Food access and the severity of newly diagnosed pediatric inflammatory bowel disease

Objectives: Inflammatory bowel disease (IBD) results from genetic susceptibility, gut microbiome, and environmental factors. Diet, one modifiable environmental factor, has been linked to the increased prevalence of IBD. This study aimed to evaluate a potential association between food deserts and disease severity at diagnosis.

Methods: This retrospective study included newly diagnosed IBD patients (ages of 2 and 21 years of age; diagnosed between January 1, 2019, and December 31, 2021). The United States Department of Agriculture (USDA's) Food Access Research Atlas was used to determine if patients resided in a food desert. The Modified Retail Food Environment Index (mRFEI) determined the ratio of healthy to unhealthy food options. The primary endpoint was disease severity at diagnosis based on endoscopy scores. Statistical analyses were applied as appropriate.

Results: Ninety-eight patients were enrolled (75 [77%] Crohn' disease; 23 [23%] ulcerative colitis), 59 (60%) identified as Non-Hispanic White. Fifteen (15%) patients lived in a food desert. Food deserts consisted of more Black patients than White (67%; p = 0.05), more public insurance (12; 80%), and lower median vitamin D (17.6 [interquartile range (IQR): 10.8-24.]). In an adjusted (sex, age, insurance, race) multivariable model mRFEI was associated with reduced odds of a living in a food desert (0.91 [95% confidence interval (CI): 0.83-0.98]). There was no difference between the severity of disease and living in a food desert or food swamp.

Conclusions: Fifteen IBD patients lived in a food desert. Food deserts have less access to healthy food retailers and higher rates of unhealthy food retailers. Further work is needed to better understand spatial disparities related to food accessibility and IBD.