Can a healthy lifestyle prevent IBD?

Adopting and maintaining a healthy lifestyle can prevent inflammatory bowel disease (IBD), according to findings from an analysis of three prospective US cohort studies, which were validated in three external European cohorts.

In the primary analysis, maintain low modifiable risk scores, based on risk factors including body mass index, smoking, nonsteroidal anti-inflammatory drug use, physical activity, and daily consumption of fruits, vegetables, fiber and polyunsaturated fatty acids. , and red meat, could have prevented 42.9% of Crohn’s disease cases and 44.4% of ulcerative colitis cases, reported Hamed Khalili, MD, MPH, of Massachusetts General Hospital in Boston, and his colleagues.

In addition, adherence to a healthy lifestyle could have prevented 61.1% of Crohn’s disease cases and 42.2% of ulcerative colitis cases, they noted in Gut.

“We were surprised by the proportion of cases that could have been prevented by lifestyle modifications,” Khalili told MedPage Today. “One reason for this finding may be that our population was older, and therefore most of our IBD cases occurred in older adults.”

“We know that lifestyle and environmental factors play a greater role in the development of IBD in this population compared to those who are diagnosed with the disease earlier in life,” he added.

These findings from the Nurses’ Health Study (NHS), the NHS II and the Health Professionals Follow-up Study (HPFS) were extensively validated in three external European cohorts: the Swedish Mammography Cohort, the Swedish Men’s Cohort, and the European Cohort Prospective Research in Cancer and Nutrition.

Looking at Crohn’s disease cases among the European validation cohorts, adherence to low-risk factors could have prevented 44-51% of cases, while adherence to a healthy lifestyle could have prevented from 49% to 60% of cases. For ulcerative colitis, adherence to low-risk factors could have prevented 21-28% of cases, while adherence to a healthy lifestyle could have prevented 47-56% of cases.

For every 1-point increase in the modifiable risk score, an increased risk of Crohn’s disease (P for trend < 0.0001) and ulcerative colitis (P for trend = 0.008) was observed, and was similar for men and women. women.

IBD affects an estimated 3.1 million people in the US and 1.3 million in Europe, and the incidence is increasing globally, especially among newly industrialized countries, Khalili’s group said. IBD is associated with an annual healthcare cost of $23,000 per patient in the US, and there are no current strategies to prevent the development of IBD. Although one approach to preventing many chronic diseases is to modify lifestyle and dietary factors, the success of adhering to such changes remains unclear.

For this study, Khalili and colleagues examined data from 72,290 NHS, 93,909 NHS II and 41,871 HPFS participants. The NHS enrolled nurses aged 30-55 in 11 states in 1976. The NHS II assessed a slightly younger cohort of nurses (aged 25-42) from 15 states from 1989, while the HPFS enrolled male physicians ages 40 to 75 in every state. states in 1986.

To externally validate their findings, the researchers evaluated data from 40,810 participants in the Swedish Men’s Cohort, 404,144 from the European Prospective Investigation into Cancer and Nutrition, and 37,275 from the Swedish Mammography Cohort.

Using participant baseline and biennial questionnaires that assessed lifestyle factors, anthropomorphic data, and medical history, Khalili and colleagues developed modifiable risk scores ranging from 0 to 6 for Crohn’s disease and ulcerative colitis. , and higher scores indicated more risk factors. Healthy lifestyle scores ranging from 0 to 9 were also developed, based on recommendations from the American Heart Association and other organizations, with higher scores indicating a healthier lifestyle.

A healthy lifestyle included never smoking, a BMI between 18.5 and 25, and physical activity of at least 7.5 metabolic equivalents of homework hours per week, in addition to consuming less than half a serving of red meat per day, at least eight servings of fruit/vegetables per day, at least half a serving of nuts or seeds per day, at least two servings of fish per week, at least 25g of fiber per day, and a maximum of one alcoholic drink per day for women and two for men.

Through 5,117,021 person-years of follow-up, 346 cases of Crohn’s disease and 456 cases of ulcerative colitis were reported.

In the falsification analysis, adherence to low-risk factors for Crohn’s disease could also have prevented 32.3% of rheumatoid arthritis cases, 13.3% of colorectal cancer cases, and 14% of cases of cardiovascular disease, although this was not the case for ulcer disease. colitis.

“This is largely due to differences in the strength of the associations and the prevalence of risk factors, and the presence of other modifiable risk factors, such as alcohol and medications or supplements, that are strongly associated with these other conditions,” Khalili and colleagues suggested.

They acknowledged that younger-onset IBD was underrepresented in their study, as the mean age of the cohort (around 45 years) was higher than the usual age of IBD onset. In addition, data on other modifiable risk factors, such as stress, were not explored, and people at high risk were not assessed.

Zaina Hamza is a staff writer for MedPage Today, covering gastroenterology and infectious diseases. She has her headquarters in Chicago.

Disclosures

This study was supported primarily by the National Institutes of Health.

Khalili reported support from the American College of Gastroenterology and Beker Foundation Senior Research Award, as well as consulting fees from AbbVie and Takeda, and grant funding from Pfizer and Takeda.

The co-authors also reported multiple industry relationships.

Source: news.google.com