Modifiable Lifestyle Factors May Help Prevent Inflammatory Bowel Disease Risk

Read Time: 5 Minutes

Inflammatory bowel disease (IBD) includes disorders characterized by chronic inflammation in all or part of the gastrointestinal tract; Crohn’s disease (CD) and ulcerative colitis (UC) are the primary types of IBD. Recent reports indicate that CD and UC affect over two million individuals in North America and 3.2 million in Europe, with incidence rising globally—especially among newly industrialized countries.1 Both CD and UC lead to digestive disorders and chronic inflammation in the digestive system, resulting in some overlapping symptoms such as pain, diarrhea, fever, fatigue, and weight loss.2

Research over the years has implicated diet and physical activity in the improvement of inflammatory bowel disease (IBD) to reduce intestinal inflammation and permeability.3,4 However, relatively few studies have examined the total contribution of lifestyle factors on IBD development at a population level.

A new observational study of 208,070 US adult men and women, published in the journal Gut, suggests that adherence to modifiable lifestyle factors and healthy lifestyle recommendations may prevent a substantial burden of IBD risk.5 The study found that adherence to low-risk modifiable lifestyle factors could have prevented 42.9% of CD and 44.4% of UC cases. Similarly, adherence to a healthy lifestyle could have prevented 61.1% of CD and 42.2% of UC cases. These findings were validated in three external European cohorts.5

Modifiable risk scores (MRS) were created for participants based on their adherence to lifestyle factors including smoking, body mass index, nonsteroidal anti-inflammatory drug use, physical activity levels, and dietary factors like meat, fruit, vegetable, and fiber intake.5 Participants were given healthy lifestyle scores based on their adherence to a healthy lifestyle, including a BMI ≥18.5 to <25 kg/m2; never smoking; physical activity ≥7.5 metabolic equivalent of task (MET)-hours/week; intakes of fruit and vegetables ≥8 servings/day, red meat <0.5 servings/day, fibre ≥25 g/day, fish ≥2 servings/ week, nuts/seeds ≥0.5 servings/day and alcohol consumption ≤1 drink (14 g)/day (women) or ≤2 drinks (28 g)/day (men). Diet and physical activity variables were cumulatively averaged to account for long-term patterns. Researchers defined a healthy lifestyle based on recommendations from the US Department of Health and Human Services (HHS), the US Department of Agriculture (USDA) Dietary Guidelines for Americans, and the American Heart Association (AHA) Guidelines for Healthy Living.5

It is important to note that the study assumes a causal relationship exists between lifestyle modification and IBD.5 Although a causal relationship between lifestyle modification and IBD has not been scientifically established, the study authors cite several lines of evidence that support the role of environmental and lifestyle factors in the development of IBD, including the following:5

  • In genome-wide association studies, genetic factors account for less than 15% of the total variance of IBD.6
  • The high incidence of IBD in industrialized societies and developing countries suggests that the Westernization of diet and environment may influence disease development.7
  • Studies suggest that for immigrants who move from low-incidence to high-incidence countries, risk for IBD is higher in second-generation than first-generation immigrants.8
  • The dietary and lifestyle factors considered in this study have also been linked with systemic inflammation, microbial dysbiosis, and gut permeability, providing mechanistic plausibility for a causal relationship.9-12

The study’s authors also hypothesize that although a participant’s family history of IBD was the single strongest risk factor for IBD in their cohorts, the collective impact of environmental factors on IBD was likely greater.5

This research aligns with the functional medicine approach, which teaches that incorporating nutrition, stress management, physical activity, and microbiome support can enhance patient engagement and improve outcomes. Ongoing research continues to uncover potential IBD etiologies and determine the most effective lifestyle-based treatment and prevention strategies. As a multi-factorial condition, IBD requires a multi-pronged approach for the best patient outcomes.  

Related Articles

Inflammatory Bowel Disease: Causes and Solutions

Inflammatory Bowel Disease & Dementia Risk

Intestinal Permeability & Associated Diseases


  1. Ananthakrishnan AN, Kaplan GG, Ng SC. Changing global epidemiology of inflammatory bowel diseases: sustaining health care delivery into the 21st century. Clin Gastroenterol Hepatol. 2020;18(6):1252-1260. doi:1016/j.cgh.2020.01.028
  2. Seyedian SS, Nokhostin F, Malamir MD. A review of the diagnosis, prevention, and treatment methods of inflammatory bowel disease. J Med Life. 2019;12(2):113-122. doi:25122/jml-2018-0075
  3. Shin DW, Lim BO. Nutritional interventions using functional foods and nutraceuticals to improve inflammatory bowel disease. J Med Food. 2020;23(11):1136-1145. doi:1089/jmf.2020.4712
  4. Davis SP, Crane PB, Bolin LP, Johnson LA. An integrative review of physical activity in adults with inflammatory bowel disease. Intest Res. 2022;20(1):43-52. doi:5217/ir.2020.00049
  5. Lopes EW, Chan SSM, Song M, et al. Lifestyle factors for the prevention of inflammatory bowel disease. Gut. Published online December 6, 2022. doi:1136/gutjnl-2022-328174
  6. Jostins L, Ripke S, Weersma RK, et al. Host-microbe interactions have shaped the genetic architecture of inflammatory bowel disease. Nature. 2012;491(7422):119-124. doi:1038/nature11582
  7. Ng SC, Shi HY, Hamidi N, et al. Worldwide incidence and prevalence of inflammatory bowel disease in the 21st century: a systematic review of population-based studies. 2017;390(10114):2769-2778. doi:10.1016/s0140-6736(17)32448-0
  8. Agrawal M, Burisch J, Colombel JF, Shah S. Viewpoint: inflammatory bowel diseases among immigrants from low- to high-incidence countries: opportunities and considerations. J Crohns Colitis. 2020;14(2):267-273. doi:1093/ecco-jcc/jjz139
  9. Jenkins AP, Trew DR, Crump BJ, et al. Do non-steroidal anti-inflammatory drugs increase colonic permeability? Gut. 1991;32(1):66-69. doi:1136/gut.32.1.66
  10.  Papoutsopoulou S, Satsangi J, Campbell BJ, Probert CS. Review article: impact of cigarette smoking on intestinal inflammation—direct and indirect mechanisms. Aliment Pharmacol Ther. 2020;51(12):1268-1285. doi:1111/apt.15774
  11.  Amre DK, D’Souza S, Morgan K, et al. Imbalances in dietary consumption of fatty acids, vegetables, and fruits are associated with risk for Crohn’s disease in children. Am J Gastroenterol. 2007;102(9):2016-2025. doi:1111/j.1572-0241.2007.01411.x
  12.  Wu GD, Chen J, Hoffmann C, et al. Linking long-term dietary patterns with gut microbial enterotypes. 2011;334(6052):105-108. doi:10.1126/science.1208344