March 11, 2020
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Healthy lifestyle linked with reduced mortality in IBD

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Ashwin N. Ananthakrishnan
Ashwin Ananthakrishnan

Patients who adhere to health lifestyle choices, including those related to diet, exercise and smoking habits, had reduced mortality, according to study results.

Ashwin N. Ananthakrishnan, MD, MPH, of the division of gastroenterology at Massachusetts General Hospital, and colleagues wrote that these lifestyle factors have been associated with reduced mortality in the general population, but some of the recommendations are contrary to what is sometimes advised or practiced in IBD.

“Active inflammation and gastrointestinal symptoms often reduce the ability to practice regular physical activity while many patients avoid alcohol due to gastrointestinal symptoms,” they wrote. “Further, there are competing influences on mortality risk in patients with IBD including penetrating complications from persistent systemic inflammation and treatment related morbidity and mortality. Consequently, the degree to which such lifestyle measures is beneficial in patients with IBD is unknown.”

Researchers collected data from the Nurses’ Health Study (1986–2014), Nurses’ Health Study II (1991–2015), and Health Professionals Follow-up Study (1986–2014) and estimated joint and individual associations between five lifestyle factors after IBD diagnosis and mortality. The factors included, never smoking, BMI between 18.5 kg/m2 and 24.9 kg/m2, vigorous physical activity in the highest 50% with non-zero value, alternate Mediterranean diet score of at least 4, and light drinking (0.1–5.0 g/d).

Investigators documented 83 deaths among 363 patients with Crohn’s disease over 4,741 person-years, and 80 deaths among 465 patients with ulcerative colitis over 6,061 person-years.

Compared with patients with no healthy lifestyle factors, patients with IBD with between 3 and 5 factors had a reduction in all-cause mortality (HR = 0.29; 95% CI, 0.16–0.52). Investigators observed the reduction in both patients with CD (P = .003) and UC (P = .0003).

Physical activity (HR according to quintiles, 0.55–0.31; P trend = .001), Mediterranean diet (HR = 0.69; 95% CI, 0.49–0.9) and alcohol consumption (0.1-5 g/d; HR= 0.61; 95% CI, 0.39–0.95 vs >15 g/d; HR = 1.84; 95% CI, 1.02–3.32) were among the individual associations for reduced mortality.

“Assessment of healthy lifestyle behaviors should be routinely performed in IBD patients and adherence to such behaviors should be encouraged to improve longevity and promote healthy aging,” they wrote. “Future work should examine the impact of changes in lifestyle behavior on mortality with accrual of more cases and longer follow-up period.” – by Alex Young

Disclosure: Ananthakrishnan reports serving as a scientific advisor board member for AbbVie, Gilead and Kyn Therapeutics and receiving research grants from Merck and Pfizer. Please see the full study for all other authors’ relevant financial disclosures.