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Healthy Lifestyle Tied to Lower Risk of All-cause Mortality in Inflammatory Bowel Disease

Key findings

  • This analysis explored associations between healthy lifestyle and mortality in older patients with established inflammatory bowel disease
  • The greater the number of a patient's healthy lifestyle factors, the lower the risk of all-cause mortality
  • Lower mortality was also linked to each individual factor: physical activity, light alcohol consumption, adherence to the alternate Mediterranean diet, not smoking and, in patients with ulcerative colitis, maintaining a normal body mass index

Some lifestyle recommendations issued to the general public run contrary to what is suggested for patients with inflammatory bowel disease (IBD). For example, many patients are advised to lower their fiber intake, and smoking cessation has been associated with worsening of ulcerative colitis (UC).

By analyzing data from three ongoing longitudinal epidemiologic studies, Chun-Han Lo, MD, postdoctoral research fellow in the Clinical and Translational Epidemiology Unit at Massachusetts General Hospital, Ashwin N. Ananthakrishnan, MBBS, director of the Mass General Crohn's and Colitis Center, and colleagues determined that familiar lifestyle interventions have mortality benefits in older patients with IBD. Their report appears in Clinical Gastroenterology and Hepatology.

Study Details

The cohorts analyzed were the:

  • Nurses' Health Study (121,700 female registered nurses who were 30 to 55 years old at enrollment in 1976)
  • Nurses' Health Study II (116,429 female registered nurses who were 25 to 42 in 1989)
  • Health Professionals Follow-up Study (51,529 male health professionals who were 40 to 75 in 1986)

In all cohorts, questionnaires were mailed to participants at enrollment and every two years afterward to obtain information on lifestyle factors and medical history. Food frequency questionnaires were distributed every four years.

If a participant reported a physician diagnosis of UC or Crohn's disease (CD), the researchers obtained permission to review their medical records and asked them to complete a detailed supplemental questionnaire.

The study included 363 patients with CD (4,741 person-years of follow-up) and 465 with UC (6,061 person-years of follow-up).

Number of Healthy Lifestyle Factors and Mortality

The study team found that the greater the number of healthy lifestyle factors, the lower the risk of all-cause mortality:

  • One healthy lifestyle factor—HR for death, 0.57 (95% CI, 0.33–1.00)
  • Two factors—HR, 0.29 (95% CI, 0.17–0.51)
  • Three to five factors—HR, 0.29 (95% CI, 0.16–0.52) (P for trend < .0001)

The magnitude of the benefit of a healthy lifestyle remained unchanged after adjusting for family history of IBD and disease severity (judged by the use of immunosuppressive therapy or need for surgery).

Individual Factors and Mortality

  • Smoking: Current smoking was associated with a fourfold increase in risk of death (HR, 4.08); when CD patients were considered alone, the risk was even greater (HR, 6.32)
  • Physical activity: Compared with patients in the first quintile of weekly energy expenditure, those in the third, fourth and fifth quintiles had lower mortality risks (HRs of 0.31–0.55)
  • Body mass index: Among patients with UC, low BMI (≤18 kg/m2) following IBD diagnosis was associated with markedly increased mortality risk (HR, 7.87)
  • Diet: The alternate Mediterranean diet score normally ranges from 0–9; in this study, a score ≥4 was associated with lower mortality than a score <4 (HR, 0.69)
  • Alcohol intake: Compared with never-drinkers, light drinkers (≤5 g/day) were at a decreased risk of death (HR, 0.61); drinkers who consumed >15 g/day were at higher risk of death than never-drinkers (HR, 1.84)


Clinicians should routinely assess lifestyle behaviors in patients with IBD, encourage adherence to healthy behaviors and educate patients so they promote healthy aging and improve longevity.

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