Lifestyle Modifications for Preventing Inflammatory Bowel Disease

May be a feasible option for future preventive strategies, researchers say

Adopting and maintaining a healthy lifestyle could prevent up to 60% of cases of inflammatory bowel disease (Crohn’s disease and ulcerative colitis), according to a large international study, published online in the journal Gut .

The findings lead the study authors to suggest that, subject to further research, particularly in those at high risk of developing these conditions, lifestyle changes may be a feasible option for future preventative strategies.

Inflammatory bowel disease, or IBD for short, affects about 3 million adults in the US and another 1.3 million in Europe. And diagnoses have been increasing, particularly in newly industrialized countries.

Previously published research has linked the risk of IBD to several lifestyle factors, but it is unclear whether adopting and maintaining a healthy lifestyle could reduce the risk of developing the condition in the first place.

To find out, they drew on data from participants in the Nurses’ Health Study (NHS), NHSII and the Health Professionals Follow-up Study (HPFS). The Nurses’ Health Study enrolled 121,700 nurses (ages 30 to 55) from 11 U.S. states in 1976, while the NHSII study, established in 1989, monitored 116,429 nurses (ages 25 to 42). years of age) from 15 US states. The HPFS included 51,529 male physicians (40 to 75) from across the US in 1986.

The researchers created modifiable risk scores (MRS) for each participant based on established modifiable risk factors for IBD to estimate the proportion of IBD cases that could have been prevented. The MRS ranged from 0 to 6, with higher scores indicating more risk factors.

These risk factors included weight (BMI); of smoking; use of non-steroidal anti-inflammatory drugs; physical activity; and daily intake of fruits, fiber, vegetables, polyunsaturated fatty acids (PUFAs), and red meat.

The researchers then calculated the proportion of preventable cases if an overall healthy lifestyle was adopted and maintained. Scores from 0 to 9 were assigned to each participant, with higher scores indicating a healthier lifestyle.

A healthy lifestyle included: BMI between 18.5 and 25; never smoke; at least 7.5 MET hours per week (METS expresses the amount of energy (calories) expended per minute of physical activity); at least 8 daily servings of fruits and vegetables; less than half a daily serving of red meat; at least 25 g of fiber/day; at least 2 weekly servings of fish; at least half a daily serving of nuts/seeds; and a maximum of 1 alcoholic drink/day for women or 2 for men.

During the follow-up period (NHS, HPFS: 1986–2016; NHSII: 1991–2017), 346 cases of Crohn’s disease and 456 cases of ulcerative colitis were reported.

Based on MRS scores, researchers estimated that low MRS could have prevented 43% and 44.5%, respectively, of Crohn’s disease and ulcerative colitis cases.

Similarly, maintaining a healthy lifestyle could have prevented 61% of Crohn’s disease cases and 42% of ulcerative colitis cases.

The researchers applied the scoring systems to data from three large European studies to validate their findings: the Swedish mammography cohort (37,275 participants); the Swedish Male Cohort (40,810); and the European Prospective Investigation into Cancer and Nutrition (404,144).

These calculations showed that low MRS and maintaining a healthy lifestyle could have prevented, respectively, 44% to 51% and 49% to 60.5% of cases of Crohn’s disease, and 21% to 28% and 47% to 56.5% of ulcerative colitis cases. .

This is an observational study and as such cannot establish cause. And researchers acknowledge that the average age at which IBD was diagnosed was older than usual. Early lifestyle factors that may have been influential were also not considered. These included antibiotic prescriptions; breast-feeding; environmental factors such as pollution; stress; and socioeconomic factors.

“A key assumption of our findings is that the relationship between lifestyle factors and the development of IBD is causal. Although this has not yet been established, several lines of evidence support the critical role of environmental and lifestyle factors in the development of IBD,” they write.

“Lifestyle modification may be an attractive target for future IBD prevention strategies,” they add. “This may be of particular relevance for high-risk groups, such as first-degree relatives of IBD patients, who have an estimated 2% to 17% lifetime risk of developing the disease.”