Nathan Constantine‐Cooke, Beatriz Gros, Nikolas Plevris, Linda J Williams, Gareth-Rhys Jones, Janet A. M. Kyle, Nicholas A Kennedy, Víctor Velasco-Pardo, Alex Rudge, Debbie Alexander, Carl A Anderson, Maiara Brusco De Freitas, Lisa Derr, Lauranne Aap Derikx, Sian Gilchrist, Paul Henderson, Graham Horgan, P Irving, Christopher A Lamb, Luke Jostins-Dean, J Lindsay, Jonathan MacDonald, Craig Mowat, Charles Murray, Miles Parkes, Spyros I. Siakavellas, Catalina A. Vallejos, Daniel R. Gaya, Jonathan M Rhodes, Alexandra M. Johnstone, C. Weir, Charlie W Lees
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 (1370 CD; 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 ≥250 µg/g: adjusted HR (aHR) 2.22; FC 50-250 µg/g: aHR 1.52 (reference <50 µg/g)) and objective flares (FC ≥250 µg/g: aHR 3.25; FC 50-250 µg/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. TRIAL REGISTRATION NUMBER: NCT03282903.