Meat Intake and Relapse Risk in Ulcerative Colitis

March 10, 2026

Issue 05

Clinical Question

Are dietary factors associated with disease flare in patients with inflammatory bowel disease in remission?

Editor’s Bottom Line

Intake of unprocessed red and white meat, but not fish, was associated with an increased risk of IBD flare. Whether this relationship is causal or confounded by other aspects of lifestyle remains unclear.

Reference

Constantine-Cooke N, Gros B, Plevris N, et al. 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. Gut. Epub ahead of print Jan 16, 2026. DOI:10.1136/gutjnl-2025-337846

Synopsis

This multi-centre, prospective cohort study examined demographic, clinical and dietary factors associated with disease flare among patients with inflammatory bowel disease (IBD) in self-reported remission. Between November 2016 and March 2020, 2,629 participants (1370 with Crohn’s disease; 1,259 with ulcerative colitis/IBD-unclassified) were recruited across 47 UK sites and followed for a median of 4.1 years (Interquartile Range: 3–5). Patients with confirmed Crohn’s disease (CD), ulcerative colitis (UC) or IBD unclassified (IBDU) in patient-reported clinical remission for over six months since diagnosis and over two months since therapy change were eligible. Exclusion criteria included systemic corticosteroids or initiation of immunomodulators or advanced therapies within the prior two months.

Baseline diet was assessed using the validated Scottish Collaborative Group Food Frequency Questionnaire. The primary outcome was time to patient-reported flare (captured by monthly IBD-Control questionnaire), while the secondary outcome was objective flare, defined as patient-reported flare plus C-reactive protein >5 mg/L and/or fecal calprotectin >250 μg/g with treatment escalation.

Patients were a median 44 years of age, 54.1% were female and the median disease duration was 10 years. At baseline, 66.5% had severe endoscopic disease, 15.7% used corticosteroids and 17.7% used immunomodulators. Complete dietary data were available for 1,091 participants (530 CD, 561 UC/IBDU). Median daily calorie intake was 2,219 kcal, with 47.6% from carbohydrates, 35.6% from fat and 16.5% from protein. Median meat and fish protein intake was 36.1 grams/day. Ultra-processed foods comprised 40.2% of total energy intake.

Analysis showed that during 24-month follow-up, the cumulative patient-reported relapse rate was 31% (95% Confidence Interval [CI]: 29–32%) and the cumulative objective relapse rate was 14% (95% CI: 12-15%). At 24 months, patient-reported and objective flare rates were 28% and 12% in CD, respectively, and 33% and 15% in UC/IBDU, respectively. After an extended follow-up of a median 3.1 years, the cumulative objective relapse rate increased to 30%.

Baseline fecal calprotectin (FC) was strongly associated with both patient-reported and objective flares. In CD, FC 50-250 μg/g versus <50 μg/g was associated with patient-reported flare (adjusted Hazard Ratio [aHR]: 1.58; 95% CI: 1.23–2.05) and objective flare (aHR: 2.02; 95% CI: 1.47-2.78). FC >250 μg/g was associated with patient-reported flare (aHR: 2.41; 95% CI: 1.82–3.20) and objective flare (aHR: 3.34; 95% CI: 2.37–4.70). This equated to an 8% risk of objective flare within two years for those with FC <50 μg/g versus 26% for those with FC >250 μg/g. Similar associations were observed in UC, where FC of 50-250 μg/g showed an aHR of 1.57 (95% CI: 1.23–2.01) for patient-reported flare and an aHR of 2.03 (95% CI: 1.49–2.77) for objective flare, while an FC >250 μg/g was linked with an aHR of 2.15 (95% CI: 1.64–2.80) for patient-reported flare and an aHR of 3.22 (95% CI: 2.33–4.46) for objective flare. The absolute risk of objective flare within two years was 11% for FC <50 μg/g and 34% for FC >250 μg/g.

In terms of dietary correlations, in UC/IBDU, higher total meat intake (white or red meat as well as fish) was associated with increased risk of objective flare (highest versus lowest quartile: aHR: 2.19; 95% CI: 1.24–3.86). Patients in the lowest quartile had a 12% chance of objective flare within two years, compared to 26% in the highest quartile.

Overall meat intake (aHR 1.95; 95% CI: 1.07–3.56), unprocessed red meat consumption (aHR: 1.81; 95% CI: 1.15-2.84) and unprocessed white meat consumption (aHR: 1.91; 95% CI: 1.10–3.30) were associated with a risk of objective flare, while fish consumption did not increase risk (aHR: 1.16; 95% CI: 0.70–1.94). No association was found for patient-reported flare and meat intake in UC, nor for patient-reported or objective flare in CD.

No consistent associations were observed for ultra-processed foods, dietary fibre or polyunsaturated fatty acids and flare in either CD or UC.

Details

Study Design: Prospective cohort study
Funding: Cure Crohn’s Colitis, Crohn’s & Colitis in Childhood, Chief Scientist Office, UK Research and Innovation Future Leaders Fellowship
Allocation: Not applicable
Setting: Multicenter
Level of Evidence: 2b