Macronutrient intake and eosinophilic gastroenteritis: a case-control study on the association of protein intake and dietary patterns with disease incidence

Background Eosinophilic gastroenteritis (EGE) is a rare immune-mediated disorder often linked to food allergy. It is still unclear whether macronutrient density and dietary patterns are independent risk factors. We aimed to identify dietary patterns and to test whether macronutrient load is associated with EGE in an Indonesian cohort.Methods This case-control study at Dr. Sardjito General Hospital, Indonesia, included 82 participants: 41 EGE cases and 41 controls. Dietary intake was assessed with 24-hour recalls and a semi-quantitative food frequency questionnaire. Intake was expressed relative to the national Recommended Dietary Allowance. Principal component analysis (PCA) identified dietary patterns and multivariable logistic regression estimated adjusted ORs (aOR).Results Patients with EGE consumed more energy, protein, fat, fibre and carbohydrate than controls (all p<0.05). The first PCA pattern was a ‘Global Dietary Quantity’ (Dimension 1; 47.4% of variance), in which nearly all nutrients were elevated together. The second was an ‘Antioxidant Vitamin’ (Dimension 2; 15.2%) driven by vitamins A, E and C. Only Dimension 1 differed between groups (p<0.001). Protein was collinear with energy intake (Spearman r=0.78), so models adjusted for body mass index (BMI), age and sex instead of energy. Protein intake (% RDA) independently predicted EGE (aOR 1.014; 95% CI 1.004 to 1.024; p=0.008). However, fibre (p=0.002) and carbohydrate (p=0.007) showed comparable associations when each replaced protein in an identical model. This points to an effect of overall macronutrient load rather than of protein specifically. We also saw a non-significant ‘BMI paradox’: cases had higher intake but lower median BMI than controls (21.09 vs 21.83 kg/m²; p=0.077).Conclusion Higher overall macronutrient intake, rather than protein specifically, is associated with EGE, and protein is the most robust single marker of this pattern. Managing EGE may need to address overall dietary quantity and density as well as avoidance of specific allergens.