Colon to Rectum
Gut. 2023;72:1093−100
Lifestyle factors for the prevention of inflammatory bowel disease
Objective: To estimate the proportion of cases of Crohn’s disease (CD) and ulcerative colitis (UC) that could be prevented by modifiable lifestyle factors.
Design: In a prospective cohort study of US adults from the Nurses’ Health Study (NHS; n = 72,290), NHSII (n = 93,909) and Health Professionals Follow-up Study (HPFS; n = 41,871), the authors created modifiable risk scores (MRS; 0−6) for CD and UC based on established lifestyle risk fac-tors, and healthy lifestyle scores (HLS; 0−9) derived from American healthy lifestyle recommendations. They calculated the population attributa-ble risk by comparing the incidence of CD and UC between low-risk (CD-MRS ≤ 1, UC-MRS ≤ 2, HLS ≥ 7) and high-risk groups. The findings were externally validated in 3 European cohorts: the Swedish Mammography Cohort (n = 37,275), Cohort of Swedish Men (n = 40,810) and European Prospective Investigation into Cancer and Nutrition (n = 404,144).
Results: Over 5,117,021 person-years of follow-up (NHS, HPFS: 1986−2016; NHSII: 1991−2017), the authors documented 346 CD and 456 UC cases. Adherence to a low MRS could have prevented 42.9% (95% confidence interval [CI]: 12.2−66.1%) of CD and 44.4% (95% CI: 9.0−69.8%) of UC cases. Similarly, adherence to a healthy lifestyle could have prevented 61.1% (95% CI: 16.8−84.9%) of CD and 42.2% (95% CI: 1.7−70.9%) of UC cases. In the validation cohorts, adherence to a low MRS and healthy lifestyle could have, respectively, prevented 43.9−51.2% and 48.8−60.4% of CD cases and 20.6−27.8% and 46.8−56.3% of UC cases.
Conclusions: Across 6 US and European cohorts, a substantial burden of inflammatory bowel diseases risk may be preventable through lifestyle modification.