Lifestyle factors for the prevention of inflammatory bowel disease Gut. 2022 Dec 6;gutjnl-2022-328174. doi: 10.1136/gutjnl-2022-328174. Online ahead of print.
Emily W Lopes 1 2, Simon S M Chan 3 4, Mingyang Song 1 2 5 6, Jonas F Ludvigsson 7 8, Niclas Håkansson 9, Paul Lochhead 1 2, Allan Clark 4, Kristin E Burke 1 2, Ashwin N Ananthakrishnan 1 2, Amanda J Cross 10 11, Domenico Palli 12, Manuela M Bergmann 13, James M Richter 1, Andrew T Chan 1 2 14, Ola Olén 15 16, Alicja Wolk 9 17, Hamed Khalili 18 2 19; EPIC-IBD investigators Collaborators
Pilar Amian, Aurelio Barricarte, Marie-Christine Boutron-Ruault, Franck Carbonnel, Olof Grip, Marc J Gunter, Rudolf Kaaks, Tim Key, María Dolores Chirlaque López, Robert Luben, Giovanna Masala, Jonas Manjer, Bas Oldenburg, Anja Olsen, Kim Overvad, Elio Riboli, Maria José Sánchez, Carlotta Sacerdote, Anne Tjønneland, Rosario Tumino, Roel Vermeulen, W M Monique Verschuren, Nick Wareham |
Author information 1Division of Gastroenterology, Massachusetts General Hospital, Boston, Massachusetts, USA. 2Clinical and Translational Epidemiology Unit, Massachusetts General Hospital, Boston, Massachusetts, USA. 3Department of Gastroenterology, Norfolk and Norwich University Hospitals NHS Foundation Trust, Norwich, UK. 4Norwich Medical School, University of East Anglia, Norwich, UK. 5Department of Epidemiology, Harvard University T.H. Chan School of Public Health, Boston, Massachusetts, USA. 6Department of Nutrition, Harvard T. H. Chan School of Public Health, Boston, MA, USA. 7Department of Medical Epidemiology and Biostatistics, Karolinska Institute, Stockholm, Sweden. 8Department of Pediatrics, Orebro universitet, Orebro, Sweden. 9Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden. 10Department of Epidemiology and Biostatistics, School of Public Health, Imperial College London, London, UK. 11Cancer Screening & Prevention Research Group, Department of Surgery & Cancer, Imperial College London, London, UK. 12Cancer Risk Factors and Life-Style Epidemiology Unit, Institute for Cancer Research, Prevention and Clinical Network-ISPRO, Florence, Italy. 13Epidemiology, German Institute of Human Nutrition Potsdam-Rehbrucke, Nuthetal, Germany. 14Channing Division of Network Medicine, Brigham and Women's Hospital, Boston, Massachusetts, USA. 15Department of Medicine, Solna, Clinical Epidemiology Unit, Karolinska institutet, Stockholm, Sweden. 16Pediatric Gastroenterology Unit, Sachs' Children's Hospital, Stockholm, Sweden. 17Department of Surgical Sciences, Uppsala Universitet, Uppsala, Sweden. 18Division of Gastroenterology, Massachusetts General Hospital, Boston, Massachusetts, USA hkhalili@partners.org. 19Broad Institute, of MIT and Harvard, Cambridge, MA, USA. Abstract 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), we created modifiable risk scores (MRS; 0-6) for CD and UC based on established lifestyle risk factors, and healthy lifestyle scores (HLS; 0-9) derived from American healthy lifestyle recommendations. We calculated the population attributable risk by comparing the incidence of CD and UC between low-risk (CD-MRS≤1, UC-MRS≤2, HLS≥7) and high-risk groups. We externally validated our findings in three 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), we documented 346 CD and 456 UC cases. Adherence to a low MRS could have prevented 42.9% (95% CI 12.2% to 66.1%) of CD and 44.4% (95% CI 9.0% to 69.8%) of UC cases. Similarly, adherence to a healthy lifestyle could have prevented 61.1% (95% CI 16.8% to 84.9%) of CD and 42.2% (95% CI 1.7% to 70.9%) of UC cases. In our 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 six US and European cohorts, a substantial burden of inflammatory bowel diseases risk may be preventable through lifestyle modification.
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