Psychological stress and eating behaviors as interacting influences on patient–reported disease activity in Italian patients with inflammatory bowel disease

Diet and psychological stress are recognized contributors to inflammatory bowel disease (IBD), yet their interaction-particularly stress-induced eating-remains underexplored. This study examined how perceived stress relates to comfort food consumption (CFC) and patient-reported outcomes among individuals with IBD. A cross-sectional online survey was conducted with 2,254 Italian patients recruited via a national patient organization. Participants completed the Perceived Stress Scale, Salzburg Stress Eating Scale, IBD Symptom Inventory, Bristol Stool Chart, and ad hoc items on CFC. Analyses included partial correlations controlling demographic and clinical covariates, group comparisons by stress level and IBD subtype, and latent class analysis (LCA) to identify psychosocial profiles. Participants reported moderate stress and increased CFC under stress. Those with higher perceived stress described greater symptom burden, softer stool consistency, more frequent CFC, and stronger emotional reliance on these foods. The LCA identified two subgroups-one low-stress/low-symptom and another high-stress/high-symptom/high-comfort-food-highlighting a stress-reactive behavioral phenotype. Stress-eating scores and food preferences did not differ by disease subtype, although patients with Crohn's disease reported higher symptom severity and softer stools. Findings underscore perceived stress as a key psychological correlate of eating behaviors and symptom perception in IBD, supporting the integration of patient-reported experiences into multidisciplinary, engagement-oriented care.