Background Diet is associated with the onset of inflammatory bowel disease [IBD]. Up to half of IBD patients believe that diet contributes to flares. However, studies on this topic are sparse and merely focus on specific nutrients, food items or food groups. We aimed to analyse the association between dietary patterns and flare occurrence in two geographically distinct Dutch cohorts. Methods In this longitudinal study, 724 IBD patients [Northern cohort: n = 486, Southern cohort: n = 238] were included and followed for 2 years. Habitual dietary intake was obtained via semi-quantitative food frequency questionnaires at baseline. Principal component analysis [PCA] was conducted on 22 food groups to identify dietary patterns. Flare occurrence was analysed in 427 patients in remission at baseline, using multivariable Cox proportional hazards. Results Compared to the Southern cohort, patients in the Northern cohort were younger at diagnosis, comprised more females, and had lower overall energy intakes [all p < 0.05]. PCA revealed three dietary patterns explaining 28.8% of the total variance. The most pronounced pattern [explaining 11.6%] was characterized by intake of grain products, oils, potatoes, processed meat, red meat, condiments and sauces, and sugar, cakes and confectionery. Of the 427 patients, 106 [24.8%] developed an exacerbation during follow-up. The above dietary pattern was associated with flare occurrence (hazard ratio [HR]: 1.51, 95% confidence interval [CI]: 1.04–2.18, p = 0.029), as was female sex [HR: 1.63, 95% CI 1.04–2.55, p = 0.032]. Conclusions A dietary pattern, which can be seen as a ‘traditional [Dutch]’ or “Western’ pattern was associated with flare occurrence. Confirmation in prospective studies is needed.

Background and Aim Myosteatosis is a prognostic factor in cancer and liver cirrhosis. It can be determined noninvasively using computed tomography or, as shown recently, by magnetic resonance (MR) imaging. The primary aim was to analyze the reproducibility of skeletal muscle signal intensity on routine MR‐enterographies, as indicator of myosteatosis, in Crohn's disease (CD) and to explore the association between skeletal muscle signal intensity at diagnosis with time to intestinal resection. Methods CD patients undergoing MR‐enterography within 6 months from diagnosis and having a maximum of 5 years follow‐up were included. Skeletal muscle signal intensity was analyzed on T1‐weighted fat‐saturated post‐contrast images. Intra‐observer and inter‐observer reproducibilities were assessed by intra‐class correlation coefficient and Cohen's kappa. Intra‐observer and inter‐observer variabilities were determined by Pearson correlation coefficient and displayed by Bland–Altman plots. Time to intestinal resection was studied by Kaplan–Meier analysis. Results Median time between diagnosis and MR‐enterography was 5 weeks (inter‐quartile range 1–9) in 35 CD patients. Skeletal muscle signal intensity showed good intra‐class correlation and substantial agreement (for intra‐observer, intraclass correlation coefficient = 0.948, κ = 0.677; and inter‐observer reproducibility, intraclass correlation coefficient = 0.858, κ = 0.622). Resection free survival was shorter in the low skeletal muscle signal intensity group (P = 0.037). Conclusion Skeletal muscle signal intensity on routine MR‐enterographies is reproducible and was associated with unfavorable disease outcome, indicating potential clinical relevance.

Background: Inflammatory bowel disease (IBD) patients are at risk of an impaired nutritional status. The impact thereof on the IBD relapse risk is clinically relevant, though sparsely investigated. Aim: The aim was to explore the association between an impaired nutritional status risk and the occurrence of disease flares in IBD outpatients participating in a longitudinal telemedicine study. Methods: IBD outpatients were recruited from the myIBDcoach study cohort, with one year clinical followup. Through myIBDcoach, a telemedicine tool, patients reported on disease activity and risk of impaired nutritional status (i.e. Short Nutritional Assessment Questionnaire >1 and/or BMI < 18.5 kg/m 2 ) every one to three months. Data was analysed by generalized estimating equation modelling. Results: In total, 417 patients were included. During follow-up, 49 patients (11.8%) flared after initial clinical remission and 53 patients (12.7%) showed an increased risk of impaired nutritional status. The risk of impaired nutritional status was associated with flare occurrence (OR 2.61 (95% CI 1.02-6.69)). Conclusions: The risk of an impaired nutritional status was associated with subsequent flares in IBD outpatients. This emphasizes the importance of monitoring disease activity in IBD patients at risk of impaired nutritional status.

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