Abstract Background Inflammatory bowel disease (IBD) affects gastrointestinal function and may alter faecal odour due to changes in the gut microbiome and metabolism. Given the relationship between diet, gut health and microbiome diversity, exploring the link between dietary habits and faecal odour in IBD seems crucial. This study investigates the associations between dietary behaviour, flatulence and faecal odour perception and disease activity in IBD patients compared to healthy controls (HC). Methods From October 2023 to October 2024, a total of 238 IBD (women: 51.3%; CD: 59.7%; remission: 33.5%) patients and 97 HC (women:70.1%) were enrolled at the IBD outpatient clinic of the Hannover Medical School. In addition to a short screening questionnaire for highly processed foods (sQ-HPF), dietary behaviour (Food Frequency Questionnaire (FFQ)), clinical (HBI, PMS) and biochemical (CRP, faecal calprotectin) parameters of disease activity were assessed as well as adherence to a mediterranean diet and changes in bowel movement odour (faecal and flatulence) were collected. Results Significant differences in flatulence (p<0.001) and faecal odour perception (p<0.001) were found between IBD patients and HC. Further associations with dietary habits revealed differences between HC and IBD individuals exhibiting strong flatulence odour demonstrating significant associations with the daily intake of carbohydrates (p = 0.007), sugar (p = 0.049), vegetables (p = 0.033), legumes (p = 0.010), and the daily energy intake (kJ) from highly- and ultra-processed foods (p = 0.002 and p = 0.007, respectively). However, the differences between HC and IBD individuals with strong faecal odour were only significant for the daily intake of legumes (p = 0.002). Further analyses revealed significant associations between flatulence and faecal odour perception and IBD activity (p < 0.001). Subgroup analyses showed significant differences between Crohn’s disease (CD) and ulcerative colitis (UC) patients with and without strong faecal odour, particularly in those with moderate disease activity (p = 0.006 and p = 0.017). Additionally, significant differences in flatulence odour were found between CD and UC patients with moderate (p = 0.008) and severe disease activity (p = 0.041). Conclusion In conclusion, significant differences in flatulence and faecal odour perception were found between IBD patients and healthy controls, with dietary associations noted for strong flatulence and faecal odour. Disease activity was strongly associated with both flatulence and faecal odour perception, with notable differences between CD and UC, particularly in moderate and severe disease activity.
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