Food Insecurity, Diet, and Clinical Outcomes in Pediatric Inflammatory Bowel Disease: The Role of Unprocessed Foods

Food insecurity (FI) is associated with lower diet quality and higher intake of ultra-processed foods, which contribute to inflammatory bowel disease (IBD). The role of FI and dietary patterns in pediatric IBD remains understudied. We aimed to assess FI prevalence, dietary intake, and clinical outcomes in newly diagnosed pediatric IBD patients.

This single-center cohort included patients aged 5-17 years. Caregivers completed the United States Department of Agriculture Household Food Security Survey Module. Dietary intake was classified according to the NOVA classification. Clinical outcomes, including remission, healthcare utilization, and mucosal healing, were assessed over 12 months. Similarity Network Fusion was used to integrate dietary, demographic, and clinical data to identify patient subtypes, which were then compared for baseline characteristics and clinical outcomes.

Among 120 patients, 14% reported FI. Food-insecure families lived in areas of greater social deprivation (0.27 vs 0.25, P < .001) and had public insurance (65% vs 18%, P < .001). Similarity Network Fusion identified 2 patient clusters primarily distinguished by unprocessed food intake, age, race, and insurance. Cluster one (younger, more racially diverse, and more public insurance) presented with more moderate/severe disease but achieved comparable normalization of labs and greater improvement in body mass index z-score (0.54 vs 0.27, P = .05) after controlling for biologic use. No differences were found in ultra-processed foods intake, FI, biologic utilization, clinical remission, mucosal healing, or healthcare utilization at 12 months.

Greater unprocessed food intake was linked to improved outcomes, highlighting the potential role of diet quality in disease management in pediatric IBD.