Healthy Lifestyle Recommended for General Public Associated With Significant Survival in Adult-Onset IBD
Monika Fischer, MD, reviewing Lo CH, et al. Clin Gastroenterol Hepatol 2020 Mar 3.
Several studies in the non-IBD population have shown that a healthy lifestyle that includes vigorous physical activity, a normal body mass index, the Mediterranean diet, light alcohol consumption, and no history of smoking is associated with a longer life span. It is unclear whether the same “common sense” recommendations can help patients living with IBD to also achieve longevity, but finding the “best diet” for IBD is a burning question.
Using 2 different Nurses’ Health studies and the Health Professionals Follow-up Study, researchers reviewed data from 363 patients with Crohn’s disease during 4741 person-years (83 deaths) and 465 patients with ulcerative colitis during 6061 person-years (80 deaths). They estimated joint and individual associations between 5 healthy lifestyle factors after IBD diagnosis and mortality: (1) never smoked; (2) a body mass index of 18.5 to 24.9 kg/m2; (3) vigorous physical activity (equivalent to 2 hours per week of jogging, running, biking, swimming, or playing tennis); (4) light alcohol intake (5-15 g/d); and (5) an alternate Mediterranean diet score ≥4 (1 point was assigned to each of the following if intake was above the median: vegetables [excluding potatoes], fruits, nuts, whole grains, legumes, fish, and a monounsaturated-to-saturated fatty acid ratio; and 1 point was assigned if red and processed meat intake was below the median.
Compared to patients with IBD and no healthy lifestyle factors, patients with IBD and 3 to 5 healthy lifestyle factors had a significant reduction in all-cause mortality (hazard ratio, 0.29; 95% confidence interval, 0.16–0.52; Ptrend<.0001). The survival benefit was unaltered after adjustment for family history of IBD, immunomodulator use, and IBD-related surgery.
COMMENT
This study gives us a powerful tool when counseling IBD patients. I find that patients with IBD are very motivated to make lifestyle modifications in order to improve their quality of life, prevent IBD-related complications, and avoid immunosuppressive therapy. While this study does not directly address the impact of a healthy lifestyle on these goals, per se, it reveals a very significant positive impact on longevity. The Mediterranean diet has recently emerged as a promising intervention in IBD, and this study strengthens the argument for it.
Monika Fischer, MD, FASGE
CITATION(S )
Lo CH, Khalili H, Song M, et al. Healthy lifestyle is associated with reduced mortality in patients with inflammatory bowel diseases. Clin Gastroenterol Hepatol 2020 Mar 3. (Epub ahead of print) (https://doi.org/10.1016/j.cgh.2020.02.047)
