Quantitative and qualitative assessment of diet and itsassociation with disease activity in pediatric ulcerativecolitis.

Abstract

Objectives: Ulcerative colitis (UC) is a chronic inflammatory bowel diseasewith increasing global prevalence, particularly in newly industrializedcountries. While diet has been implicated in disease pathogenesis, its role inmodifying clinical outcomes remains unclear. This study aimed to evaluatedietary intake and habits in pediatric UC patients and assess their associ-ation with clinical remission (CR) and mucosal healing (MH).Methods: A cross‐sectional study was conducted in a Spanish tertiary hospital,including UC patients aged 8–18 years. Dietary assessment was performed usinga 3‐day food diary, dietary questionnaires, and the NOVA classification. K‐meansclustering identified dietary patterns associated with CR and MH. Predictivemodels were developed using logistic regression, random forest, and gradientboosting.Results: A total of 47 patients were included. Patients in Cluster 1(CR + MH) exhibited superior dietary quality, characterized by a higherintake of unprocessed/minimally processed foods, fiber, and essentialmicronutrients (p < 0.05). Conversely, patients without CR or MH (Cluster3) had a diet rich in ultra‐processed foods (UPFs) and saturated fats(p < 0.01). UPFs intake and poor dietary quality were significant predictorsof worse outcomes, independent of pharmacological therapy.Conclusions: Dietary quality was associated with both disease activity andtreatment response. While these findings highlight a potentially relevantrelationship, the cross‐sectional nature of the study precludes establishingcausality. Higher consumption of minimally processed foods and specificmicronutrients was associated with better clinical outcomes, while UPFsintake correlated with persistent inflammation. These findings highlight theimportance of integrating dietary strategies into UC management to opti-mize therapeutic outcomes.