Associations between demographic, clinical and dietary factors and flares in inflammatory bowel disease: the PRognostic effect of Environmental factors in Crohn’s and Colitis (PREdiCCt) prospective cohort study

doi:10.1136/gutjnl-2025-337846

Associations between demographic, clinical and dietary factors and flares in inflammatory bowel disease: the PRognostic effect of Environmental factors in Crohn’s and Colitis (PREdiCCt) prospective cohort study

Respiratory Medicine and Gastroenterology

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Abstract

Background IBD is characterised by recurrent flares, but evidence on whether modifiable dietary factors influence flare risk is limited. Objective The PREdiCCt study was designed to examine demographic, clinical and dietary factors associated with disease flare among patients with IBD in self-reported remission. Design Multicentre, prospective cohort study conducted across 47 UK centres. Patients with Crohn’s disease (CD), ulcerative colitis (UC) or IBD unclassified (IBDU) in self-reported remission were prospectively followed up. The baseline diet was assessed using a validated food frequency questionnaire. The primary outcome was time to patient-reported flare (captured by monthly IBD-Control) and objective flare (clinical flare plus C-reactive protein >5 mg/L and/or faecal calprotectin (FC) >250 µg/g with treatment escalation). Associations were evaluated using Cox frailty models adjusted for demographic, clinical and biochemical variables, including baseline FC. Results Between November 2016 and March 2020, 2629 participants (1370CD; 1259 UC/IBDU) were enrolled and followed up for a median of 4.1 years (IQR 3.0–5.0). Baseline FC was strongly associated with patient-reported flares (FC ≥250µg/g: adjusted HR (aHR) 2.22; FC 50–250µg/g: aHR 1.52 (reference <50µg/g)) and objective flares (FC ≥250µg/g: aHR 3.25; FC 50–250µg/g: aHR 1.98). In UC, higher total meat intake was associated with increased risk of objective flares (highest versus lowest quartile: aHR 1.95, 95%CI 1.07 to 3.56). No consistent associations were observed for ultraprocessed foods, fibre or polyunsaturated fatty acids and flare. Conclusion Higher habitual meat intake was associated with increased risk of objective flare in UC, suggesting diet may contribute to flare susceptibility in specific patient groups.

Original language	English
Journal	Gut
Early online date	19 Jan 2026
DOIs	https://doi.org/10.1136/gutjnl-2025-337846
Publication status	E-pub ahead of print - 19 Jan 2026

ASJC Scopus subject areas

Gastroenterology

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© Author(s) (or their employer(s)) 2026. Re- use permitted under CC BY. Published by BMJ Group.
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@article{e0652f7927dd41eb8b112125441103e2,

title = "Associations between demographic, clinical and dietary factors and flares in inflammatory bowel disease: the PRognostic effect of Environmental factors in Crohn{\textquoteright}s and Colitis (PREdiCCt) prospective cohort study",

abstract = "Background IBD is characterised by recurrent flares, but evidence on whether modifiable dietary factors influence flare risk is limited. Objective The PREdiCCt study was designed to examine demographic, clinical and dietary factors associated with disease flare among patients with IBD in self-reported remission. Design Multicentre, prospective cohort study conducted across 47 UK centres. Patients with Crohn{\textquoteright}s disease (CD), ulcerative colitis (UC) or IBD unclassified (IBDU) in self-reported remission were prospectively followed up. The baseline diet was assessed using a validated food frequency questionnaire. The primary outcome was time to patient-reported flare (captured by monthly IBD-Control) and objective flare (clinical flare plus C-reactive protein >5 mg/L and/or faecal calprotectin (FC) >250 µg/g with treatment escalation). Associations were evaluated using Cox frailty models adjusted for demographic, clinical and biochemical variables, including baseline FC. Results Between November 2016 and March 2020, 2629 participants (1370CD; 1259 UC/IBDU) were enrolled and followed up for a median of 4.1 years (IQR 3.0–5.0). Baseline FC was strongly associated with patient-reported flares (FC ≥250µg/g: adjusted HR (aHR) 2.22; FC 50–250µg/g: aHR 1.52 (reference <50µg/g)) and objective flares (FC ≥250µg/g: aHR 3.25; FC 50–250µg/g: aHR 1.98). In UC, higher total meat intake was associated with increased risk of objective flares (highest versus lowest quartile: aHR 1.95, 95\%CI 1.07 to 3.56). No consistent associations were observed for ultraprocessed foods, fibre or polyunsaturated fatty acids and flare. Conclusion Higher habitual meat intake was associated with increased risk of objective flare in UC, suggesting diet may contribute to flare susceptibility in specific patient groups.",

author = "Nathan Constantine-Cooke and Beatriz Gros and Nikolas Plevris and Williams, \{Linda J.\} and Jones, \{Gareth Rhys\} and Janet Kyle and Kennedy, \{Nicholas A.\} and Victor Velasco-Pardo and Alexander Rudge and Debbie Alexander and Anderson, \{Carl A.\} and \{de Freitas\}, \{Maiara Brusco\} and Derr, \{Lisa M.\} and Derikx, \{Lauranne A.A.P.\} and Sian Gilchrist and Paul Henderson and Horgan, \{Graham W.\} and Peter Irving and Lamb, \{Christopher A.\} and Luke Jostins-Dean and Lindsay, \{James O.\} and Jonathan MacDonald and Craig Mowat and Charles Murray and Miles Parkes and Siakavellas, \{Spyros I.\} and Vallejos, \{Catalina A.\} and Gaya, \{Daniel R.\} and Rhodes, \{Jonathan M.\} and Johnstone, \{Alexandra M.\} and Weir, \{Christopher J.\} and Lees, \{Charlie W.\}",

note = "Publisher Copyright: {\textcopyright} Author(s) (or their employer(s)) 2026.",

year = "2026",

month = jan,

day = "19",

doi = "10.1136/gutjnl-2025-337846",

language = "English",

journal = "Gut",

issn = "0017-5749",

publisher = "BMJ Publishing Group",

}

TY - JOUR

T1 - Associations between demographic, clinical and dietary factors and flares in inflammatory bowel disease

T2 - the PRognostic effect of Environmental factors in Crohn’s and Colitis (PREdiCCt) prospective cohort study

AU - Constantine-Cooke, Nathan

AU - Gros, Beatriz

AU - Plevris, Nikolas

AU - Williams, Linda J.

AU - Jones, Gareth Rhys

AU - Kyle, Janet

AU - Kennedy, Nicholas A.

AU - Velasco-Pardo, Victor

AU - Rudge, Alexander

AU - Alexander, Debbie

AU - Anderson, Carl A.

AU - de Freitas, Maiara Brusco

AU - Derr, Lisa M.

AU - Derikx, Lauranne A.A.P.

AU - Gilchrist, Sian

AU - Henderson, Paul

AU - Horgan, Graham W.

AU - Irving, Peter

AU - Lamb, Christopher A.

AU - Jostins-Dean, Luke

AU - Lindsay, James O.

AU - MacDonald, Jonathan

AU - Mowat, Craig

AU - Murray, Charles

AU - Parkes, Miles

AU - Siakavellas, Spyros I.

AU - Vallejos, Catalina A.

AU - Gaya, Daniel R.

AU - Rhodes, Jonathan M.

AU - Johnstone, Alexandra M.

AU - Weir, Christopher J.

AU - Lees, Charlie W.

PY - 2026/1/19

Y1 - 2026/1/19

N2 - Background IBD is characterised by recurrent flares, but evidence on whether modifiable dietary factors influence flare risk is limited. Objective The PREdiCCt study was designed to examine demographic, clinical and dietary factors associated with disease flare among patients with IBD in self-reported remission. Design Multicentre, prospective cohort study conducted across 47 UK centres. Patients with Crohn’s disease (CD), ulcerative colitis (UC) or IBD unclassified (IBDU) in self-reported remission were prospectively followed up. The baseline diet was assessed using a validated food frequency questionnaire. The primary outcome was time to patient-reported flare (captured by monthly IBD-Control) and objective flare (clinical flare plus C-reactive protein >5 mg/L and/or faecal calprotectin (FC) >250 µg/g with treatment escalation). Associations were evaluated using Cox frailty models adjusted for demographic, clinical and biochemical variables, including baseline FC. Results Between November 2016 and March 2020, 2629 participants (1370CD; 1259 UC/IBDU) were enrolled and followed up for a median of 4.1 years (IQR 3.0–5.0). Baseline FC was strongly associated with patient-reported flares (FC ≥250µg/g: adjusted HR (aHR) 2.22; FC 50–250µg/g: aHR 1.52 (reference <50µg/g)) and objective flares (FC ≥250µg/g: aHR 3.25; FC 50–250µg/g: aHR 1.98). In UC, higher total meat intake was associated with increased risk of objective flares (highest versus lowest quartile: aHR 1.95, 95%CI 1.07 to 3.56). No consistent associations were observed for ultraprocessed foods, fibre or polyunsaturated fatty acids and flare. Conclusion Higher habitual meat intake was associated with increased risk of objective flare in UC, suggesting diet may contribute to flare susceptibility in specific patient groups.

AB - Background IBD is characterised by recurrent flares, but evidence on whether modifiable dietary factors influence flare risk is limited. Objective The PREdiCCt study was designed to examine demographic, clinical and dietary factors associated with disease flare among patients with IBD in self-reported remission. Design Multicentre, prospective cohort study conducted across 47 UK centres. Patients with Crohn’s disease (CD), ulcerative colitis (UC) or IBD unclassified (IBDU) in self-reported remission were prospectively followed up. The baseline diet was assessed using a validated food frequency questionnaire. The primary outcome was time to patient-reported flare (captured by monthly IBD-Control) and objective flare (clinical flare plus C-reactive protein >5 mg/L and/or faecal calprotectin (FC) >250 µg/g with treatment escalation). Associations were evaluated using Cox frailty models adjusted for demographic, clinical and biochemical variables, including baseline FC. Results Between November 2016 and March 2020, 2629 participants (1370CD; 1259 UC/IBDU) were enrolled and followed up for a median of 4.1 years (IQR 3.0–5.0). Baseline FC was strongly associated with patient-reported flares (FC ≥250µg/g: adjusted HR (aHR) 2.22; FC 50–250µg/g: aHR 1.52 (reference <50µg/g)) and objective flares (FC ≥250µg/g: aHR 3.25; FC 50–250µg/g: aHR 1.98). In UC, higher total meat intake was associated with increased risk of objective flares (highest versus lowest quartile: aHR 1.95, 95%CI 1.07 to 3.56). No consistent associations were observed for ultraprocessed foods, fibre or polyunsaturated fatty acids and flare. Conclusion Higher habitual meat intake was associated with increased risk of objective flare in UC, suggesting diet may contribute to flare susceptibility in specific patient groups.

UR - https://gut.bmj.com/content/early/2026/01/19/gutjnl-2025-337846

UR - https://www.scopus.com/pages/publications/105028010963

U2 - 10.1136/gutjnl-2025-337846

DO - 10.1136/gutjnl-2025-337846

M3 - Article

C2 - 41554630

AN - SCOPUS:105028010963

SN - 0017-5749

JO - Gut

JF - Gut

ER -

Associations between demographic, clinical and dietary factors and flares in inflammatory bowel disease: the PRognostic effect of Environmental factors in Crohn’s and Colitis (PREdiCCt) prospective cohort study

Abstract

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