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Eating more unprocessed or minimally processed foods was linked to a lower risk of Crohn's disease, with no association seen for ulcerative colitis, according to data on participants in the European Prospective Investigation into Cancer and Nutrition (EPIC) cohort.

Among over 400,000 participants, the highest quartile of unprocessed or minimally processed food consumption was associated with a lower risk of Crohn's disease compared with the lowest quartile (adjusted HR 0.57, 95% CI 0.35-0.93, P-trend<0.01), reported Franck Carbonnel, MD, PhD, of the University Hospital of Bicêtre in Paris, and colleagues.

Specifically, consumption of fruit and vegetables was negatively associated with the risk of Crohn's (aHR for the fourth vs first quartile 0.54, 95% CI 0.34-0.87 and aHR 0.55, 95% CI 0.34-0.91, respectively), they noted in .

However, there was no association observed between unprocessed or minimally processed food consumption and the risk of ulcerative colitis (aHR 0.89, 95% CI 0.65-1.21), nor was there any association between ultra-processed food consumption and the risk of Crohn's disease (aHR 1.48, 95% CI 0.79-2.76) or ulcerative colitis (aHR 0.93, 95% CI 0.61-1.43), Carbonnel and team said.

"This study suggests a beneficial impact of giving preference to the consumption of non-processed/minimally processed foods with regard to CD [Crohn's disease] risk; particularly in persons who are at high risk for this disease such as first-degree relatives of CD patients," they concluded.

The incidence of inflammatory bowel disease (IBD) has been on the rise, especially among older adults, and prior research has suggested a link between diet and IBD risk, Carbonnel's group noted.

The consumption of ultra-processed foods has also increased worldwide and has been associated with risks of hypertension, obesity, diabetes, and cancer, among other conditions. found that a diet pattern with high consumption of sugar/soft drinks and low consumption of vegetables was tied to risk of ulcerative colitis, while the PURE study found that consumption of ultra-processed foods and fried food was associated with a higher risk of IBD, but with no differences between subtypes. Other recent studies have found a link between .

For this study, Carbonnel and colleagues examined data on 413,590 healthy volunteers who completed a validated food frequency intake questionnaire across eight European countries participating in . Participants were stratified into categories of processed food consumption -- ultra-processed or unprocessed/minimally processed -- and then further stratified into quartiles based on the NOVA classification system. The researchers adjusted for location, age, sex, BMI, physical activity, educational level, energy intake, alcohol consumption, and smoking status.

Mean baseline age was 51.7, and 68.6% were women. Over a mean follow-up of 13.2 years, 431 participants developed ulcerative colitis and 179 developed Crohn's disease.

While results remained unchanged after excluding the first couple years of follow-up in a sensitivity analysis, a positive correlation was observed between ultra-processed food intake and Crohn's disease (aHR for the fourth vs first quartile of consumption 2.02, 95% CI 1.00-4.06, P=0.06).

Carbonnel and colleagues acknowledged that residual confounding from unmeasured factors may have occurred. Although IBD cases were based on self-reports that were subsequently verified, some cases may have been missed, they noted. Furthermore, diet was only assessed at baseline and could have changed over time, and findings may not be generalizable to younger individuals.

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