Lifestyle factors for the prevention of inflammatory bowel diseaseInstitute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden.
Division of Gastroenterology, Massachusetts General Hospital, Boston, Massachusetts, USA; Clinical and Translational Epidemiology Unit, Massachusetts General Hospital, Boston, Massachusetts, USA.
Norwich Medical School, University of East Anglia, Norwich, UK.
Division of Gastroenterology, Massachusetts General Hospital, Boston, Massachusetts, USA; Clinical and Translational Epidemiology Unit, Massachusetts General Hospital, Boston, Massachusetts, USA.
Division of Gastroenterology, Massachusetts General Hospital, Boston, Massachusetts, USA; Clinical and Translational Epidemiology Unit, Massachusetts General Hospital, Boston, Massachusetts, USA.
Department of Epidemiology and Biostatistics, School of Public Health, Imperial College London, London, UK; Cancer Screening & Prevention Research Group, Department of Surgery & Cancer, Imperial College London, London, UK.
Cancer Risk Factors and Life-Style Epidemiology Unit, Institute for Cancer Research, Prevention and Clinical Network-ISPRO, Florence, Italy.
Epidemiology, German Institute of Human Nutrition Potsdam-Rehbrucke, Nuthetal, Germany.
Division of Gastroenterology, Massachusetts General Hospital, Boston, Massachusetts, USA.
Division of Gastroenterology, Massachusetts General Hospital, Boston, Massachusetts, USA; Clinical and Translational Epidemiology Unit, Massachusetts General Hospital, Boston, Massachusetts, USA; Channing Division of Network Medicine, Brigham and Women's Hospital, Boston, Massachusetts, USA.
Department of Medicine, Solna, Clinical Epidemiology Unit, Karolinska institutet, Stockholm, Sweden; Pediatric Gastroenterology Unit, Sachs' Children's Hospital, Stockholm, Sweden.
Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden; Department of Surgical Sciences, Uppsala Universitet, Uppsala, Sweden.
Division of Gastroenterology, Massachusetts General Hospital, Boston, Massachusetts, USAg; Clinical and Translational Epidemiology Unit, Massachusetts General Hospital, Boston, Massachusetts, USA; Broad Institute, of MIT and Harvard, Cambridge, MA, USA.
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2023 (English)In: Gut, ISSN 0017-5749, E-ISSN 1468-3288, Vol. 72, no 6, p. 1093-1100, article id gutjnl-2022-328174Article in journal (Refereed) Published
Abstract [en]
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.
Place, publisher, year, edition, pages
BMJ Publishing Group Ltd, 2023. Vol. 72, no 6, p. 1093-1100, article id gutjnl-2022-328174
Keywords [en]
Crohn's disease, diet, epidemiology, ulcerative colitis
National Category
Gastroenterology and Hepatology
Identifiers
URN: urn:nbn:se:oru:diva-103129DOI: 10.1136/gutjnl-2022-328174ISI: 000904125500001PubMedID: 36591609Scopus ID: 2-s2.0-85144860456OAI: oai:DiVA.org:oru-103129DiVA, id: diva2:1727677
Funder
Swedish Cancer SocietySwedish Research CouncilRegion SkåneRegion Västerbotten
Note
Funding agencies:
CoSM cohorts Swedish research infrastructure (SIMPLER) grant VR 2017-00644 SMC
World Health Organization
NIHR Imperial Biomedical Research Centre (BRC)
Danish Cancer Society
Ligue nationale contre le cancer
Institut Gustave Roussy
Mutuelle Generale de l'Education Nationale
Institut National de la Sante et de la Recherche Medicale (Inserm)
Deutsche Krebshilfe
Helmholtz Association
German Institute of Human Nutrition Potsdam-Rehbruecke (DIfE)
Federal Ministry of Education & Research (BMBF)
Fondazione AIRC per la ricerca sul cancro
Compagnia di San Paolo
Dutch Ministry of Public Health, Welfare and Sports (VWS)
Netherlands Cancer Registry (NKR)
LK Research Funds
Dutch Prevention Funds
Netherlands Organization for Scientific Research (NWO)
World Cancer Research Fund International (WCRF)
Netherlands Government
Health Research Fund (FIS)-Instituto de Salud Carlos III (ISCIII)
Regional Governments of Andalucia, Asturias
Basque Government
Murcia and Navarra
Catalan Institute of Oncology-ICO (Spain)
Cancer Research UK
UK Research & Innovation (UKRI)
Medical Research Council UK (MRC) 14136 C8221/A29017
Crohn's and Colitis Foundation 1000143 MR/M012190/1
United States Department of Health & Human Services
National Institutes of Health (NIH) - USA
American College of Gastroenterology junior faculty development award T32 DK007191 UM1 CA186107 NHS U01 CA176726 NHSII U01 CA167552 HPFS
2023-01-172023-01-172024-09-02Bibliographically approved