The secret to IBD prevention may simply be healthy lifestyle

The simple treatment for inflammatory bowel disease may be to lead a healthy lifestyle. A significant multinational study published in the journal Gut found that lifestyle modifications could have avoided up to 60% of IBD occurrences.

Research has so far linked a number of lifestyle factors to an increased risk of IBD, but there is currently no conclusive evidence that leading a healthy lifestyle lowers the risk of developing the condition. 

Nearly three million adults in the United States and 1.3 million in Europe have IBD, and the number of diagnoses isn't showing any signs of slowing down.

In recent years, IBD has grown in importance as a health problem. In order to find out how leading a healthy lifestyle may completely avoid it, a team of researchers examined data from the Nurses' Health Study (NHS), NHSII, and the Health Professionals Follow-up Study (HPFS).

In 1976, 121,700 female nurses (aged 30-55) from 11 US states participated in the Nurses Health Study. In 1989, 116,429 female nurses (ages 25–42) from 15 states participated in the NHSII study, while in 1986, 51,529 male doctors (ages 40–75) from all over the nation participated in the HPFS study.

To calculate the percentage of IBD cases that may have been prevented, the researchers created modifiable risk scores (MRS) for each participant based on known IBD modifiable risk factors. Higher scores indicated greater risk factors; the values ranged from 0-6. The team considered variables including body mass index (BMI), smoking, consumption of NSAIDs like Advil, exercise, and nutritional quality (fruits, vegetables, fibre, fat, and red meat intake).

The researchers then calculated the percentage of incidents that could have been prevented if the subjects lived generally healthy lifestyles. Each participant received a score between 0 and 9, with higher values indicating a healthier lifestyle.

According to the team, leading a healthy lifestyle includes maintaining a BMI between 18.5 and 25, never smoking, engaging in at least 7.5 weekly hours of physical activity, eating at least eight servings of fruit and vegetables daily, consuming less than half a serving of red meat daily, meeting a minimum of 25 grammes of fibre per day, eating at least two servings of fish per week, and consuming no more than one alcoholic beverage per day.

The group discovered that there were 346 new instances of Crohn's disease and 456 new cases of ulcerative colitis. Based on MRS scoring, the researchers hypothesised that those who maintained a lower risk score may have been able to avoid 43% and 44.5%, respectively, of these cases. 

The Swedish Mammography Cohort (37,275 participants), the Cohort of Swedish Men (40,810 participants), and the European Prospective Investigation into Cancer and Nutrition (404,144 people) were used in a comparable experiment to check if the findings were consistent. This study confirmed their initial findings, showing that a low MRS and a healthy lifestyle could each prevent between 44% and 60% of Crohn's disease cases and between 21 and 56% of ulcerative colitis cases.

Despite the fact that both tests' results seem to support the prevention of IBD by leading a healthy lifestyle, the team is unable to establish a causal link because this research is observational in nature.

“A key assumption of our findings is that the relationship between lifestyle factors and IBD 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 IBD,” the researchers wrote in a media release.

“Lifestyle modification may be an attractive target for future prevention strategies in IBD,” they add. “This may be of particular relevance to high-risk groups, such as first-degree relatives of IBD patients, who have an estimated 2%–17% risk of developing the disease over their lifetime.”