Dietary Inflammatory Potential and Risk of Crohn's Disease and Ulcerative Colitis

Gastroenterology. 2020 Sep;159(3):873-883.e1. doi: 10.1053/j.gastro.2020.05.011. Epub 2020 May 7.


Background & aims: Inflammation is a potential mechanism through which diet modulates the onset of inflammatory bowel disease. We analyzed data from 3 large prospective cohorts to determine the effects of dietary inflammatory potential on the risk of developing Crohn's disease (CD) and ulcerative colitis (UC).

Methods: We collected data from 166,903 women and 41,931 men in the Nurses' Health Study (1984-2014), Nurses' Health Study II (1991-2015), and Health Professionals Follow-up Study (1986-2012). Empirical dietary inflammatory pattern (EDIP) scores were calculated based on the weighted sums of 18 food groups obtained via food frequency questionnaires. Self-reported CD and UC were confirmed by medical record review. Cox proportional hazards models were used to calculate hazard ratios (HRs) and 95% confidence intervals (CIs).

Results: We documented 328 cases of CD and 428 cases of UC over 4,949,938 person-years of follow-up. The median age at IBD diagnosis was 55 years (range 29-85 years). Compared with participants in the lowest quartile of cumulative average EDIP score, those in the highest quartile (highest dietary inflammatory potential) had a 51% higher risk of CD (HR 1.51; 95% CI 1.10-2.07; Ptrend = .01). Compared with participants with persistently low EDIP scores (at 2 time points, separated by 8 years), those with a shift from a low to high inflammatory potential of diet or persistently consumed a proinflammatory diet had greater risk of CD (HR 2.05; 95% CI 1.10-3.79 and HR 1.77; 95% CI 1.10-2.84). In contrast, dietary inflammatory potential was not associated with the risk of developing UC (Ptrend = .62).

Conclusions: In an analysis of 3 large prospective cohorts, we found dietary patterns with high inflammatory potential to be associated with increased risk of CD but not UC.

Keywords: Food; Inflammatory Bowel Disease; Lifestyle Factor; Nutrition.

Publication types

  • Research Support, N.I.H., Extramural
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adult
  • Aged
  • Aged, 80 and over
  • Colitis, Ulcerative / epidemiology*
  • Colitis, Ulcerative / immunology
  • Colitis, Ulcerative / prevention & control
  • Crohn Disease / epidemiology*
  • Crohn Disease / immunology
  • Crohn Disease / prevention & control
  • Diet Surveys / statistics & numerical data*
  • Feeding Behavior / physiology*
  • Female
  • Follow-Up Studies
  • Humans
  • Incidence
  • Inflammation / complications
  • Inflammation / immunology
  • Inflammation / prevention & control
  • Intestinal Mucosa / immunology
  • Male
  • Middle Aged
  • Observational Studies as Topic
  • Prospective Studies
  • Risk Assessment / statistics & numerical data
  • Risk Factors
  • Self Report / statistics & numerical data
  • United States / epidemiology