Lifestyle factors for the prevention of inflammatory bowel disease

Lopes, Emily W., Chan, Simon S. M., Song, Mingyang, Ludvigsson, Jonas F., Håkansson, Niclas, Lochhead, Paul, Clark, Allan ORCID:, Burke, Kristin E., Ananthakrishnan, Ashwin N., Cross, Amanda J., Palli, Domenico, Bergmann, Manuela M., Richter, James M., Chan, Andrew T., Olén, Ola, Wolk, Alicja and Khalili, Hamed (2023) Lifestyle factors for the prevention of inflammatory bowel disease. Gut, 72 (6). pp. 1093-1100. ISSN 0017-5749

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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.

Item Type: Article
Additional Information: Funding Information: Funded by UM1 CA186107 NHS cohort infrastructure grant, U01 CA176726 NHSII cohort infrastructure grant and U01 CA167552 HPFS cohort infrastructure grant; the content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health. This work is also funded by the VR 2017-00644 SMC and CoSM cohorts Swedish research infrastructure (SIMPLER) grant. The coordination of EPIC is financially supported by International Agency for Research on Cancer (IARC) and also by the department of epidemiology and biostatistics, School of Public Health, Imperial College London which has additional infrastructure support provided by the NIHR Imperial Biomedical Research Centre (BRC). The national cohorts are supported by: Danish Cancer Society (Denmark); Ligue Contre le Cancer, Institut Gustave Roussy, Mutuelle Générale de l’Education Nationale, Institut National de la Santé et de la Recherche Médicale (INSERM) (France); German Cancer Aid, German Cancer Research Center (DKFZ), German Institute of Human Nutrition Potsdam-Rehbruecke (DIfE), Federal Ministry of Education and Research (BMBF) (Germany); Associazione Italiana per la Ricerca sul Cancro-AIRC-Italy, Compagnia di SanPaolo and National Research Council (Italy); Dutch Ministry of Public Health, Welfare and Sports (VWS), Netherlands Cancer Registry (NKR), LK Research Funds, Dutch Prevention Funds, Dutch ZON (Zorg Onderzoek Nederland), World Cancer Research Fund (WCRF), Statistics Netherlands (The Netherlands); Health Research Fund (FIS)—Instituto de Salud Carlos III (ISCIII), Regional Governments of Andalucía, Asturias, Basque Country, Murcia and Navarra, and the Catalan Institute of Oncology—ICO (Spain); Swedish Cancer Society, Swedish Research Council and County Councils of Skåne and Västerbotten (Sweden); Cancer Research UK (14136 to EPIC-Norfolk; C8221/A29017 to EPIC-Oxford), Medical Research Council (1000143 to EPIC-Norfolk; MR/M012190/1 to EPIC-Oxford) (United Kingdom). This study was also funded by a senior research award from the Crohn’s and Colitis Foundation to HK and a senior research award from the Crohn’s and Colitis Foundation to ATC. EWL was funded from NIH T32 DK007191 during work on this manuscript and is currently funded by an American College of Gastroenterology junior faculty development award. Publisher Copyright: © 2023 Journal. All rights reserved.
Uncontrolled Keywords: crohn's disease,diet,epidemiology,ulcerative colitis,gastroenterology,sdg 3 - good health and well-being ,/dk/atira/pure/subjectarea/asjc/2700/2715
Faculty \ School: Faculty of Medicine and Health Sciences > Norwich Medical School
UEA Research Groups: Faculty of Medicine and Health Sciences > Research Centres > Population Health
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Depositing User: LivePure Connector
Date Deposited: 20 Jun 2023 14:50
Last Modified: 19 Oct 2023 03:36
DOI: 10.1136/gutjnl-2022-328174


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