Maiara Brusco de Freitas

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 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.

Salivary biomarkers have been explored as potential non-invasive tools for the diagnosis and monitoring of inflammatory bowel diseases (IBD), including Crohn’s Disease (CD) and Ulcerative Colitis (UC). This study presents a scoping review and evidence mapping on the use of saliva as a matrix in which biomarkers can be identified for these conditions. A systematic search of multiple databases and studies was conducted until 28 January 2025, resulting in the selection of 12 relevant articles. The quantified evidence synthesis identified eight molecular and microbial categories. Of these, four classes, including cytokines, microRNAs, calprotectin, and the microbiome, have demonstrated the most consistent potential. Alterations in these biomarkers, such as an increase in the Prevotella genus within the microbiome, and elevated PSMA7 levels, may reflect disruptions in intestinal barrier integrity and immune response. However, factors such as oral health status, hygiene habits, and medication must be carefully considered. Therefore, further clinical research is essential to validate specific biomarkers.

Background/Aims: Inflammatory bowel diseases (IBDs), including Crohn’s disease (CD) and ulcerative colitis (UC), are chronic conditions marked by dysregulated inflammation in the gastrointestinal tract. Although the pathophysiology of IBD remains incompletely understood, it involves complex interactions between genetic predisposition and environmental triggers, such as gut microbiota imbalances and immune dysfunction, leading to chronic inflammation and mucosal injury. IBD affects approximately 7 million individuals globally, with prevalence increasing in Europe, North America, and Oceania. This rise parallels the growing consumption of ultra-processed foods (UPFs), which are typically rich in sugars, fats, and additives but low in fiber, vitamins, and other essential nutrients. These associations, this review critically examines the influence of UPF consumption on gut microbiota composition and function and its potential link to IBD. Methods: A bibliographic search was conducted in the SciELO, PubMed, and Cochrane databases. Results and Conclusions: High UPF consumption is associated with intestinal dysbiosis, marked by reduced microbial diversity, decreased short-chain fatty acid production, impaired barrier integrity, and mucus layer disruption. These alterations may promote immune-mediated diseases, including IBD, where dysbiosis is often characterized by an overgrowth of pathogenic bacteria such as Clostridium and Enterococcus, ultimately triggering inflammatory responses in the host.

Inflammatory bowel diseases (IBD), including Crohn's disease (CD) and ulcerative colitis (UC), are chronic conditions marked by dysregulated inflammation in the gastrointestinal tract. Although the pathophysiology of IBD remains incompletely understood, it involves complex interactions between genetic predisposition and environmental triggers, such as gut microbiota imbalances and immune dysfunction, leading to chronic inflammation and mucosal injury. IBD affects approximately 7 million individuals globally, with prev-alence increasing in Europe, North America and Oceania. This rise parallels the growing consumption of ultra-processed foods (UPF), which are typically rich in sugars, fats, and additives but low in fiber, vitamins, and other essential nutrients. High UPF consumption is associated with intestinal dysbiosis, marked by reduced microbial diversity, decreased short-chain fatty acid production, impaired barrier integrity, and mucus layer disruption. These alterations may promote immune-mediated diseases, including IBD, where dysbio-sis is often characterized by an overgrowth of pathogenic bacteria such as Clostridium and Enterococcus, ultimately triggering inflammatory responses in the host. Considering these associations, this review critically examines the influence of UPF consumption on gut mi-crobiota composition and function, and its potential link to IBD.

Background: This study explores associations of maternal organic food consumption and diet quality during pregnancy with pediatric-onset inflammatory bowel disease (IBD) risk in offspring, including Crohn’s disease (CD) and ulcerative colitis (UC).Methods: Pregnant mothers and their offspring were enrolled in the Danish National Birth Cohort, a nationwide prospective cohort study, in 1996–2002. In gestational week 30, telephone interviews assessed overall maternal organic food consumption during pregnancy. In gestational week 25, a food frequency questionnaire assessed maternal diet during the previous 4 weeks, including six different organic food types (eggs, dairy, meat, fruit, vegetables, and cereals). A Healthy Eating Index evaluated maternal diet quality based on adherence to Danish official dietary guidelines. Offspring with pediatric-onset IBD (≤18 years) were identified in national patient registries. Cox regression explored associations of maternal organic food consumption and diet quality during pregnancy with offspring’s risk of pediatric-onset IBD, CD, and UC.Results: The study included 60,274 singleton mother–child pairs, of which 168 children developed pediatric-onset IBD. Frequent maternal organic food consumption during pregnancy was not significantly associated with offspring’s IBD risk (HR: 0.63; 95% CI: 0.33–1.19). However, frequent organic food consumption during pregnancy, particularly organic eggs and dairy, lowered offspring’s risk of CD (HR: 0.40; 95% CI: 0.17–0.94), but not UC (HR: 1.11; 95% CI: 0.41–3.00). Maternal diet quality during pregnancy was not significantly associated with offspring’s risk of IBD (HR: 0.99; 95% CI: 0.97–1.01), CD, and UC.Conclusion: In this large prospective cohort study, we show that maternal organic food consumption, particularly eggs and dairy, during pregnancy may lower offspring’s risk of pediatric-onset CD, but not UC.

Importance: Poor nutrition and growth in childhood have short-term and long-term consequences, so understanding the timing of the onset of an impaired nutritional status is crucial for diagnosing and treating inflammatory bowel disease (IBD) at its earliest stage.Objective: To assess anthropometric trajectories before a pediatric diagnosis of IBD and growth recovery after diagnosis.Design, Setting, and Participants: This population-based cohort study included children born in Denmark from January 1, 1997, through December 31, 2015, with weight and length or height measurements at birth and at least 1 length or height and weight measurement at school age based on the Danish Medical Birth Register and the Danish National Child Health Register. Within this population, all individuals diagnosed with IBD at ages 5 to 17 years, according to the Danish National Patient Register, were identified. Data were analyzed from October 13, 2023, to April 17, 2024.Exposure: A pediatric diagnosis of IBD compared with the corresponding population without the disease.Main Outcomes and Measures: The outcome measures were z scores for length or height, weight, and body mass index (BMI [calculated as weight in kilograms divided by height in meters squared]) before and after pediatric IBD diagnosis compared with reference and sibling populations.Results: The final study population included 916 133 individuals (51.2% male) with a median of 3 pairs of length or height and weight measurements collected (IQR, 2-6 pairs). Of those, 1522 (median age, 14.3 years [IQR, 11.8-16.3 years]; 763 female [50.1%]) were diagnosed with IBD (851 [55.9%] with Crohn disease [CD] and 671 [44.1%] with ulcerative colitis [UC]). Compared with children without IBD, individuals with a later diagnosis of CD had declining anthropometric measures 3 years (weight: mean, −0.12 g [95% CI, −0.20 to −0.03 g]; BMI: mean, −0.13 [95% CI, −0.21 to −0.04]) and 1 year (length or height: mean, −0.20 cm [95% CI, −0.29 to −0.10 cm]) prior to diagnosis, whereas this was observed 1 year prior to a diagnosis of UC for weight (mean, −0.12 g [95% CI, −0.22 to −0.02 g]) and BMI (mean, −0.13 [95% CI, −0.23 to −0.03]). Deviating anthropometric patterns persisted after diagnosis, with the slowest recovery observed in children with CD.Conclusions and Relevance: The findings of this large-scale population-based cohort study of anthropometrics in children suggest impaired nutritional status as assessed by weight up to 3 years and by length or height 1 year before a diagnosis of CD and by weight up to 1 year before a diagnosis of UC. These findings emphasize that the onset of pediatric IBD may occur years prior to diagnosis, that growth recovery may first occur after diagnosis and treatment, and that frequent nutritional screenings may help ensure a healthy transition to adulthood.

This manuscript aims to report the nutrition transition in Brazilian children under 5 years old from 2006 to 2019. Microdata from the Brazilian National Survey on Demography and Health of Women and Children (PNDS 2006) and the Brazilian National Survey on Child Nutrition (ENANI-2019) were analyzed. The indicators considered were: micronutrient status (anemia and vitamin A deficiency), anthropometric status (stunting and excessive weight), and breastfeeding practice (exclusive breastfeeding among children < 6 months and continued breastfeeding among children 12-23 months). We also analyzed minimum dietary diversity (MDD), consumption of ultra-processed foods, consumption of meat or eggs, and not consuming fruits or vegetables in children 6-59 months of age only for ENANI-2019. Equiplot charts were generated according to geographic region, maternal schooling level, and maternal race/skin color. From 2006 to 2019, the prevalence rates of anemia and vitamin A deficiency decreased from 20.5% to 10.1% and 17.2% to 6%, respectively. The prevalence of stunting remained at 7%, and excessive weight rates increased from 6% to 10.1%. The prevalence of exclusive breastfeeding among children < 6 months increased from 38.6% to 45.8%, and of continued breastfeeding among children 12-23 months from 34.6% to 43.6%. In 2019, 61.5% of children achieved the MDD, 88.8% consumed ultra-processed foods, 83.1% consumed meat or egg, and 25.7% did not consume fruits or vegetables the day before the survey. Trends of decreased micronutrient deficiencies, increased breastfeeding, and excessive weight rates, as well as reductions in disparities related to geographic region, maternal schooling level, and maternal race/skin color, were observed for most of the indicators.

We appreciate the commentators’ reflections on the study entitled Nutrition Transition in Brazilian Children Under 5 Years Old from 2006 to 2019¹ 1. Castro IRR, Anjos LA, Lacerda EMA, Boccolini CS, Farias DR, Alves-Santos NH, et al. Nutrition transition in Brazilian children under 5 years old from 2006 to 2019. Cad Saúde Pública 2023; 39 Suppl 2:e00216622. . Next, we will describe our reflections on three central points that recurrently and convergently emerged from this set of comments.

Malnutrition affects billions of individuals worldwide and represents a global health challenge. This study aimed to determine the prevalence of malnutrition (undernutrition or overweight) among mother-child dyads in children under 5 years old in Brazil in 2019 and to estimate changes in this prevalence from 2006 to 2019. Individual-level data from the Brazilian National Survey on Child Nutrition (ENANI-2019) and the Brazilian National Survey of Demography and Health of Women and Children carried out in 2006 (PNDS 2006) were analyzed. Malnutrition outcomes in mother-child dyads included overweight mother and child, undernourished mother and child, and the double burden of malnutrition, i.e., overweight mother and child having any form of undernourishment (stunting, wasting, or underweight). Prevalence and 95% confidence intervals (95%CI) were estimated. Most women (58.2%) and 9.7% of the children were overweight, 6.9% were stunted, and 3.1% of mothers and 2.9% of the children were underweight. The prevalence of overweight in the mother-child dyad was 7.8% and was statistically higher in Southern Brazil (9.7%; 95%CI: 7.5; 11.9) than in the Central-West (5.4%; 95%CI: 4.3; 6.6). The prevalence of overweight mother and stunted child was 3.5%, with statistically significant difference between the extremes of the mother’s education [0-7 vs. ≥ 12 years, 4.8% (95%CI: 3.2; 6.5) and 2.1%, (95%CI: 1.2; 3.0), respectively]. Overweight in the dyad increased from 5.2% to 7.8%, and the double burden of malnutrition increased from 2.7% to 5.2% since 2006. Malnutrition in Brazilian mother-child dyads seems to be a growing problem, and dyads with lower formal education, higher maternal age, and from the South Region of Brazil were more vulnerable.

This study compared the distribution of stunting and height-for-age (HAZ) Z-scores among age groups in data from the Brazilian National Survey on Demography and Health of Women and Children (PNDS 2006) and the Brazilian National Survey on Child Nutrition (ENANI-2019). The final sample comprised 4,408 and 14,553 children < 59 months of age in the PNDS 2006 and ENANI-2019, respectively. Children with HAZ scores < -2 according to the World Health Organization (WHO) growth standard were classified as stunted. Prevalence, 95% confidence intervals (95%CI), means, and standard deviations were estimated for Brazil and according to age. The distribution of HAZ scores at each age (in months) was estimated using the svysmooth function of the R survey package. Analyses considered the complex sampling design of the studies. Statistical differences were determined by analyzing the 95%CI of the overlap of point estimates. From 2006 to 2019, the prevalence of stunting for children < 12 months of age increased from 4.7% to 9%. As expected, the smoothed curves showed a higher mean HAZ score for children < 24 months of age in 2006 than in 2019 with no overlap of 95%CI among children aged 6-12 months. For children ≥ 24 months of age, we observed a higher mean HAZ score in 2019. Although the prevalence of stunting among children < 59 months of age was similar between 2006 and 2019, mean HAZ scores among children ≥ 24 months of age increased, whereas the mean HAZ score among children < 24 months of age decreased. Considering the deterioration in living conditions and the potential impact of the COVID-19 pandemic, we expect a greater prevalence of stunting in Brazil in the near future.