Abstract

Healthy Lifestyle is Associated with Reduced Mortality in Patients with Inflammatory Bowel Diseases

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

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.

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 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.

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

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.

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.

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; Ptrend<.0001). This reduction was significant in patients with CD (Ptrend =.003) as well as in patients with UC (Ptrend =.0003). Individual associations were more than 25 pack-years (HR, 1.92; 95% CI, 1.24-2.97; Ptrend<.0001), physical activity (HR according to quintiles, 0.55-0.31; Ptrend=.001), Mediterranean diet (HR, 0.69; 95% CI, 0.49-0.98), and alcohol consumption (HR0.1-5 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.

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