Poor quality, pro-inflammatory diet in children with Crohn’s disease and healthy controls: a cross-sectional study

Diet plays a critical role in the development and progression of Crohn's disease (CD). Dietary indices are important tools to evaluate diet quality and inflammatory potential, and we investigated their associations with paediatric CD compared with healthy children. A cross-sectional study including 144 children with CD (122 with clinically active and twenty-two with quiescent disease) and fifty-seven healthy controls aged 6-18 years was conducted. Dietary intake was estimated using three 24-h dietary recalls. Diet quality was assessed using the Healthy Eating Index (HEI)-2015, alternate Mediterranean diet (aMed) score and dietary inflammatory potential using the modified Children-Dietary Inflammatory Index (mC-DII). Children with active CD had lower total HEI-2015 and aMed scores than healthy controls. A similar pro-inflammatory mC-DII score was found across the three groups. A higher mC-DII score in patients with CD was associated with higher intake of refined sugars, saturated fats and protein, and lower intake of whole grains and dairy, identifying dietary components contributing to dietary nflammatory potential. Similarly, healthy children in the highest mC-DII tertile consumed more added sugars and sodium and fewer whole grains, fruits, vegetables and plant proteins. Fibre intake was significantly lower in children with active CD (median %DRI: 37·0 (22·6-48·3) vs 41·2 (34·1-49·1) vs 45·8 (35·7-62·0), P < 0·001). Overall both children with CD and healthy children in this cohort consume a poor-quality, pro-inflammatory diet low in fibre, but the quality and fibre content are significantly lower in children with active CD. Future randomised controlled trials are needed to evaluate dietary interventions on the risk and progression of paediatric CD.