P0300 Ultra-processed food consumption affects body composition in a cohort of italian patients with inflammatory bowel disease
Authors: Ambrosio C , Compare D , Sgamato C , Minieri S , Zerella G , Cinque S , Marchitto S A , Nardone G , Compare D , Sgamato C , Ambrosio C , Minieri S , Marchitto S A , Cinque S , Zerella G , Nardone G 
Published: January 2025

Abstract

Background
Diet is a key factor in the development of IBD, which are showing rising incidence in industrialized countries, where the “Western” diet, rich in ultra-processed foods (UPF), is prevalent. Consumption of UPFs has been linked to an increased risk of both IBD developing and relapse. However, there is limited data on the relationship between UPF intake and body composition in IBD patients. We aimed to evaluate the impact of UPF consumption on body composition in individuals with IBD.

Methods
In this single-center observational study, we enrolled adult IBD patients. Exclusion criteria were active disease, defined as Harvey-Bradshaw Index &gt; 5 for Crohn’s disease (CD) and Partial Mayo Score &gt; 2 for Ulcerative Colitis (UC), pregnant or breastfeeding women, use of corticosteroids, high physical activity as assessed by the International Physical Activity Questionnaire (IPAQ), and previous bowel surgery. UPF consumption was assessed using country-specific validated food frequency questionnaires (FFQ), whose evaluated foods were categorized based on the NOVA classification into 4 classes according to their degree of processing. The percentage of UPF consumption was divided into 3 tertiles (T1=low; T3=high). Body composition was assessed through bioimpedance analysis. Continuous variables were expressed as mean±standard deviation (SD) or as median and interquartile range (IQR) according to their distribution assessed by the Kolmogorov-Smirnov test. Frequencies were calculated for the categorical variables. The Mann-Whitney rank-sum test, t-test, or ANOVA test was used to compare continuous variables; the Chi-square and Fisher’s exact test were used to compare categorical variables. Multiple linear regression analysis was used for fatty-free mass (FFM) predicted by UPF consumption.

Results
We enrolled 40 IBD patients (12 UC and 28 CD). The mean age and BMI were 42.5±16.2 years and 25±4.4 kg/m², respectively. UPF consumption was higher in CD than UC patients, both in terms of g/day (823±312 vs 609±248, p=0.04) and % weight (20.3±6.9 vs 15.1±6.1, p=0.028). Patients with T3 UPF consumption compared to T1 had a lower age (37.69±10.7 vs 55.9±17, p=0.001) and lower FFM (0.69±0.06 vs 0.75±0.09, p=0.012). When adjusting for age, sex and disease type the percentage of FFM was lower in T3 compared with T1 (β= -0.56; p=0.002). Higher UPF consumption was associated with FFM reduction in younger IBD patients.

Conclusion
Our findings emphasize the need for nutrition counseling in IBD patients, focusing on reducing the intake of UPFs, which can exacerbate the disease either by directly inflaming the bowel or by negatively impacting body composition. Further large-scale prospective studies are needed to validate our results.

References
1.Elly Mertens, Chiara Colizzi, Josè L. Penalvo. Ultra-processed food consumption in adults across Europe. 61(3):1521-1539.
2.Narula N, Wong ECL, Dehghan M, et al. Association of ultra-processed food intake with risk of inflammatory bowel disease: Prospective cohort study. BMJ 374:n1554
3.Kathy Vagianos, Casandra Dolovich, KelcieWitges, Lesley A.Graff, Charles N. Bernstei. Ultra-Processed Food, Disease Activity, andInflammation in Ulcerative Colitis: The Manitoba Living With IBD Study. The American College of Gastroenterology 2024. 119(6):1102-1109.
4.Carlos A Monteiro, Geoffrey Cannon, Renata B Levy; Jean-Claude Moubarac, Maria LC Louzada, Fernanda Rauber. Ultra-processed foods: what they are and how to identify them. Public Health Nutrition 2018. 936-941
5.Eva Visser, Judith Wellens, Joao Sabino. Ultra-processed foods as a possible culprit for the rising prevalence of inflammatory bowel diseases. Frontiers in Medicine 2022.9:1058373
6.Dinu M, Bonaccio M, Martini D, Madarena MP, Vitale M, Pagliai G, Esposito S, Ferraris C, Guglielmetti M, Rosi A, Angelino D. Reproducibility and validity of a food-frequency questionnaire (NFFQ) to assess food consumption based on the NOVA classification in adults. Int J Food Sci Nutr. 2021 Sep;72(6):861-869