Journal of the Academy of Nutrition and Dietetics · 2026
Emulsifier Intake in Healthy Controls and Patients with Inflammatory Bowel Disease: A Cross-Sectional Comparative Study with Longitudinal Follow-Up of Long-Term Outcomes.
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Wellens Judith, Debrauwere Mathia, Hoekx Sien, Lenfant Matthias, Vanderstappen Julie, De Maegd Eline, Luppens Martijn, Vissers Eva, Verstockt Bram, Ferrante Marc, Vermeire Séverine, Sabino João
Аннотация
BACKGROUND: Ultra-processed foods (UPFs) and dietary emulsifiers have been linked to inflammatory bowel disease (IBD) pathophysiology, but intake in IBD patients compared to healthy controls (HCs) and their association with clinical outcomes remains incompletely understood.
OBJECTIVE: We hypothesized that IBD patients consume higher amounts of UPFs and emulsifiers than HCs and this associates with long-term IBD-relevant outcomes including hospitalization, surgery and emergency department (ED) visits in patients.
DESIGN: The study has a cross-sectional design comparing dietary intakes between HCs and IBD patients with a longitudinal extension for the IBD cohort only.
PARTICIPANTS/SETTING: 186 subjects (65 HC, 59 Crohn's disease (CD) and 62 ulcerative colitis (UC) patients) were recruited and analyzed. For the cross-sectional study, dietary intake was calculated from Food Frequency Questionnaires in all subjects, complemented by two 24-hour dietary recalls in IBD patients and two prospective food records in HC recruited for an interventional study in Leuven, Belgium (November 2022-April 2023). Patients were recruited at the infusion unit of Leuven University Hospital (September 2023-April 2024) and followed up for one year for the longitudinal assessment. Eligible patients were aged 18-65 years, excluding those who had undergone terminal ileostomy or ileo-anal pouch anastomosis, as well as pregnant or breastfeeding women.
MAIN OUTCOME MEASURE: We cross-sectionally compared the intake of emulsifiers and UPFs between HCs and IBD patients and longitudinally assessed associations of intake of emulsifiers and UPFs with IBD-related outcomes for IBD patients only.
STATISTICAL ANALYSES: Kruskal Wallis with post-hoc Dunn test and Fisher exact test were used to compare UPF and emulsifier intake. Kaplan-Meier survival analysis and log-rank tests were used to assess the association between nutritional intake and IBD-related outcomes. Adjusted analyses for confounding variables including age, sex, disease activity, energy and fiber intake were performed.
RESULTS: While UPF intake (mean ± SD servings) was not different among groups, significantly higher total emulsifier intake was observed in IBD patients, with the lowest consumption in HC (5.64±4.94) followed by UC (8.50±6.13, p=0.003) and highest in CD (9.02±5.28, p=0.0004). After adjustment for confounding emulsifier intake in UC patients (adjusted p=0.002) and CD patients (adjusted p=0.00009) remained higher compared to controls. When stratified by exposure level, Kaplan-Meier estimator curves demonstrated a separation between high- and low-tier consumers, for combined IBD-related adverse related events (p=0.02, HR 2.93 CI 95% 2.34-24.26 for UPFs, and p=0.04, HR 4.85, 95% CI 1.05-22.47 for emulsifiers). In univariate continuous Cox proportional hazards model analysis, number of UPF (p=0.02), but not emulsifier (p=0.08) servings were associated with increased risk of adverse IBD outcomes. However, when modeled in multivariable Cox regression, neither UPF nor emulsifier intake remained a significant independent predictor.
CONCLUSIONS: Intake of emulsifiers, but not UPFs, was higher in IBD patients compared to controls. Although unadjusted analyses suggested an association between higher UPF and emulsifier intake and adverse IBD-related outcomes, neither remained an independent predictor after adjustment for potential confounders, yet larger studies are warranted.
OBJECTIVE: We hypothesized that IBD patients consume higher amounts of UPFs and emulsifiers than HCs and this associates with long-term IBD-relevant outcomes including hospitalization, surgery and emergency department (ED) visits in patients.
DESIGN: The study has a cross-sectional design comparing dietary intakes between HCs and IBD patients with a longitudinal extension for the IBD cohort only.
PARTICIPANTS/SETTING: 186 subjects (65 HC, 59 Crohn's disease (CD) and 62 ulcerative colitis (UC) patients) were recruited and analyzed. For the cross-sectional study, dietary intake was calculated from Food Frequency Questionnaires in all subjects, complemented by two 24-hour dietary recalls in IBD patients and two prospective food records in HC recruited for an interventional study in Leuven, Belgium (November 2022-April 2023). Patients were recruited at the infusion unit of Leuven University Hospital (September 2023-April 2024) and followed up for one year for the longitudinal assessment. Eligible patients were aged 18-65 years, excluding those who had undergone terminal ileostomy or ileo-anal pouch anastomosis, as well as pregnant or breastfeeding women.
MAIN OUTCOME MEASURE: We cross-sectionally compared the intake of emulsifiers and UPFs between HCs and IBD patients and longitudinally assessed associations of intake of emulsifiers and UPFs with IBD-related outcomes for IBD patients only.
STATISTICAL ANALYSES: Kruskal Wallis with post-hoc Dunn test and Fisher exact test were used to compare UPF and emulsifier intake. Kaplan-Meier survival analysis and log-rank tests were used to assess the association between nutritional intake and IBD-related outcomes. Adjusted analyses for confounding variables including age, sex, disease activity, energy and fiber intake were performed.
RESULTS: While UPF intake (mean ± SD servings) was not different among groups, significantly higher total emulsifier intake was observed in IBD patients, with the lowest consumption in HC (5.64±4.94) followed by UC (8.50±6.13, p=0.003) and highest in CD (9.02±5.28, p=0.0004). After adjustment for confounding emulsifier intake in UC patients (adjusted p=0.002) and CD patients (adjusted p=0.00009) remained higher compared to controls. When stratified by exposure level, Kaplan-Meier estimator curves demonstrated a separation between high- and low-tier consumers, for combined IBD-related adverse related events (p=0.02, HR 2.93 CI 95% 2.34-24.26 for UPFs, and p=0.04, HR 4.85, 95% CI 1.05-22.47 for emulsifiers). In univariate continuous Cox proportional hazards model analysis, number of UPF (p=0.02), but not emulsifier (p=0.08) servings were associated with increased risk of adverse IBD outcomes. However, when modeled in multivariable Cox regression, neither UPF nor emulsifier intake remained a significant independent predictor.
CONCLUSIONS: Intake of emulsifiers, but not UPFs, was higher in IBD patients compared to controls. Although unadjusted analyses suggested an association between higher UPF and emulsifier intake and adverse IBD-related outcomes, neither remained an independent predictor after adjustment for potential confounders, yet larger studies are warranted.