Assessing Highly Processed Food Consumption in Patients with Inflammatory Bowel Disease: Application of the German...

Background/Objectives: The consumption of highly processed foods (HPFs) is increasing on a global scale, and these foods have been associated with non-communicable diseases (NCDs). In particular, the consumption of HPFs has been associated with the intensification of inflammatory responses, with these foods being implicated in the exacerbation of chronic inflammatory conditions. Conversely, ultra-processed foods (UPFs) have been indicated as a possible factor in the pathogenesis of inflammatory bowel disease (IBD), particularly Crohn's disease (CD). Methods: From October 2023 to October 2024, 275 patients with IBD were screened at a tertiary referral center. This study's control cohort comprises 101 individuals from the local population. All study participants answered a questionnaire asking about the participants' sex, body type and weight, height, age, marital status, employment, and other sociodemographic information. All subjects had to complete a food frequency questionnaire (FFQ) and the German version of the Screening Questionnaire of Highly Processed Food Consumption (sQ-HPF). IBD patients answered questions about their disease course and history as well as objective parameters of inflammation have been collected. Results: The sQ-HPF (%) showed significant differences (p < 0.001; g = -0.5) between the IBD cohort and the control group, suggesting higher HPF consumption within the IBD cohort. A subsequent analysis of the IBD cohort found no significant difference by disease type (Crohn's disease: p = 0.441; g = -0.1; ulcerative colitis: p = 0.170; g = -0.3) or sex (women: p = 0.219; g = 0.2; men: p = 0.522; g = 0.1), but men with colitis did show higher HPF% compared to women with the same diagnosis. Spearman's rho revealed no significant correlation between fecal calprotectin and HPF% in men with CD (p = 0.155, r = 0.191) or women with CD (p = 0.836, r = 0.026), and no correlation in men with UC (p = 0.707, r = 0.057) or women with UC (p = 0.560, r = -0.099). IBD health-related quality of life showed a significant positive correlation with HPF consumption in CD men (p = 0.026, r = 0.278), but not in CD women (p = 0.539, r = 0.075). No significant correlations between HPF consumption and health-related quality of life have been found in UC (men: p = 0.663, r = -0.064; women: p = 0.445, r = 0.121). Conclusions: The German version of the sQ-HPF is a reliable tool for rapid screening of habitual HPF% consumption in IBD patients. The findings of this analysis indicate a clear deviation from the recommended nutritional regimens for IBD, emphasizing the imperative for further investigation and the potential development of interventions to address these dietary discrepancies, with the ultimate goal of optimizing health outcomes for these patients.