onset Crohn's Disease: Results From Two Large Prospective Cohort Studies

Hamed Khalili et al. Gut.


Objective: To examine the relationship between Mediterranean diet and risk of later-onset Crohn's disease (CD) or ulcerative colitis (UC).

Design: We conducted a prospective cohort study of 83 147 participants (age range: 45-79 years) enrolled in the Cohort of Swedish Men and Swedish Mammography Cohort. A validated food frequency questionnaire was used to calculate an adherence score to a modified Mediterranean diet (mMED) at baseline in 1997. Incident diagnoses of CD and UC were ascertained from the Swedish Patient Register. We used Cox proportional hazards modelling to calculate HRs and 95% CI.

Results: Through December of 2017, we confirmed 164 incident cases of CD and 395 incident cases of UC with an average follow-up of 17 years. Higher mMED score was associated with a lower risk of CD (Ptrend=0.03) but not UC (Ptrend=0.61). Compared with participants in the lowest category of mMED score (0-2), there was a statistically significant lower risk of CD (HR=0.42, 95% CI 0.22 to 0.80) but not UC (HR=1.08, 95% CI 0.74 to 1.58). These associations were not modified by age, sex, education level, body mass index or smoking (all Pinteraction >0.30). The prevalence of poor adherence to a Mediterranean diet (mMED score=0-2) was 27% in our cohorts, conferring a population attributable risk of 12% for later-onset CD.

Conclusion: In two prospective studies, greater adherence to a Mediterranean diet was associated with a significantly lower risk of later-onset CD.

Keywords: Crohn's disease; elderly; epidemiology; inflammatory bowel disease; ulcerative colitis.

Conflict of interest statement

Competing interests: HK receives consulting fees from Abbvie. HK also receives grant support from Takeda and Pfizer. ATC receives consulting fees from Janssen, Pfizer and Bayer Pharma AG. SC has received consulting fees from Abbvie, Takeda and Ferring. OO has been Principal Investigaor (PI) on projects at Karolinska Institutet partly financed by investigator-initiated grants from Janssen, Ferring, Takeda and Pfizer. None of those studies have any relation to this study. Karolinska Institutet has received fees for OO's lectures and participation on advisory boards from Janssen, Ferring, Takeda and Pfizer regarding topics not related to this study. OO was supported by grants from the Swedish Medical Society (Project grants; Fund for Research in Gastroenterology; and Ihre Foundation), Mag-tarmfonden, Karolinska Institutet Foundations, Swedish Foundation for Strategic Research and Regional Agreement on Medical Training and Clinical Research between Stockholm County Council and Karolinska Institutet. JFL coordinates a study on behalf of the Swedish IBD quality register (SWIBREG). This study has received funding from Janssen.

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