P0768 Ultra Processed Food in Inflammatory Bowel Disease – Friend or Foe? An examination into the contribution of UPFs to nutrient intake in an IBD remission cohort
Authors: Katarachia V , Westoby C , McDonnell M , Sartain S , Cummings J R F , Wooton S ,   INTICO 2
Published: January 2025

Abstract

Background
Ultra-processed foods (UPFs) and their effect on the gut microbiome and their role in the pathogenesis and activity of inflammatory bowel disease (IBD) are attracting increasing interest. Dietary restrictions in Crohn’s Disease (CD) are common, whether self-imposed or result from adherence to advice from health professionals1. Increasing attention in UPFs may lead to further food restrictions and impact on nutrient intake. This study investigated the intake of UPFs of adults with CD during disease remission and explored their contribution to overall macro and micronutrient intake.

Methods
195 CD outpatients in clinical remission (HBI &lt;5 and faecal calprotectin &lt;250µg) were recruited from a single UK IBD centre as part of the INTICO 2 observational study. Seven-day food diaries were electronically recorded (Nutritics® Libro) and used to determine dietary adequacy (number of nutrients &lt;LRNI). UPF intake was determined using NOVA Scoring System2 to determine UPF (NOVA 4) intake by two registered dietitians. Product ingredient lists were examined to assign a NOVA score. Consensus on NOVA Scoring was achieved, and a data dictionary was prospectively updated to justify the assigned score.

Results
Mean Nova 4 score was 39.8 (SD 15.7) per 7 day food diary. Inadequacies of micronutrient intake were common and often multiple, with a mean of 6(SD 4) micronutrients below the LRNI per subject. UPFs contributed significantly to overall macro and micronutrient intake from food with 54% energy, 60% carbohydrates, 55% fat and 50% fibre intake derived from foods categorised as NOVA 4. There was no association between NOVA 4 intake and the degree of nutrient inadequacy as the number of nutrients below RNI in this cohort (Pearson’s Correlation P=0.629). Figure 1 and 2 describe the contribution of each NOVA group to micronutrients and fibre respectively.

Conclusion
In a CD remission cohort, UPF intake as captured by NOVA score was comparable with what was seen in other reports of healthy adults and other studies of patients with IBD. Eating more UPFs was not associated with a lower intake of micronutrients. Importantly, food categorised as NOVA-4 contributed to a significant proportion of energy, fibre, and micronutrient intake. NOVA scoring does not differentiate between UPFs high in fat, sugar, and salt and those that are not. Advice to "avoid UPFs" must be balanced against the potential consequences of reducing micronutrient intake, especially in those with low or marginal nutrient intakes. A targeted approach to reduce the intake of UPFs that provide little nutritional value is required to maintain nutrient intake.

References
1)Holt D.Q., Strauss B.J. & Moore G.T. (2017) Patients with inflammatory bowel disease and their treating clinicians have different views regarding diet. J Hum Nutr Diet. 30, 66–72 doi: 10.1111/jhn.12400
2)SACN statement on processed foods and health. GOV.UK. https://www.gov.uk/government/publications/sacn-statement-on-processed-foods-and-healthOffice. SACN statement on processed foods and health - summary report. GOV.UK. Published July 11, 2023. https://www.gov.uk/government/publications/sacn-statement-on-processed-foods-and-health/sacn-statement-on-processed-foods-and-health-summary-report#results

Figure 1: Micronutrient intake characterised by NOVA score

Figure 2: Fibre intake characterised by NOVA Score