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Pre-Diagnosis Dietary Pattern Differences in Australian Children with Inflammatory Bowel Disease: Exposure Across
Nisha Thacker1,2,3, Shoma Dutt3,4, Emily C Hoedt5,6
1School of Health Sciences, College of Health Medicine and Wellbeing, The University of Newcastle, Newcastle, NSW 2308, Australia.
Insights
This study found that non-Caucasian children with newly diagnosed paediatric inflammatory bowel disease (PIBD) had lower vitamin D levels and a Western diet, suggesting non-genetic factors may play a role. Low plant food diversity was common across all ethnicities.
Area of Science:
- Pediatric Gastroenterology
- Nutritional Science
- Epidemiology
Background:
- Dietary intake in newly diagnosed multi-ethnic paediatric inflammatory bowel disease (PIBD) is poorly understood.
- Environmental factors and diet are increasingly implicated in the development of IBD.
- Understanding pre-diagnosis factors is crucial for early intervention in PIBD.
Purpose of the Study:
- To describe the pre-diagnosis diet and environmental factors in children with newly diagnosed PIBD.
- To investigate potential ethnic differences in dietary patterns and vitamin D levels in PIBD.
- To explore the role of non-genetic factors in PIBD development.
Main Methods:
- Pilot cross-sectional study conducted between February 2022 and February 2023.
- Involved 56 children with newly diagnosed PIBD (Crohn's disease and Ulcerative Colitis).
- Data collected on dietary intake, environmental factors, and serum vitamin D levels.
Main Results:
- Non-Caucasian children had significantly lower serum vitamin D levels compared to Caucasian children.
- Western-style dietary patterns, including processed meats and fast food, were prevalent.
- Low intake of whole-food plant protein and low plant food diversity were observed across ethnicities.
- A higher proportion of non-Caucasian children with Crohn's disease reported a diet differing from traditional patterns.
Conclusions:
- Lower vitamin D levels and Western diet in non-Caucasian PIBD patients suggest non-genetic factors are important.
- Further research into diet and environmental factors in migrant populations with PIBD is recommended.
- Low pre-diagnosis plant food diversity is a novel finding, but causality requires cautious interpretation due to study limitations.
Background/Objectives:
The pre-diagnosis dietary intake in newly diagnosed multi-ethnic paediatric inflammatory bowel disease (PIBD) is not well understood. This study aimed to describe the pre-diagnosis diet and environmental factors in children with newly diagnosed PIBD attending a single Australian tertiary children's hospital.
Methods:
A pilot cross-sectional study was conducted from February 2022 to February 2023 involving children with newly diagnosed PIBD.
Results:
Of 56 children confirmed with PIBD, 54% had Crohn's disease (CD)-mean ± SD age, 11.55 years ± 2.84-and 46% had Ulcerative Colitis (UC)-11.50 years ± 2.94 (45%, non-Caucasian). More Caucasians had an IBD family history (48.3% vs. 20%; p = 0.02 *). Non-Caucasian children demonstrated significantly lower mean serum vitamin D levels than Caucasian children (42.5 vs. 69 nmol/L; p ≤ 0.001 ***). Most children across ethnicities for both IBD subtypes had 'regular' intakes of red meat, whereas more Caucasian children had 'regular' intakes of processed/deli meat (72% vs. 39%; p = 0.02 *). A total of 64% of non-Caucasian children with CD reported a usual pre-diagnosis diet that differed from the traditional diet, compared to 42% with UC (p = 0.29). When eating out, fast foods were chosen regularly by most children with PIBD. Pre-diagnosis dietary intake data indicated that most with PIBD 'rarely/never' had whole-food sources of plant protein and had 'infrequent' intake of rice. Plant food diversity was low (mean 11 types/week).
Conclusions:
The significantly lower likelihood of IBD family history, along with relatively lower vitamin D levels, and the predominance of a Western-style dietary pattern among non-Caucasian children are compatible with the hypothesis that non-genetic factors may be important in PIBD, warranting further investigation into diet and environmental factors in this group. Further investigation of the pre-disease modifiable non-genetic factors contributing to the development of PIBD in the migrant population group is recommended. The finding across ethnicities of low pre-diagnosis plant food diversity was novel; however, due to the lack of healthy controls and the use of a novel but non-validated exposome tool, causality associations should be interpreted cautiously.
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