Ultra-processed foods as a possible culprit for the rising prevalence of inflammatory bowel diseases

Abstract

Inflammatory bowel diseases (IBD) are chronic inflammatory disorders of the gastrointestinal tract, and the exact pathogenesis is still unclear. It is believed that IBD develops in response to a complex interaction between the microbiota, environmental factors, and the immune system, in genetically predisposed individuals. Identifying these environmental factors will offer more insight in the development of the disease, and reveal new therapeutic targets for IBD patients. One of the environmental factors that has gained more interest over the last years is our diet. The prevalence of IBD has increased significantly and this increase is thought to be associated with a ‘Western diet', characterized by high intake of fats, added sugar, meat, and ultra-processed foods (UPFs). The UPFs now account for almost 50% of the energy intake in Westernized countries and are therefore an important characteristic of this Western diet. UPFs are characterized by higher amounts of salt, fat, sugar and the presence of different food additives. Epidemiological studies have found associations between UPF intake and a range of non-communicable diseases, including inflammatory bowel disease (IBD). Preclinical and clinical evidence suggest that non-nutritive ingredients and additives, present in UPFs, can negatively affect different components of the intestinal barrier, such as the microbiota, the mucus layer, the epithelium, and the immune cells in the lamina propria. Disruption of this barrier can cause the immune system to encounter an increased bacterial exposure, leading to an aberrant immune response. In this article, the available evidence on the possible role of UPFs and their components in the increasing incidence and prevalence of IBD is reviewed. These findings can be translated to the clinic and may be helpful to consider when giving dietary advice to IBD patients. A better understanding of the role of UPFs may lead to less restrictive diets for patients with IBD, hence increasing the dietary compliance and efficacy of exclusion diets.

Ultra-processed foods consumption is positively associated with the clinical activity of inflammatory bowel diseases

“…The association between UPF and IBD activity can be explained by several mechanisms. A mechanistic interplay between food components and disease activity has been suggested, speci cally the harmful effect of food additives such as emulsi ers, thickeners and preservatives present in UPFs on the in ammatory process [9,10,28,29]. Different food additives were shown to induce dysbiosis, increase epithelial permeability and stimulate proin ammatory pathways [9,10,29].…”

“…A mechanistic interplay between food components and disease activity has been suggested, speci cally the harmful effect of food additives such as emulsi ers, thickeners and preservatives present in UPFs on the in ammatory process [9,10,28,29]. Different food additives were shown to induce dysbiosis, increase epithelial permeability and stimulate proin ammatory pathways [9,10,29]. In addition to food additives, ultra-processed products are also characterized with high amount of saturated fat, re ned carbohydrate and low content of ber that could also be related to IBD pathogenesis [29].…”

Uncovering the link between gut microbiome, highly processed food consumption and diet quality through bioinformatics methods

“…In fact, as of 2022, HPFs account for more than 50% of the energy intake in Westernised countries, like the United Kingdom, the United States and Australia [9]–[12]. HPFs are formulations ready for ingestion, made from refined food substances (such as glucose syrup, hydrogenated oils and modified starch) and a combination of simple sugars, salt, fat and multiple additives [5], [9], [10], [13], [14]. As a result, HPFs are rich in refined sugars, fats and salt, while low in proteins, fibres and micronutrients [10], [13].…”

“…The intake of fruits, vegetables and fresh products is quickly decreasing while the consumption of HPFs is increasing worldwide, especially in highincome countries [5]- [8]. In fact, as of 2022, HPFs account for more than 50% of the energy intake in Westernised countries, like the United Kingdom, the United States and Australia [9]- [12]. HPFs are formulations ready for ingestion, made from refined food substances (such as glucose syrup, hydrogenated oils and modified starch) and a combination of simple sugars, salt, fat and multiple additives [5], [9], [10], [13], [14].…”

“…These foods, which include sugar-sweetened beverages (SSBs), processed meat products, snacks, industrially processed pastries and pre-packaged meals [5], [9], [11], [13], among others, are not recommended for extended consumption, not only for their low nutritional quality, but also their hyper-palatable attributes which promote overconsumption [5], [9], [10], [13], [15]. This induces a lot of economic interest on companies, which make a special effort on the branding and marketing of these products, targeted particularly toward children and young adults [13], contributing on the adoption of unhealthy eating habits by the youngest generations and thereby increasing the risk of developing an NCD.…”