Lo CH¹, Khalili H², Song M³, Lochhead P², Burke KE², Richter JM⁴, Giovannucci EL⁵, Chan AT⁶, Ananthakrishnan AN⁷. Clin Gastroenterol Hepatol. 2020 Mar 3. pii: S1542-3565(20)30266-4. doi: 10.1016/j.cgh.2020.02.047. [Epub ahead of print]

Author information

1 Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA; Division of Gastroenterology, Massachusetts General Hospital and Harvard Medical School, Boston, MA.

2 Division of Gastroenterology, Massachusetts General Hospital and Harvard Medical School, Boston, MA;; Clinical and Translational Epidemiology Unit, Massachusetts General Hospital and Harvard Medical School, Boston, MA.

3 Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA; Division of Gastroenterology, Massachusetts General Hospital and Harvard Medical School, Boston, MA;; Clinical and Translational Epidemiology Unit, Massachusetts General Hospital and Harvard Medical School, Boston, MA; Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, MA.

4 Division of Gastroenterology, Massachusetts General Hospital and Harvard Medical School, Boston, MA.

5 Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA; Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, MA; Channing Division of Network Medicine, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA.

6 Division of Gastroenterology, Massachusetts General Hospital and Harvard Medical School, Boston, MA;; Clinical and Translational Epidemiology Unit, Massachusetts General Hospital and Harvard Medical School, Boston, MA; Channing Division of Network Medicine, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA.

7 Division of Gastroenterology, Massachusetts General Hospital and Harvard Medical School, Boston, MA;; Clinical and Translational Epidemiology Unit, Massachusetts General Hospital and Harvard Medical School, Boston, MA. Electronic address: aananthakrishnan@mgh.harvard.edu.

Abstract

BACKGROUND & AIMS: It is not clear whether a healthy lifestyle affects mortality of patients with inflammatory bowel diseases (IBD), including Crohn's disease (CD) and ulcerative colitis (UC).

METHODS: We collected data form the Nurses' Health Study (1986-2014), Nurses' Health Study II (1991-2015), and Health Professionals Follow-up Study (1986-2014), which assess lifestyles with serial questionnaires. We estimated joint and individual associations between 5 healthy lifestyle factors after IBD diagnosis (never smoking, body mass index 18.5-24.9 kg/m², vigorous physical activity in the highest 50% with non-zero value, alternate Mediterranean diet score ≥4, and light drinking [0.1-5.0 g/d]) and mortality using Cox proportional hazards models.

RESULTS: We documented 83 deaths in 363 patients with CD during 4741 person-years and 80 deaths in 465 patients with UC during 6061 person-years. The median age of IBD diagnosis was 55 y. Compared to patients with IBD with no healthy lifestyle factors, patients with IBD with 3-5 healthy lifestyle factors had a significant reduction in all-cause mortality (hazard ratio [HR], 0.29; 95% CI, 0.16-0.52; P_trend<.0001). This reduction was significant in patients with CD (P_trend =.003) as well as in patients with UC (P_trend =.0003). Individual associations were more than 25 pack-years (HR, 1.92; 95% CI, 1.24-2.97; P_trend<.0001), physical activity (HR according to quintiles, 0.55-0.31; P_trend=.001), Mediterranean diet (HR, 0.69; 95% CI, 0.49-0.98), and alcohol consumption (HR_{0.1-5 g/d} 0.61; 95% CI, 0.39-0.95 vs HR_{>15 g/d} 1.84; 95% CI, 1.02-3.32). The findings did not change when we adjusted for family history of IBD, immunomodulator use, and IBD-related surgery.

CONCLUSIONS: In an analysis of data from 3 large cohort studies, we associated adherence to a healthy lifestyle with reduced mortality in patients with CD or UC.