Maintaining a healthy lifestyle can prevent up to 60% of inflammatory bowel disease cases such as Crohn’s disease and ulcerative colitis.
Lifestyle changes in people at high risk of developing these conditions could be a feasible option for future preventive strategies against inflammatory bowel disease, according to researchers from a large international study.
The study has been published online in the journal Gut.
Cases of inflammatory bowel disease are on the rise
It is estimated that around three million people in the US, and a further 1.3 million in Europe, suffer from Inflammatory bowel disease. Diagnoses of the condition have been increasing, especially in newly industrialised countries.
Previous research on inflammatory bowel disease has linked the condition to various lifestyle factors. However, it has not been confirmed if adopting and maintaining a healthy lifestyle can lower the risk of developing the condition in the first place.
The researchers decided to draw on participant data from the Nurses’ Health Study (NHS), NHSII, and the Health Professionals Follow-up Study (HPFS).
The Nurses Health Study included 121,700 female nurses (aged 30–55) from 11 US states in 1976, while the NHSII study, established in 1989, monitored 116,429 female nurses (aged 25–42) from 15 US states. The HPFS included 51,529 male doctors (40–75) from across the US in 1986.
The researchers created modifiable risk scores (MRS) for every participant based on established modifiable risk factors for inflammatory bowel disease, which they used to estimate the proportion of cases that could have been avoided. The MRS scores ranged from 0-6, with higher scores representing more risk factors.
Risk factors included body weight, smoking, use of non-steroidal anti-inflammatory drugs, physical activity, and daily intake of fruit, fibre, vegetables, polyunsaturated fatty acids, and red meat.
Next, the researchers estimated the number of avoidable cases if an overall healthy lifestyle was adopted and maintained by the patient. Each participant was given a score from 0-9, with higher scores representing a healthier lifestyle.
A healthy lifestyle had clear benefits
During the study, 346 cases of Crohn’s disease and 456 cases of ulcerative colitis were reported. Based on the MRS scores, the researchers estimated that a low MRS score could have prevented 43% of Crohn’s disease cases and 44.5% of ulcerative colitis cases. The results also suggested that maintaining a healthy lifestyle could have prevented 61% of Crohn’s disease cases and 42% of ulcerative colitis cases.
The researchers then applied the MRS scoring systems to data from three large European studies to cross-reference their findings. These were the Swedish Mammography Cohort, the Cohort of Swedish Men, and the European Prospective Investigation into Cancer and Nutrition.
The researcher’s calculations revealed that a low MRS and a healthy lifestyle could have, respectively, prevented 44%–51% and 49%–60.5% of Crohn’s disease cases, 21%–28% and 47%–56.5% of ulcerative colitis cases.
The researchers acknowledge that as this was an observational study and they were therefore unable to confirm the cause of inflammatory bowel disease. They also acknowledge that the average age at which inflammatory bowel disease was diagnosed was older than is typical in their study. It should also be considered that some early lifestyle factors that may be influential were not considered. These included antibiotic prescriptions, breastfeeding, environmental factors such as pollution, stress, and socioeconomic factors.
“A key assumption of our findings is that the relationship between lifestyle factors and inflammatory bowel disease development is causal. Though this has yet to be established, several lines of evidence support the critical role of environmental and lifestyle factors in the development of the condition,” wrote the authors.
“Lifestyle modification may be an attractive target for future prevention strategies in inflammatory bowel disease. This may be of particular relevance to high-risk groups, such as first-degree relatives of inflammatory bowel disease patients, who have an estimated 2%–17% risk of developing the disease over their lifetime,” they concluded.