Abstract
Background & Aims: Little is known about inflammatory bowel disease (IBD) progression and dietary impacts in areas with rising incidence. The GIVES-21 consortium, established in 2021, includes 106 hospitals across 18 regions (13 in Asia, 4 in Latin America, 1 in Africa). We aimed to investigate IBD incidence, progression, and dietary influences.
Methods: From 2021 to 2023, we recruited 828 newly diagnosed IBD patients (508 ulcerative colitis (UC), 284 Crohn’s disease (CD), 36 IBD unclassified; median age 37.8 years). We examined disease course severity and mortality. High- and low-income countries were classified according to gross national income by World Bank Atlas. Food additives intake was quantified using Current Additive Intake Questionnaires validated questionnaire developed by expert dietitians, at recruitment, 6 months, and 12 months. It assesses intake frequency and amount over the past year. Maximal exposure to food additives (aluminosilicates, aspartame, carboxymethylcellulose, carrageenan, polysorbate-80, saccharin, sucralose, sulphites, titanium dioxide) was estimated in mg/year based on the maximal permissible level (MPL) of additives in food, or concentration data from literature. Logistic regression was used to identify dietary risk factors associated with disease progression, biologic use, and surgery needs.
Results: The cumulative probability of CD progressing from inflammatory' to stricturing or penetrating disease at 1 year was 17.9%. A total of 95 CD (33.5%) and 59 UC patients (10.8%) required biologic within 1 year of diagnosis. Presence of B2/B3 phenotype (Hazard ratio (HR) 2.77; 95% CI 1.53-5.02; p<0.001) and perianal Crohn’s disease (HR 2.99; 95%CI 1.35-6.61; p=0.007) was associated with increased risk of biologic use in CD. For UC, E3 phenotype was associated with 3.7-fold greater risk of requiring biologics (HR 3.72; 95%CI 2.12-6.52; p<0.001). In both CD and UC, high-income countries reported significantly higher biologic use compared with low- income countries (CD: 38.2% vs. 17.9%; p=0.002; UC: 15.5% vs. 3.4%, p<0.001). Within first year, 21.2% CD and 3.7% UC patients underwent surgery. Presence of B2/B3 phenotype was associated with 2.7-fold increased risk of surgery in CD (HR 2.67; 95%CI 1.29-5.53; p= 0.008). Overall, 23% of IBD patients developed extra-intestinal manifestation in first year of diagnosis. Overall mortality was 0.5%. Amount of food additives intake was not associated with subsequent biologic use, surgical requirement and change from inflammatory to stricturing or penetrating disease in CD and UC.
Conclusion: This population-based study shows a significant proportion of CD patients progressed to complicated phenotypes in their first year, with notable treatment disparities based on national income. The lack of correlation between food additives and disease outcomes suggests need for further exploration of other dietary factors to enhance IBD understanding and patient care across diverse regions.