Carbohydrate Intake in the Etiology of Crohn's Disease and Ulcerative Colitis.
Chan, Simon S. M. MB BChir, PhD 1,2; Luben, Robert BSc 3; van Schaik, Fiona MD, PhD 4; Oldenburg, Bas MD, PhD 4; Bueno-de-Mesquita, H. Bas MD, PhD 4,5,6; Hallmans, Goran MD, PhD 7; Karling, Pontus PhD 8; Lindgren, Stefan MD, PhD 9; Grip, Olof MD, PhD 9; Key, Timothy DPhil 10; Crowe, Francesca L. PhD 10; Bergmann, Manuela M. PhD 11; Overvad, Kim PhD 12; Palli, Domenico MD, MPH 13; Masala, Giovanna MD, PH 13; Khaw, Kay-Tee MB BChir 3; Racine, Antoine MD, MSc 14,15,16; Carbonnel, Franck MD, PhD 14,15,16; Boutron-Ruault, Marie-Christine MD, PhD 14,15; Olsen, Anja PhD, MSc 17; Tjonneland, Anne PhD, DMSc 17; Kaaks, Rudolf PhD 18; Tumino, Rosario MD, MSc 19; Trichopoulou, Antonia MD, PhD 20; Hart, Andrew R. MB ChB, MD 1,2
Inflammatory Bowel Diseases.
20(11):2013-2021, November 2014.
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Background: Diet may have a role in the etiology of inflammatory bowel disease. In previous studies, the associations between increased intakes of carbohydrates, sugar, starch, and inflammatory bowel disease are inconsistent. However, few prospective studies have investigated the associations between these macronutrients and incident Crohn's disease (CD) or ulcerative colitis (UC).
Methods: A total of 401,326 men and women were recruited between 1991 and 1998. At recruitment, dietary intakes of carbohydrate, sugar, and starch were measured using validated food frequency questionnaires. The cohort was monitored identifying participants who developed incident CD or UC. Cases were matched with 4 controls, and odds ratios were calculated for quintiles of total carbohydrate, sugar, and starch intakes adjusted for total energy intake, body mass index, and smoking.
Results: One hundred ten participants developed CD, and 244 participants developed UC during follow-up. The adjusted odds ratio for the highest versus the lowest quintiles of total carbohydrate intake for CD was 0.87, 95% CI = 0.24 to 3.12 and for UC 1.46, 95% CI = 0.62 to 3.46, with no significant trends across quintiles for either (CD, Ptrend = 0.70; UC, Ptrend = 0.41). Similarly, no associations were observed with intakes of total sugar (CD, Ptrend = 0.50; UC, Ptrend = 0.71) or starch (CD, Ptrend = 0.69; UC, Ptrend = 0.17).
Conclusions: The lack of associations with these nutrients is in agreement with many case-control studies that have not identified associations with CD or UC. As there is biological plausibility for how specific carbohydrates could have an etiological role in inflammatory bowel disease, future epidemiological work should assess individual carbohydrates, although there does not seem to be a macronutrient effect.
(C) Crohn's & Colitis Foundation of America, Inc.