From the AGA Journals

Crohn’s: Red meat avoidance won’t prevent flares

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Meat intake and Crohn's disease

For understandable reasons, many patients believe that their symptoms or gastrointestinal disorders emanate from some interaction with a component of their diet. Crohn’s disease is no exception; various dietary factors have been incriminated in disease pathogenesis and the induction of relapse among those already affected. Furthermore, a number of dietary strategies or interventions have been recommended as therapeutic. For the induction of relapse, meat and related dietary components, such as fat, have been primary suspects.

Dr. Eamonn M. Quigley

This association was examined in this study by comparing the effects of low- or high-meat intakes (red meat and processed meat) over 49 weeks on clinical relapse rates in Crohn’s patients in remission at baseline. Sixty-two percent relapsed, and 42% had a moderate to severe relapse. However, there was no difference in time to relapse or rates of moderate/severe relapse between the two dietary groups.

Dietary intervention studies are notoriously difficult to perform; what is remarkable was that the investigators were able to complete the study with high rates of compliance over almost a year! Whether dietary patterns earlier in life (when the microbiota is more susceptible) or over longer periods could affect the natural history of inflammatory bowel disease remains to be determined. For now, this study has shown us that high-quality dietary studies can be performed and that variations in meat intake, within the range of those likely to occur in real life, do not affect relapse rates in Crohn’s disease.

Eamonn M. Quigley, MD, is the David M. Underwood Chair of Medicine in Digestive Disorders, Institute for Academic Medicine; director, Lynda K. and David M. Underwood Center for Digestive Disorders, Houston Methodist Hospital. He has no relevant conflicts of interest.



For adults with Crohn’s disease in remission at baseline, eating red and processed meat no more than once per month did not reduce risk of relapse in a randomized control trial.

A shopper reads the label on a package of red meat. Fuse/Thinkstock

After 49 weeks, there were no significant differences in time to relapse, time to moderate or severe relapse, or time to persistent relapse between the low- and high-meat groups, reported Lindsey G. Aldenberg, DO, of the Children’s Hospital of Philadelphia and coinvestigators. The findings were published in Gastroenterology.

The randomized study included 213 adults with Crohn’s disease whose short Crohn’s Disease Activity Index (sCDAI) score was 150 or less at baseline and who consumed red meat at least once weekly. They were instructed to consume one serving (3 ounces) of red meat or any processed (smoked, salted, or otherwise preserved) meat at least twice weekly (high-meat group) or no more than once monthly (low-meat group). To create a placebo-like effect, all patients were told to drink at least 16 ounces of water daily. Each week, patients were emailed a web-based survey of disease status and dietary adherence. At baseline and during six other weeks, they also received a daily survey of disease activity and current medications. The primary outcome was symptomatic relapse, defined as at least a 70-point rise such that sCDAI score exceeded 150, surgery for Crohn’s disease flare, or self-reported initiation or dose increase of mesalamine, thiopurine, methotrexate, corticosteroid, anti–tumor necrosis factor-alpha therapy, or natalizumab.

In all, 78% (166) of patients either completed the study or experienced an outcome. Symptomatic relapse occurred in 62% of these 166 patients, while 42% and 35% had moderate to severe or persistent relapses, respectively. “There were no significant differences in time to relapse for any of the outcomes (P greater than .3 for all outcomes),” the researchers wrote. Results were similar when they assumed that patients who completed no surveys all relapsed at week 1.

At week 20, median fecal calprotectin levels were higher in the high-meat arm (74.5 mcg/g) than in the low-meat arm (36.0 mcg/g), but the difference was not statistically significant. Proportions of patients with fecal calprotectin levels above 150 or 250 mcg/g also did not significantly differ between arms.

Adherence to the diets was reasonable: Patients in the high-meat group reported consuming at least two servings of red or processed meat during 98.5% of weeks, while patients in the low-meat arm completely abstained from red or processed meat during 57.3% of weeks. A logistic regression model showed that the high-meat group was much more likely to consume a least two servings of red or processed meat in the prior week than the low-meat group (P less than .0001). Approximately 90% of patients in both arms drank the recommended amount of water.

Study participants were part of IBD Partners, an Internet-based cohort of more than 15,000 patients with inflammatory bowel disease. Recruitment into the trial occurred through emails, social media, educational and fundraising events, and the Crohn’s & Colitis Foundation website, the researchers said.

“Based on these results, there is insufficient evidence to recommend reduction of red and processed meat consumption solely for the purpose of improving Crohn’s disease outcomes, although there may be some benefit for other health conditions,” Dr. Aldenberg and associates concluded.

The Crohn’s and Colitis Foundation and the National Institutes of Health supported the work. Dr. Aldenberg disclosed receiving research funding from Seres Therapeutics. Two of six coinvestigators disclosed ties to Nestle Health Science, AbbVie, Pfizer, Eli Lilly, and several other pharmaceutical companies.

SOURCE: Aldenberg L et al. Gastroenterology. 2019 Mar 11. doi: 10.1053/j.gastro.2019.03.01.

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