Department of Gastroenterology, The Third Xiangya Hospital, Central South University, Changsha, China.
Center for Global Health, Zhejiang University School of Medicine, Hangzhou, China.
J Nutr. 2023 Aug;153(8):2274-2282. doi: 10.1016/j.tjnut.2023.06.013. Epub 2023 Jun 15.
Evidence for the effects of dietary fiber on adverse outcomes in individuals with inflammatory bowel disease (IBD) is insufficient and controversial.
We aimed to prospectively explore the association between dietary fiber intake and the risk of IBD-related surgery.
We identified 5580 individuals with diagnosed IBD [Crohn disease (CD, n = 1908) and ulcerative colitis (UC, n = 3672)] at baseline in the UK Biobank via electronic medical records and self-reported information. Dietary fiber intake was estimated by a partial fiber score derived from a valid food frequency questionnaire. IBD-related surgery (enterotomy, perianal surgery, and others) was ascertained via inpatient data. Cox proportional model was applied to estimate hazard ratios with 95% confidence intervals (CIs) of dietary fiber in quartiles for the risk of IBD-related surgery.
During a mean follow-up period of 11.2 y, we documented 624 IBD-related surgery among 5580 individuals with IBD (mean age, 57.3; 52.8% females). Compared with individuals in the lowest quartiles, those with second to fourth quartiles of fiber intake were associated with 23% (95% CI: 5%, 38%, P = 0.015), 29% (95% CI: 11%, 43%, P = 0.003), and 28% (95% CI: 10%, 43%, P = 0.005) reduced risk (P-trend = 0.002) of IBD-related surgery. Similar associations were observed in CD (P-trend = 0.005) but not UC (P-trend = 0.131). We observed inverse associations of fiber in vegetables and fruits (P-trend = 0.017 and 0.007) but positive associations of fiber in bread (P-trend = 0.046) with the risk of IBD-related surgery.
Higher intake of fiber is associated with reduced IBD-related surgery risk in patients with IBD with CD but not UC.
膳食纤维对炎症性肠病（IBD）患者不良结局影响的证据不足且存在争议。
我们旨在前瞻性探索膳食纤维摄入与 IBD 相关手术风险之间的关系。
我们通过电子病历和自我报告信息，在英国生物库中确定了 5580 名确诊为 IBD 的个体（CD 患者 1908 例，UC 患者 3672 例），并基于有效食物频率问卷得出膳食纤维的部分纤维评分来估计膳食纤维摄入量。通过住院数据确定 IBD 相关手术（肠切开术、肛周手术等）。应用 Cox 比例风险模型估计四分位数膳食纤维摄入量与 IBD 相关手术风险的风险比（HR）及其 95%置信区间（CI）。
在平均 11.2 年的随访期间，我们在 5580 名 IBD 患者中记录了 624 例 IBD 相关手术（平均年龄 57.3 岁，52.8%为女性）。与最低四分位数的个体相比，第二至四分位数的膳食纤维摄入量与 23%（95%CI：5%，38%，P = 0.015）、29%（95%CI：11%，43%，P = 0.003）和 28%（95%CI：10%，43%，P = 0.005）的 IBD 相关手术风险降低相关（P 趋势 = 0.002）。在 CD 中也观察到了相似的关联（P 趋势 = 0.005），但在 UC 中未观察到关联（P 趋势 = 0.131）。我们观察到膳食纤维在蔬菜和水果中的摄入量与 IBD 相关手术风险呈负相关（P 趋势 = 0.017 和 0.007），而膳食纤维在面包中的摄入量与 IBD 相关手术风险呈正相关（P 趋势 = 0.046）。
在 CD 患者中，膳食纤维摄入量较高与 IBD 相关手术风险降低相关，但在 UC 患者中则无此关联。
