| Background and aimsCrohn's disease(CD)is a chronic inflammatory disease that can affect any part of the digestive tract.Although the etiology of CD remains unclear,it is generally believed that genetic and environmental factors play a role in the pathogenesis of CD.Recently,there are increasing interests in the effect of dietary factors on CD.Studies report that dietary nutrients could influence the development of CD by affecting intestinal mucosal permeability,inflammatory factor secretion or intestinal flora.Currently,the epidemiological study about the relationship between dietary nutrients intakes and risk of CD is relatively limited and the results of these studies are quite different.And there is no research investigating the correlation between dietary nutrients intakes and CD risk in China.In addition,researches indicate that the inflammatory level of diet may have an impact on the intestinal inflammatory level,and the dietary inflammatory index(DII)has been used to evaluate the inflammatory potential of diet.At present,there is no study to evaluate the association between the inflammatory potential of diet and risk of CD.Therefore,a multicenter case-control study was performed to examine the role of dietary nutrients intakes and dietary inflammatory potential in the development of CD.MethodsCD patients and 1:2 matched controls were recruited from August 2019 to January 2020 in six referral hospitals in China,including the First Affiliated Hospital of Zhejiang University School of Medicine,Southern Medical University Nanfang Hospital,Jiang Su Province Hospital,Zhongshan Hospital of Fudan University,Ningbo First Hospital,and Peking University People's Hospital.Baseline clinical data and dietary data were collected by trained researchers through face-to-face interviews.Dietary information was measured using a validated semi-quantitative Chinese food frequency questionnaire.The inflammatory potential of diet was assessed by energy-adjusted DII(E-DII).Odds ratio(OR)and 95% confidence intervals(CI)were estimated using logistic regression models after adjusting for confounders.ResultsA total of 142 CD cases and 284 matched controls were included in this study.The increasing dietary intakes of total carbohydrates(OR = 0.47,95% CI: 0.27–0.82 P = 0.006),n-6 polyunsaturated fatty acids(PUFAs)(OR = 0.51,95% CI: 0.30–0.86,P = 0.008),vitamin E(OR = 0.27,95% CI: 0.15–0.50,P <0.001),folate(OR = 0.41,95% CI: 0.24–0.71,P = 0.001)and manganese(OR = 0.33,95% CI: 0.18–0.58,P <0.001)reduced the risk of CD and the increased intakes of fat(OR = 2.44,95% CI: 1.40–4.27,P = 0.001),monounsaturated fatty acids(MUFAs)(OR = 2.83,95% CI: 1.61–4.98,P <0.001),cholesterol(OR = 3.11,95% CI: 1.75–5.51,P <0.001),vitamin D(OR = 2.49,95% CI: 1.43–4.43,P = 0.004),vitamin B1(OR = 1.69,95% CI: 1.03–2.77,P = 0.021),vitamin B2(OR = 1.73,95% CI: 1.01–2.97,P = 0.023),phosphorus(OR = 1.73,95% CI: 1.05-3.05,P = 0.031),potassium(OR = 1.79,95% CI: 1.05–3.05,P = 0.019),sodium(OR = 1.68,95% CI: 0.99–2.84,P = 0.035),selenium(OR = 0.77,95% CI: 1.07–2.94,P = 0.010)and copper(OR = 2.02,95% CI: 1.19-3.42,P = 0.006)increased the CD risk.Dietary fiber,total protein,animal protein,saturated fatty acids(SFAs),PUFAs,n-3 PUFAs,vitamin A,vitamin B6,vitamin C,niacin,calcium,magnesium,iron,iodine and zinc had no significant association with the risk of CD(all P >0.05).Participants with higher E-DII scores had a greater risk of CD when E-DII was used as a continuous variable(OR = 4.80,95% CI: 2.86–8.06,P <0.001).When E-DII was expressed as tertiles,subjects in the highest tertile were more likely to have CD compared to those in the lowest tertile(OR = 4.27,95% CI: 2.32–7.86,P <0.001).In subsequently stratified analysis,the significantly positive correlation between E-DII and CD was not affected by the location of CD,but was modified by the behavior of CD,age,gender,smoking status and drinking status with a positive association observed in non-strictured and non-penetrated CD patients,strictured CD patients,individuals aged ?40 years,men,non-smokers and non-drinkers.ConclusionsOur results suggest that dietary factors are closely related to risk of CD.Dietary consumptions of carbohydrates,n-6 PUFAs,vitamin E,folate and manganese are associated with lower CD risk,while dietary intakes of fat,MUFAs,cholesterol,vitamin D,vitamin B1,vitamin B2,phosphorus,potassium,sodium,selenium and copper are correlated with higher risk of developing CD.A pro-inflammatory diet is related with an increased risk for CD.Further studies are necessary to verify these findings and to explore the potential mechanisms. |
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